Smoking is a major risk factor for anastomotic leak in patients undergoing low anterior resection

Richards, Colin H.; Campbell, Victoria; Ho, Chris; Hayes, Julian; Elliott, Thomas B.; Thompson‐Fawcett, Mark

doi:10.1111/j.1463-1318.2011.02718.x

Cited by 49 publications

(44 citation statements)

References 28 publications

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“…The incidence of anastomotic leak after colorectal cancer surgery ranges from 2.6% to 19.0% (19)(20)(21)(22)(23)(24). Anastomotic leak after colorectal surgery increases postoperative morbidity, mortality, length of hospital stay, and nosocomial infection rates, and decreases quality of life (18,25,26).…”

Section: Discussionmentioning

confidence: 99%

The Effects of Hyperthermic Intraperitoneal Chemoperfusion on Colonic Anastomosis: An Experimental Study in a Rat Model

Aghayeva

Benlice

Bilgin

et al. 2017

Tumori

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Introduction Cytoreductive surgery (CRS) with subsequent hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising modality to treat and prevent peritoneal metastases. However, this treatment is associated with signficant morbidity and mortality. Whether or not CRS with HIPEC interferes with anastomotic healing has also been debated. This study was designed to investigate the effects of mitomycin C, cisplatin, oxaliplatin, and doxorubicin used in HIPEC treatment on colonic anastomosis healing in a rat model. Methods Sixty Wistar albino rats were employed in the study. Sigmoid resection and end-to-end colorectal anastomosis was performed in all rats. Group 1 rats underwent the surgical procedure alone, while group 2 rats were given hyperthermic intraperitoneal lavage with heated saline following surgery. Groups 3, 4, 5, and 6 had surgery with concomitant HIPEC treatment with mitomycin C, cisplatin, oxaliplatin, and doxorubicin, respectively. Anastomotic bursting pressures and hydroxyproline levels were evaluated. Results Regarding the hydroxyproline levels, groups 1 and 2 showed significantly higher values than other groups (p<0.001). However, there was no significant difference between the HIPEC treatment groups (groups 3, 4, 5, and 6) (p>0.05). When groups were compared regarding bursting pressure values, no significant differences were observed (p = 0.81). Conclusions This study demonstrated that the HIPEC procedure with mitomycin C, cisplatin, oxaliplatin and doxorubicin had negative effects on hydroxyproline levels, but had no detrimental effect on anastomotic bursting pressure in a rat model.

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Section: Discussionmentioning

confidence: 99%

The Effects of Hyperthermic Intraperitoneal Chemoperfusion on Colonic Anastomosis: An Experimental Study in a Rat Model

Aghayeva

Benlice

Bilgin

et al. 2017

Tumori

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“…1,[29][30][31] This increase has been shown to be approximately fourfold compared to nonsmokers. 32 As surgeons, we are often left with the difficult task of counselling smoking cessation.…”

Section: Smokingmentioning

confidence: 94%

“…Patients with anastomotic leaks have higher lengths of stay, higher mortality rates, higher readmission rates, more reoperations, and an overall greater impact on quality of life. 1 Patients who have anastomotic leaks following cancer operations have a higher risk of distant recurrence. 2 These patients also experience large delays in receiving indicated adjuvant chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

Phillips¹

2016

OAS

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Various techniques and interventions have been developed in an effort to obviate gastrointestinal anastomotic leaks. This review is intended to delineate potential modifications that can be made to reduce the risk of anastomotic leaks following gastrointestinal surgery. It may also serve to aid in identifying patients who are at increased risk of anastomotic leak. Modifiable risk factors for leak discussed include malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique. Based upon literature review, operative techniques should include minimizing operative time, reducing ischemia, and utilizing stapled anastomoses. Buttressing of anastomoses with omentum has proven utility for esophageal surgery. Further recommendations include 5-7 days of immune-modifying nutritional supplementation for malnourished patients, discontinuation of smoking in the perioperative period, limiting steroid use, utilization of oral antibiotic preparation for colorectal surgery, avoidance of early operations (,4 weeks) following chemotherapy, limiting pressor use, and the utilization of goal-directed fluid management.

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“…The association between cigarette smoking and AL has been reported; specifically, both current smoking 17,18) and a high smoking index are associated with AL 19,20) . The mechanism through which smoking affects AL is still unclear; however, involvement of a decrease in mucosal blood flow has been reported [21][22][23] .…”

Section: Discussionmentioning

confidence: 99%

Smoking and tumor obstruction are risk factors for anastomotic leakage after laparoscopic anterior resection during rectal cancer treatment

Matsuzaki

Ishihara

Kawai

et al. 2017

J Anus Rectum Colon

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Abstract:Objectives: To clarify the surgical outcomes and risk factors for anastomotic leakage (AL) following laparoscopic anterior resection (Lap-AR) for the treatment of rectal cancer. Methods: We retrospectively reviewed the records of 175 consecutive primary rectal cancer patients who had undergone Lap-AR at our institution between April 2012 and November 2015. Patient, tumor, and surgical variables were analyzed using univariate analyses. Results: Of 175 patients, 116 were men (66.3%). All four patients who had AL (2.3%) were men and current smokers with heavy smoking histories. In three of the AL cases, preoperative total colonoscopy was impossible owing to tumor obstruction, and the other case had concomitant obstructive colitis after oral bowel preparation. Univariate analysis identified tumor size, tumor obstruction, and smoking history as factors significantly associated with AL development. Conclusions: Tumor size, tumor obstruction, and smoking history were risk factors for AL following Lap-AR for the treatment of primary rectal cancer.

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Smoking is a major risk factor for anastomotic leak in patients undergoing low anterior resection

Abstract: Smoking and the presence of metastatic disease are major risk factors for the development of anastomotic leak following low anterior resection.

Cited by 49 publications

References 28 publications

The Effects of Hyperthermic Intraperitoneal Chemoperfusion on Colonic Anastomosis: An Experimental Study in a Rat Model

The Effects of Hyperthermic Intraperitoneal Chemoperfusion on Colonic Anastomosis: An Experimental Study in a Rat Model

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

Smoking and tumor obstruction are risk factors for anastomotic leakage after laparoscopic anterior resection during rectal cancer treatment

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