Standardized Algorithms for Management of Anastomotic Leaks and Related Abdominal and Pelvic Abscesses After Colorectal Surgery

Phitayakorn, Roy; Delaney, Conor P.; Reynolds, Harry L.; Champagne, Brad; Heriot, Alexander G.; Neary, Paul; Senagore, Anthony J.; Ambrosetti, P.; Bailey, Charles; Billingham, Richard P.; Braga, Marco; Buie, W. Donald; Darzi, Ara; Douglas, P. R.; Dozois, Eric J.; Fearnhead, Nicola; Frizelle, Frank; Gearhart, Susan L.; González, Quintín H; Haaga, John R.; Harris, G. J. C.; Horgan, Alan; Horgan, Paul G.; Kehlet, Henrik; Kim, S. H.; Lacy, Antonio M.; Leroy, Joël; López-Köstner, Francisco; Ludwig, Kirk; Marks, Jeffrey M.; Megibow, Alec J.; Merlino, James; Monson, J. R. T.; Motson, R. W.; Nakamoto, Dean A.; Newstead, Graham L.; O'Connell, P. R.; Panis, Yves; Penninckx, Freddy; Rajput, Ashwani; Choen, Francis Seow; Stamos, Michael J.; Vignali, Andrea; Wexner, Steven D.; Wong, K. S.

doi:10.1007/s00268-008-9468-1

Cited by 170 publications

(134 citation statements)

References 76 publications

(33 reference statements)

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“…Prospective randomised studies on treatment are difficult to design due to the lack of a golden standard and due to logistic problems. To overcome these problems, Phitayakorn et al [18] used a Delphi-round to establish a treatment algorithm for CAL. In their study, the authors came to a consensus among 43 experts on colorectal surgery and radiology.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

et al. 2012

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Anastomotic leakage after colorectal surgery is correlated with considerable morbidity and mortality. Although many studies focus on risk factors and detection, studies on the treatment strategy for colorectal anastomotic leakage are scarce. A national questionnaire amongst 350 members of the Dutch Society for Gastrointestinal Surgery was undertaken on the current treatment of colorectal anastomotic leakage. The response was 40% after two anonymous rounds. 27% of the respondents state that a leaking anastomosis above the level of the promontory should be salvaged in ASA 1-2 patients <80 years of age, for ASA 3 and/or >80 years of age this percentage is 7.3%. For an anastomosis under the promontory, 50% of the respondents choose preserving the anastomosis for ASA 1-2 compared to 17% for ASA 3 and/or >80 years of age. In ASA 1-2 patients with a local abscess after a rectum resection without protective ileostomy, 31% of the respondents will create an protective ileostomy, 40% break down the anastomosis to create a definite colostomy, in ASA 3 and/or >80 years of age 14% of the respondents create a protective ileostomy and 63% a definitive colostomy. In ASA 1-2 patients with peritonitis after a rectum resection with deviating ileostomy, 31% prefer a laparotomy for lavage and repair of the anastomosis, 25% for lavage without repair and 36% of the respondents prefer to break down the anastomosis. When the patient is ASA 3 and/or >80 years of age, 13% prefer repair, 9% a lavage and 74% breaking down the anastomosis. This questionnaire shows that in contrast to older people, more surgeons make an effort to preserve the anastomosis in younger people.

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Section: Introductionmentioning

confidence: 99%

Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

et al. 2012

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“…Recidiva depinde şi de gradul de penetrare al peretelui colic de către tumoră, variind între 0-1% pentru pT 1 , faţă de 17-44% pentru pT 2 [14]. Existenţa tumorii reziduale creşte frecvenţa recidivei locale la nivelul anastomozei [26,37,38]. Recurenţa locoregională este mai frecventă dacă a existat adenopatie regională şi este diferită pe stadii clinice: stadiul I -0%, stadiul II -2%, stadiul III -10%.…”

Section: Discuţiiunclassified

“…Clasificarea TNM în care se ia în considerare numărul nodulilor limfatici regionali cu metastaze, are valoare predictivă mai mare decât clasificarea Dukes [27]. Analizele multivariate arată că metastazele în nodulii limfatici regionali au valoare statistică semnificativă pentru supravieţuire [4,12,20,22,27,[31][32][33][34][35][36][37][38][39][40][41]. Detalii ale supravieţuirii în funcţie de numărul nodulilor limfatici cu metastaze, aduce…”

Section: Discuţiiunclassified

Metastatic Lymphadenopathy in Colon Cancer

Păunescu¹,

Pop-Began²,

Pop-Began³

et al. 2013

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METASTATIC LYMPHADENOPATHY IN COLON CANCER (Abstract): INTRODUCTION:The incidence and prevalence of colon cancer is increasing in the last decades, in Romania. The aim of this paper is to evaluate the place of metastatic lymphadenopathy as risk factor for postoperative morbidity and mortality. MATHERIAL AND METHODS: We perfomed a prospective study; 126 patients with colon cancer were included and prospectively reviwed. RESULTS: The men / women ratio was 70 / 56. The mean age was 65.26 years old (range 20-89 years). Most cases were in stage III (n=72, 57.14%) and IV (n=49, 38.89%) with tumors located more frequently on the left colon (n=86, 68.25%) and especially on the sigmoid colon (n=64, 50.79%). 33.33% patients (n=42) were operated in emergency. Colic wall invasion depth (pT 3 =49, 38.9%, pT 4 =72, 57.1%) were accompanied by an increase in the number of affected regional lymph nodes (pN 1 =29, 23.0%, pN 2 =43, 34.1%). Postoperative complications occurred only in patients in stages III (n=11, 15.41%) and IV (n=15, 30.61%). The 30 days postoperative mortality rate was 19.04% (n=24), mostly in stage pT 4 tumors (n=18, 25%). Metastatic adenopathy was found as risk factor for postoperative mortality rate: 16.66% (n=4) deaths for pN 1 , 30.23% (n=13) for pN 2 and resoectively 13.07% (n=7) mortality rate for pN 0 . The five years survival rate was 100% for stage I, 59.64% for stage II, 33.57% for stage III and nul for stage IV. CONCLUSIONS: The presence of metastatic adenopathy is crucial in assessing the informational value of early and late postoperative evolution.

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“…Rzadko są na tyle sprzyjające warunki, aby wykonać wtórną resekcję i zespolenie lub odnowienie zespolenia i czasową stomię odbarczającą. Równie ważnym elementem jest usunięcie zniszczonych, zainfekowanych tkanek oraz właściwe zdrenowanie okolicy, włącznie z założeniem drenażu płuczącego [12,14,41]. Obowiązuje antybiotykoterapia zgodna z wykonanym posiewem.…”

Section: Leczenie Zasadniczeunclassified

Perforations in the colon

Ćwik¹,

Solecki²,

Ciechański³

et al. 2012

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Standardized Algorithms for Management of Anastomotic Leaks and Related Abdominal and Pelvic Abscesses After Colorectal Surgery

Abstract: This process was a useful first step toward establishing guidelines for the management of anastomotic leak.

Cited by 170 publications

References 76 publications

Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

Treatment of Colorectal Anastomotic Leakage: Results of a Questionnaire amongst Members of the Dutch Society of Gastrointestinal Surgery

Metastatic Lymphadenopathy in Colon Cancer

Perforations in the colon

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