The Impact of Anastomotic Leakage on Long-term Function After Anterior Resection for Rectal Cancer

Hultberg, Daniel Kverneng; Svensson, Johan; Jutesten, Henrik; Rutegård, Jörgen; Matthiessen, Peter; Lydrup, Marie Louise; Rutegård, Martin

doi:10.1097/dcr.0000000000001613

Cited by 68 publications

(35 citation statements)

References 38 publications

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“…Its symptoms include changes in defecation frequency, rhythm disorder, incontinence, and constipation, which have been proven to seriously affect the postoperative quality of life [3]. About 30%-55% of patients with rectal cancer have severe LARS symptoms after they complete anal preservation surgery, which can last for several years [4,5].…”

Section: Introductionmentioning

confidence: 99%

A Novel Remote Follow-Up Tool Based on an Instant Messaging/Social Media App for the Management of Patients With Low Anterior Resection Syndrome: Pilot Prospective Self-Control Study (Preprint)

Liu¹,

Guo²,

Su³

et al. 2020

Preprint

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BACKGROUND Low anterior resection syndrome (LARS) is a common functional disorder that develops after patients with rectal cancer undergo anal preservation surgery. Common approaches to assess the symptoms of patients with LARS are often complex and time consuming. Instant messaging social media (IMSM) has great application potential in low anterior resection syndrome (LARS) follow-up, but has been underdeveloped. OBJECTIVE To compare data from a novel instant messaging social media (IMSM) follow-up system and a telephone interview (TI) in patients with low anterior resection syndrome (LARS) and to analyse the consistency of the IMSM platform. METHODS R0-resectable rectal cancer patients who accepted several defecation function visits via the IMSM platform and a telephone interview (TI) after the operation using the same questionnaire, including subjective questions and LARS scores, were included. Differences between the two methods were analysed in pairs and the diagnostic consistency of IMSM was calculated based on TI results. RESULTS In total, 21 questionnaires from 15 patients were included. The positive rates of defecation satisfaction, life restriction and medication use were 52.4%, 52.4%, 38.1% for TI and 52.4%, 61.9%, 23.8% for IMSM, respectively. No statistically significant difference was observed between IMSM and TI in terms of total LARS score (22.4 ± 11.9 vs 24.7 ± 10.7,P < 0.213) and LARS categories (Z = −0.264, P = 0.792); however, IMSM showed a more negative tendency. The Kappa values of three subjective questions were 0.618, 0.430 and 0.674, respectively. The total LARS scores were consistent between both groups (Pearson coefficient 0.760, P < 0.001; category correlation coefficient 0.570, P = 0.005). Patients with major LARS had highly consistent results, with sensitivity, specificity, kappa value and p of 77.8%, 91.7%, 0.704 and 0.001, respectively. CONCLUSIONS IMSM can be a significant LARS screening method. However, further research on information accuracy and user acceptance is needed before implementing a mature application. CLINICALTRIAL This study is a subproject of the registered study Bas-1611, which was registered on ClinicalTrail.org website and numbered NCT03009747 in January 2017.

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Section: Introductionmentioning

confidence: 99%

A Novel Remote Follow-Up Tool Based on an Instant Messaging/Social Media App for the Management of Patients With Low Anterior Resection Syndrome: Pilot Prospective Self-Control Study (Preprint)

Liu¹,

Guo²,

Su³

et al. 2020

Preprint

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“…AL is a major postoperative complication after colorectal surgery and is associated with high postoperative morbidity and mortality, functional defects, and poor oncologic outcomes. 4,5,16,17 AL is defined as a defect in the bowel wall integrity at the zone of attachment between the colon and the rectum that leads to communication between the intestinal lumen and the pelvic cavity. There is no universal grading for AL; however, a three-grade scale proposed by the International Study Group of Rectal Cancer in 2010 is often used for rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of active drainage in the management of anastomotic leakage after anterior resection for rectal cancer

Tan

Zhang

et al. 2021

J Int Med Res

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Objective Anastomotic leakage (AL) is the most serious postoperative complication following anterior resection for rectal cancer. We aimed to investigate the efficacy of active drainage for the management of AL. Methods This was a retrospective study using information from a database of patients who underwent colorectal resection without a defunctioning ileostomy at our center between September 2013 and January 2021. We identified 122 cases with definitive AL who did not require revision emergent laparotomy. Among these patients, we evaluated those who received active drainage to replace the original passive drainage. Results There were 62 cases in the active drainage group and 60 cases in the passive drainage group. The active drainage group had a shorter mean AL spontaneous resolution time (26.9 ± 3.3 vs. 32.2 ± 4.8 days) and lower average hospitalization costs (82,680.6 vs. 92,299.3 renminbi (RMB)) compared with the passive drainage group, respectively. Moreover, seven patients in the passive drainage group subsequently underwent diverting stoma to resolve the Al, while all ALs resolved spontaneously after replacing the passive drainage with active drainage. Conclusions Our study suggests that active drainage may accelerate the spontaneous resolution of AL.

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“…This approach, however, can be associated with mortality and significant morbidity [16]. Anastomotic leaks are more common after NACRT and are associated with functional outcomes that are poor and have significant repercussions for the patient [17]. Often the anastomosis is not salvaged and the patient is subjected to chronic pelvic sepsis and marked morbidity with or without a non‐reversed loop ileostomy or an additional end colostomy.…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcomes of real world ‘watch and wait’ data for rectal cancer after neoadjuvant chemoradiotherapy

et al. 2020

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Aim A 'watch and wait' (W&W) strategy after neoadjuvant long-course chemoradiotherapy (NACRT) remains controversial. Whilst encouraging short-term data exist, the strategy will be judged on long-term data. We present long-term, real-world UK data from a single National Health Service trust. Methods An analysis was performed of a prospectively maintained W&W database over 9 years between 2010 and 2018. Outcome measures include incidence and time to regrowth and overall and disease-free survival. Results We diagnosed 563 rectal cancers in 9 years. In all, 283 patients underwent rectal resection (50.3%). NACRT was used in 155 patients for margin-threatened tumours on staging MRI. Forty-nine patients (31.6%) experienced either a 'near complete' or a complete clinical response (cCR) at their 10 weeks post-NACRT assessment (MRI and endoscopy). The median age was 69 years (range 44-83), and the male to female ratio was 32:17. The median follow-up was 38 months (range 12-96). The median tumour distance from the anal verge was 7 cm (1-15 cm). Twenty-two patients had a cCR on initial assessment and 27 patients had a 'near' cCR. Of those 27 who experienced a 'near' cCR, 17 (63%) progressed to cCR on repeat assessment and 10 (37%) did not. Of these 10 patients, seven underwent standard surgical resection and three were unfit for surgery. R0 for the seven with delayed resection was 100%. Of 39 patients (22 cCR and 17 'near' cCR who progressed to cCR) (25.2% of those receiving NACRT), six patients experienced local regrowth (15.4%). The median time to local regrowth was 29 months (15-60 months). One of these six patients underwent salvage abdominoperineal resection, one was advised to have contact radiotherapy and four opted against surgery and also had contact radiotherapy. The overall survival was 100% at 2 years and 90% at 5 years. Disease-free survival was 90.47% at 2 years and 74.8% at 5 years. Conclusion A W&W treatment strategy was employed safely in this patient cohort with acceptable rates of local regrowth and survival. Keywords rectal cancer, watch and wait, complete response, neoadjuvant chemoradiotherapy What does this paper add to the literature? This paper provides an account of a watch and wait rectal cancer programme with long-term results in a single large district general hospital in the UK, demonstrating that this treatment protocol can be employed with success in a real-world practice.

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The Impact of Anastomotic Leakage on Long-term Function After Anterior Resection for Rectal Cancer

Cited by 68 publications

References 38 publications

A Novel Remote Follow-Up Tool Based on an Instant Messaging/Social Media App for the Management of Patients With Low Anterior Resection Syndrome: Pilot Prospective Self-Control Study (Preprint)

A Novel Remote Follow-Up Tool Based on an Instant Messaging/Social Media App for the Management of Patients With Low Anterior Resection Syndrome: Pilot Prospective Self-Control Study (Preprint)

Retrospective study of active drainage in the management of anastomotic leakage after anterior resection for rectal cancer

Long‐term outcomes of real world ‘watch and wait’ data for rectal cancer after neoadjuvant chemoradiotherapy

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