The problem of colorectal anastomosis safety

Kryžauskas, Marius; Poškus, Eligijus; Dulskas, Audrius; Baušys, Augustinas; Jakubauskas, Matas; Imbrasaitė, Ugnė; Makūnaitė, Gabija; Kuliavas, Justas; Baušys, Rimantas; Stratilatovas, Eugenijus; Strupas, Kęstutis; Poškus, Tomas

doi:10.1097/md.0000000000018560

Cited by 17 publications

(15 citation statements)

References 31 publications

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“…However, a considerable sample size, multicenter approach, and significant national registry-based long-term follow-ups increase the power of the study to demonstrate that AL is associated with impaired long-term outcomes in patients undergoing surgery for left-sided CRC. Future research is needed to find strategies to reduce or prevent the rate of AL in such patients [40].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

et al. 2020

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Background: Anastomotic leakage (AL) significantly impairs short-term outcomes. The impact on the long-term outcomes remains unclear. This study aimed to identify the risk factors for AL and the impact on long-term survival in patients with left-sided colorectal cancer. Methods: Nine-hundred patients with left-sided colorectal carcinoma who underwent sigmoid or rectal resection were enrolled in the study. Risk factors for AL after sigmoid or rectal resection were identified, and long-term outcomes of patients with and without AL were compared. Results: AL rates following sigmoid and rectal resection were 5.1% and 10.7%, respectively. Higher ASA score (III-IV; OR = 10.54, p = 0.007) was associated with AL in patients undergoing sigmoid surgery on multivariable analysis. Male sex (OR = 2.40, p = 0.004), CCI score > 5 (OR = 1.72, p = 0.025), and T3/T4 stage tumors (OR = 2.25, p = 0.017) were risk factors for AL after rectal resection on multivariable analysis. AL impaired disease-free and overall survival in patients undergoing sigmoid (p = 0.009 and p = 0.001) and rectal (p = 0.003 and p = 0.014) surgery. Conclusion: ASA score of III-IV is an independent risk factor for AL after sigmoid surgery, and male sex, higher CCI score, and advanced T stage are risk factors for AL after rectal surgery. AL impairs the long-term survival in patients undergoing left-sided colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

et al. 2020

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“…Given these factors and the recent proliferation of studies on this topic, our meta-analysis contributes to the literature by pooling a much larger number of studies than previous metaanalyses and by incorporating recently published randomized controlled trials and prospective studies in the analysis. While we fully acknowledge that there are at least 2 other randomized controlled trials that are recruiting patients at present, the IntACT and ICG-COLORAL trials, 40,41 given that recruitment started in 2019, it is likely that results will only be released in 2 to 3 years' time. Our meta-analysis, therefore, serves as a bridge until results from those studies can be further analyzed.…”

Section: Discussionmentioning

confidence: 99%

“…23,25,27,28,37 We identified only 1 trial which had ongoing recruitment on clinicaltrials. gov, the ICG-COLORAL trial, 40 whereas another trial protocol was identified during the literature search, the IntAct study. 41 Notably, the PILLAR III, a randomized controlled, multicenter, open-label trial, is recorded as having been terminated early owing to slow recruitment on clinicaltrials.gov.…”

Section: Study Characteristicsmentioning

confidence: 99%

Indocyanine green fluorescence angiography decreases the risk of colorectal anastomotic leakage: Systematic review and meta-analysis

Chan

Lee

Ang

2020

Surgery

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Background: Anastomotic leakage after a colorectal resection results in devastating consequences for patients. Indocyanine green fluorescence angiography is a modality to visualize vascular perfusion at the anastomotic site and can help surgeons decide the viability of the anastomosis. We performed this systematic review and meta-analysis to evaluate the efficacy of indocyanine green fluorescence angiography in decreasing anastomotic leakage. Methods: PubMed, Web of Science, Embase, and the Cochrane Library were searched to identify studies comparing the use of indocyanine green fluorescence angiography versus standard care on rates of anastomotic leakage. Data were pooled with the Mantel-Haenszel method and analyzed based on a random-effects model to estimate the pooled odds ratio and 95% confidence interval. The heterogeneity of studies was evaluated using I 2 statistic. Results: Twenty studies were included in this meta-analysis of 5,498 patients. The pooled estimate of the odds ratio was 0.46 (95% confidence interval 0.34e0.62; P < .00001) favoring indocyanine green fluorescence angiography. The overall anastomotic leak rate was 3.7% (n ¼ 82) in the intervention group and 8.6% (n ¼ 282) in the control group. Indocyanine green fluorescence angiography led to a change in the anastomotic site in 216 (9.7%) patients. Subgroup analyses of anastomotic leakage requiring intervention, patients requiring a low colorectal anastomosis, and prospective studies had a pooled estimate of odds ratio 0.55 (95% confidence interval 0.35e0.89), odds ratio 0.38 (95% confidence interval 0.27e0.54; P < .0001), and odds ratio 0.49 (95% confidence interval 0.30e0.81; P ¼ .005) respectively. Conclusion: The use of indocyanine green fluorescence angiography is associated with a decrease in anastomotic leakage. This association is present in patients with severe anastomotic leakage requiring intervention as well as low colorectal anastomoses.

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“…Our ongoing study investigates mechanical integrity testing by air-leak and methylene blue in combination with vascular perfusion evaluation by ICG-FA and its impact on AL. [ 42 ]…”

Section: Discussionmentioning

confidence: 99%

Intraoperative testing of colorectal anastomosis and the incidence of anastomotic leak

et al. 2020

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Background: AL remains one of the most threatening complications in colorectal surgery. Significant efforts are put to understand the pathophysiological mechanisms involved in the development of leakage and to create the strategies to prevent it. We aimed to determine whether intraoperative testing of mechanical integrity and perfusion of colorectal anastomosis could reduce the incidence of AL. Methods: A systematic review and meta-analysis of papers published before November 2019 on PubMed, Scopus, Web of Science, and Cochrane Library databases and comparing intraoperative testing of the colorectal anastomosis with standard care were conducted. Odds ratios (ORs) and 95% confidence interval (CIs) were used to assess the association between intraoperative testing and AL. Results: A total of 23 studies totaling 7115 patients were included. Pooled analysis revealed intraoperative tests, for integrity (OR 0.52, 95% CI 0.34–0.82, P < .001) and perfusion (OR 0.40, 95% CI 0.22–0.752, P < .001) of the lower gastrointestinal tract anastomoses are associated with significantly lower AL rate. Conclusions: Intraoperative testing for either integrity or perfusion of anastomoses both reduce the AL rate. Studies looking at the combination of these two testing methods of anastomosis, especially intraoperative endoscopy, and indocyanine green fluorescence angiography may be very promising to further reduction of the AL.

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The problem of colorectal anastomosis safety

Cited by 17 publications

References 31 publications

Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

Indocyanine green fluorescence angiography decreases the risk of colorectal anastomotic leakage: Systematic review and meta-analysis

Intraoperative testing of colorectal anastomosis and the incidence of anastomotic leak

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