Treatment of anastomotic leakage after rectal cancer resection: The TENTACLE–Rectum study

Workum, Frans van; Talboom, Kevin; Hannink, Gerjon; Wolthuis, Albert; Lacy, Borja F. de; Lefèvre, Jérémie H.; Solomon, Michael J.; Frasson, Matteo; Rotholtz, Nicolás A.; Denost, Quentin; Perez, Rodrigo Oliva; Konishi, Tsuyoshi; Rosman, Camiel; Hompes, Roel; Tanis, Pieter J.; Wilt, Johannes H. W. de

doi:10.1111/codi.15435

Cited by 20 publications

(15 citation statements)

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“…Invited experts were either part of the steering committee of the TENTACLE-Rectum study or the international TaTME Guidance collaborative. [9,10] Invited experts are all experienced colorectal surgeons performing TME surgery and being actively involved in relevant scientific projects and/or colorectal societies. This survey consisted of a short general questionnaire and case discussions.…”

Section: Methodsmentioning

confidence: 99%

International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: a case-vignette study

Talboom

Greijdanus²,

Workum³

et al. 2022

Int J Colorectal Dis

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Purpose Little is known about the optimal treatment of anastomotic leakage after low anterior resection (LAR) for rectal cancer and whether treatment strategy depends on leakage features and patient characteristics. The objective of this study was to determine which treatment principles are used by expert colorectal surgeons worldwide. Methods In this international case-vignette study, participants completed a survey on their preferred treatment for 11 clinical cases with varying leakage features and two patient scenarios depending on surgical risk (a total of 22 cases). Results In total, 42 of 64 invited surgeons completed the survey from 18 countries worldwide. The majority worked at a university training hospital (62%) and had more than 15 years of experience performing LAR for rectal cancer (52%). Early leaks in septic patients were preferably treated by major salvage surgery, to some extent depending on the patient scenario. In early leaks in non-septic patients, drainage and faecal diversion were the cornerstones of the proposed treatment. Endoscopic vacuum therapy was more often proposed than percutaneous drainage. A minority proposed anastomotic reconstruction, more often for larger defects. Treatment of late leaks ranged from watchful waiting, drainage, or transanal repair to major (non-)restorative salvage surgery, with minimal influence of the degree of symptoms on the proposed strategy. Leaks of the blind loop and rectovaginal fistulae showed high variability in the proposed treatment strategy. Conclusion This TENTACLE-Rectum case-vignette study demonstrates tailored treatment strategies depending on the clinical type of leak and patient characteristics, with variable degrees of consensus and knowledge gaps which should be addressed in future studies.

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Section: Methodsmentioning

confidence: 99%

International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: a case-vignette study

Talboom

Greijdanus²,

Workum³

et al. 2022

Int J Colorectal Dis

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“…2,26 Su detección y tratamiento precoz determinan el desarrollo de la morbimortalidad asociada. 27 Nuestra serie presentó un índice de FA del 7,8%, lo cual impactó directamente en la tasa de reoperación. De los pacientes que presentaron este evento, se tuvieron que reoperar el 76,9%.…”

Section: Discussionunclassified

Cirugía colorrectal laparoscópica en un centro privado de Bahía Blanca

Beder¹,

Rueda²,

Amondarain³

et al. 2022

Rev. Argent. Coloproctol.

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Introducción: La cirugía laparoscópica es una vía de abordaje fundamental para el tratamiento de la patología colorrectal. Se debe evaluar si los resultados de centros de referencia pueden ser reproducidos por centros de menor volumen con cirujanos entrenados en laparoscopía. Objetivo: Analizar resultados a corto plazo obtenidos con el abordaje laparoscópico de la patología colorrectal, factores asociados a conversión y reoperación. Diseño: Cohorte, retrospectivo. Materiales y Métodos: Pacientes tratados por laparoscopía entre Octubre 2014 y Agosto 2020 en un Hospital Privado de la Ciudad de Bahía Blanca; excluyendo cirugías de urgencia, tumores de ano y patología combinada. Conversión, readmisión y morbilidad fueron analizadas en base a las variables demográficas, técnica quirúrgica y curva de aprendizaje. Análisis multivariado para conversión y reoperación. Resultados: 167 pacientes, 51,5 % hombres, edad media 66,1 años, IMC promedio de 26,5 km/m2, estadía hospitalaria 4 días, conversión 5,4%. Tiempo operatorio 231,27 minutos, siendo significativamente mayor para los tumores de recto (p<0,001). Se reoperó el 9,6% y se reinternó el 16,8% de la población. 26% de los pacientes presentaron complicaciones postoperatorias menores (Clavien I-II) el y 16% mayores (Clavien III-IV-V), siendo las más frecuentes: infección del sitio quirúrgico (21%), íleo (13,8%) y fístula anastomótica (7,8%). Mortalidad 3,6%. Se complicaron más los pacientes con ASA ≥3 (p=0,015) y sexo masculino (p=0,01). Pacientes complicados con fístula anastomótica se reintevinieron más que el resto (p<0,01), siendo esta complicación un factor predictivo de reoperación. Tienen más chance de conversión los pacientes masculinos y cirugía RAUB. Conclusiones: El abordaje laparoscópico de la patología colorrectal en nuestro medio demostró ser un procedimiento eficaz y seguro que permite cumplir con los estándares de resultados a corto plazo establecidos por la comunidad científica. Los pacientes masculinos y las cirugías RAUB tienen más chance de conversión. La fístula anastomótica es un factor predictivo de reoperación.

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“…One of the most serious complications of colorectal cancer surgery is anastomotic leakage. It occurs in 1 to 30% of all cases [1][2][3][4], with the highest rate (of up to 20%) reported for rectal anastomotic leakage [5]. An anastomotic fistula seriously affects patients' quality of life, prognosis, and hospitalization costs and increases the risk of death [6,7].…”

Section: Introductionmentioning

confidence: 99%

Left colic artery diameter is an important factor affecting anastomotic blood supply in sigmoid colon cancer or rectal cancer surgery: a pilot study

Wang

Shui-jin

et al. 2022

World J Surg Onc

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Background Anastomotic blood supply is vital to anastomotic healing. The aim of this study was to demonstrate the effect of the left colic artery (LCA) on blood supply in the anastomotic area, explore the relationship between individual differences in the LCA and blood supply in the anastomotic area, and elucidate the relevant indications for LCA retention during radical resection for sigmoid or rectal cancer. Method Radical sigmoid or rectal cancer resection with LCA retention was performed in 40 patients with colorectal cancer who participated in this study. Systemic pressure, LCA diameter, and the distance from the root of the LCA to the root of the inferior mesenteric artery were measured and recorded. The marginal artery stump pressure in the anastomotic colon before and after the LCA clamping was measured, respectively. Results There is a significant difference between the marginal artery stump pressure before LCA ligation and after ligation (53.1 ± 12.38 vs 42.76 ± 12.71, p < 0.001). The anastomotic blood supply positively and linearly correlated with body mass index and systemic pressure. Receiver-operating curve analysis revealed that LCA diameter (area under the curve 0.971, cutoff 1.95 mm) was an effective predictor of LCA improving anastomosis blood supply. No relationship was found between the LCA root location and anastomotic blood supply. Conclusion Preserving the LCA is effective in improving blood supply in the anastomotic area, and larger LCA diameters result in a better blood supply to the anastomotic area.

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Treatment of anastomotic leakage after rectal cancer resection: The TENTACLE–Rectum study

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 20 publications

References 20 publications

International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: a case-vignette study

International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: a case-vignette study

Cirugía colorrectal laparoscópica en un centro privado de Bahía Blanca

Left colic artery diameter is an important factor affecting anastomotic blood supply in sigmoid colon cancer or rectal cancer surgery: a pilot study

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