Peroperative observation of marginal artery bleeding: A predictor of anastomotic leakage

Abstract Background The aim of this study was to investigate the safety and clinical usefulness of early oral feeding (EOF) after rectosigmoid resection with anastomosis for the treatment of primary ovarian cancer. Methods We performed a retrospective review of all consecutive patients who had undergone rectosigmoid resection with anastomosis for primary ovarian, tubal, or peritoneal cancer between April 2012 and March 2019 in a single institution. Patient-related, disease-related, and surgery-related data including the incidence of anastomotic leakage and postoperative hospital stay were collected. EOF was introduced as a postoperative oral feeding protocol in September 2016. Before the introduction of EOF, conventional oral feeding (COF) had been used. Results Two hundred and one patients who underwent rectosigmoid resection with anastomosis, comprised of 95 patients in the COF group and 106 patients in the EOF group, were included in this study. The median number of postoperative days until the start of diet intake was 5 (range 2–8) in the COF group and 2 (range 2–8) in the EOF group (P < 0.001). Postoperative morbidity was equivalent between the groups. The incidence of anastomotic leakage was similar (1%) in both groups. The median length of the postoperative hospital stay was reduced by 6 days for the EOF group: 17 (range 9–67) days for the COF group versus 11 (8–49) days for the EOF group (P < 0.001). Conclusion EOF provides a significant reduction in the length of the postoperative hospital stay without an increased complication risk after rectosigmoid resection with anastomosis as a part of cytoreductive surgery for primary ovarian cancer.

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Time interval between rectal cancer resection and reintervention for anastomotic leakage and the impact of a defunctioning stoma: A Dutch population‐based study

Colorectal Disease ◽

10.1111/codi.15878 ◽

2021 ◽

Author(s):

Anne‐Loes K. Warps ◽

Rob A. E. M. Tollenaar ◽

Pieter J. Tanis ◽

Jan Willem T. Dekker ◽

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Population Based ◽

Time Interval ◽

Dutch Population ◽

Population Based Study ◽

Defunctioning Stoma ◽

Cancer Resection ◽

Rectal Cancer Resection ◽

The Impact

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The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2021.05.042 ◽

2021 ◽

Author(s):

Francesco Guerra ◽

Filippo Petrelli ◽

Paola Antonella Greco ◽

Valerio Sisti ◽

Marco Catarci ◽

...

Keyword(s):

Liver Resection ◽

Propensity Score ◽

Anastomotic Leakage ◽

Colorectal Resection ◽

Propensity Score Match ◽

Study Group ◽

Match Analysis ◽

Propensity Score Match Analysis ◽

The Impact ◽

Synchronous Liver Resection

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Difference in surgical outcomes of rectal cancer by study design: meta-analyses of randomized clinical trials, case-matched studies, and cohort studies

BJS Open ◽

10.1093/bjsopen/zraa067 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

N Hoshino ◽

T Sakamoto ◽

K Hida ◽

Y Takahashi ◽

H Okada ◽

...

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Robotic Surgery ◽

Cohort Studies ◽

Anastomotic Leakage ◽

Study Design ◽

Randomized Clinical Trials ◽

Postoperative Mortality ◽

Resection Margins ◽

Meta Analyses

Abstract Background RCTs are considered the standard in surgical research, whereas case-matched studies and propensity score matching studies are conducted as an alternative option. Both study designs have been used to investigate the potential superiority of robotic surgery over laparoscopic surgery for rectal cancer. However, no conclusion has been reached regarding whether there are differences in findings according to study design. This study aimed to examine similarities and differences in findings relating to robotic surgery for rectal cancer by study design. Methods A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane CENTRAL to identify RCTs, case-matched studies, and cohort studies that compared robotic versus laparoscopic surgery for rectal cancer. Primary outcomes were incidence of postoperative overall complications, incidence of anastomotic leakage, and postoperative mortality. Meta-analyses were performed for each study design using a random-effects model. Results Fifty-nine articles were identified and reviewed. No differences were observed in incidence of anastomotic leakage, mortality, rate of positive circumferential resection margins, conversion rate, and duration of operation by study design. With respect to the incidence of postoperative overall complications and duration of hospital stay, the superiority of robotic surgery was most evident in cohort studies (risk ratio (RR) 0.83, 95 per cent c.i. 0.74 to 0.92, P < 0.001; mean difference (MD) –1.11 (95 per cent c.i. –1.86 to –0.36) days, P = 0.004; respectively), and least evident in RCTs (RR 1.12, 0.91 to 1.38, P = 0.27; MD –0.28 (–1.44 to 0.88) days, P = 0.64; respectively). Conclusion Results of case-matched studies were often similar to those of RCTs in terms of outcomes of robotic surgery for rectal cancer. However, case-matched studies occasionally overestimated the effects of interventions compared with RCTs.

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