scholarly journals An evaluation of short-term outcomes after reoperations for anastomotic leakage in colon cancer patients

2021 ◽  
Author(s):  
A. K. Warps ◽  
J. W. T. Dekker ◽  
P. J. Tanis ◽  
R. A. E. M. Tollenaar
Keyword(s):  
Colon Cancer ◽  
Anastomotic Leakage ◽  
Subtotal Colectomy ◽  
Postoperative Mortality ◽  
Admission Rate ◽  
Sigmoid Resection ◽  
Right Hemicolectomy ◽  
Short Term ◽  
Stoma Creation ◽  
Icu Admission

Abstract Purpose Scarce data are available on differences among index colectomies for colon cancer regarding reoperation for anastomotic leakage (AL) and clinical consequences. Therefore, this nationwide observational study aimed to evaluate reoperations for AL after colon cancer surgery and short-term postoperative outcomes for the different index colectomies. Methods Patients who underwent resection with anastomosis for a first primary colon carcinoma between 2013 and 2019 and were registered in the Dutch ColoRectal Audit were included. Primary outcomes were mortality, ICU admission, and stoma creation. Results Among 39,565 patients, the overall AL rate was 4.8% and ranged between 4.0% (right hemicolectomy) and 15.4% (subtotal colectomy). AL was predominantly managed with reoperation, ranging from 81.2% after transversectomy to 92.4% after sigmoid resection (p < 0.001). Median time to reoperation differed significantly between index colectomies (range 4–8 days, p < 0.001), with longer and comparable intervals for non-surgical reinterventions (range 13–18 days, p = 0.747). After reoperation, the highest mortality rates were observed for index transversectomy (15.4%) and right hemicolectomy (14.4%) and lowest for index sigmoid resection (5.6%) and subtotal colectomy (5.9%) (p < 0.001). Reoperation with stoma construction was associated with a higher mortality risk than without stoma construction after index right hemicolectomy (17.7% vs. 8.5%, p = 0.001). ICU admission rate was 62.6% overall (range 56.7–69.2%), and stoma construction rate ranged between 65.5% (right hemicolectomy) and 93.0% (sigmoid resection). Conclusion Significant differences in AL rate, reoperation rate, time to reoperation, postoperative mortality after reoperation, and stoma construction for AL were found among the different index colectomies for colon cancer, with relevance for patient counseling and perioperative management.

Comparison of Intra-Abdominal Infection Risk Between Intracorporeal and Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy for Colon Cancer: A Single-Center Retrospective Study

2020 ◽  
pp. 000313482095029
Author(s):  
Tetsuo Ishizaki ◽  
Kenji Katsumata ◽  
Masanobu Enomoto ◽  
Junichi Mazaki ◽  
Takahiro Wada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Bacterial Contamination ◽  
Patient Characteristics ◽  
Right Hemicolectomy ◽  
Short Term ◽  
Abdominal Infection ◽  
Significant Difference ◽  
Extracorporeal Anastomosis ◽  
Laparoscopic Right Hemicolectomy ◽  
Intra Abdominal Infection

Background No previous study has compared the risk of surgical site infection (SSI) between intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) related to intra-abdominal infection in laparoscopic right hemicolectomy. Therefore, this study aimed to compare the risk of SSI in IA and EA in this context. Methods From July 2014 to March 2018, 101 consecutive (median age, 73 years; male, 54) patients underwent laparoscopic right hemicolectomy for colon cancer. The IA and EA groups consisted of 51 and 50 cases, respectively. After either IA or EA, lavage was performed with 100 mL of saline in the area surrounding the anastomosis, and a sample was collected for bacterial culture. The product of the virulence score and dose of bacterial contamination score called the risk of SSI score was evaluated in both groups, and short-term outcomes in both groups were analyzed retrospectively. Results No significant difference was found in patient characteristics between the 2 groups. The frequency of organ/space SSI in the IA group was significantly higher than that in the EA group (7.8% vs 0%, P = .04). The risk of SSI score was significantly higher in the IA group than in the EA group (median, 9 vs 1, P < .01). Conclusions Compared with EA, IA in laparoscopic right hemicolectomy increased organ/space SSI rates, signifying intra-abdominal infection. We strongly recommend prevention of intra-abdominal infection when performing an IA.

scholarly journals Influence of Intestinal Microorganisms on Anastomotic Leakage after Colorectal Surgery

2020 ◽  
Vol 19 (1-2) ◽  
pp. 51-54
Author(s):  
Justina Rugieniūtė ◽  
Matas Pažusis ◽  
Aistė Mačiulaitytė ◽  
Karolis Černauskis ◽  
Žilvinas Saladžinskas
Keyword(s):  
Anastomotic Leakage ◽  
Intestinal Microbiota ◽  
Klebsiella Oxytoca ◽  
Colon Surgery ◽  
Sigmoid Resection ◽  
Right Hemicolectomy ◽  
Colon Resection ◽  
Small Sample ◽  
E Coli ◽  
Intestinal Microorganisms

Introduction. One of the most common and serious complications of near-postoperative surgery after colon resection with anastomosis is intestinal leakage with a frequency of 1 to 24%. Therefore, it is very important to evaluate the factors that may determine the development of this complication. One of the etiological factors behind the development of this complication is the intestinal microbiota, which is playing an increasingly important role in this process. Nevertheless, there is still a lack of comprehensive clinical evidence on the influence of the intestinal microbiota on postoperative complications such as anastomotic leakage. Purpose. To evaluate the influence of intestinal microorganisms on anastomotic leakage after elective intestines surgery. Methods. A prospective study was performed at the Lithuanian University of Health Sciences Hospital, Kaunas Clinics, Clinic of Surgery. There were included patients who underwent colon surgery (right hemicolectomy, left hemicolectomy, sigmoid resection and closure of ileostomy). Intestinal mucosal biopsy performed before restoring intestinal integrity and sent for microbiological and antibiotic examination. Patients were also observed postoperatively for anastomotic leakage. Results. The majority of patients were treated for colon cancer – 46 (92.0%). In 19 patients crop (38.0%) grown one microorganism, in 12 (24.0%) – 2 microorganisms, in 5 (10.0%) – 3 microorganisms, in 1 (2.0%) – 4 types of bacteria. In the most of the crops were observed growth by E. coli – 30 (60.0%), Enterococcus spp. – 12 (24.0%), Bacteroides spp. – 4 (8.0%), Klebsiella oxytoca – 2 (4.0%), Beta hemolytic streptococcus – 2 (4.0%) patients. Citrobacter fundii, Citrobacter brakii, Parabacteroides distasonis, Proteus mirabilis, Klebsiella pneumoniae, Enterobacteriaceae daacea grew only in 1 (2.0%) patients crop. Postoperative anastomotic leakage diagnosed in 2 (4.0%) patients. Conclusions. The major microorganisms that grown were E. coli. Due to the small sample, tendency can not be predicted, but microorganisms that promote small blood vessels thrombosis may be one of the factors that cause anastomotic leakage.

Operations for Colon Cancer

2020 ◽  
Author(s):  
Kevork Kazanjian ◽  
David A Etzioni
Keyword(s):  
United States ◽  
Colon Cancer ◽  
Colorectal Anastomosis ◽  
Vascular Anatomy ◽  
The United States ◽  
Sigmoid Resection ◽  
Right Hemicolectomy ◽  
Colon Anastomosis ◽  
Partial Colectomy ◽  
Laparoscopic Right Hemicolectomy

Colon cancer is the third most commonly diagnosed cancer in the United States. Partial colectomy is beneficial for the majority of these patients; more than 250,000 of these procedures are performed in the United States annually, with colon cancer being the most common indication. Although these procedures are commonly performed, there is considerable associated morbidity and mortality. This review details the indications for surgery, the preoperative planning, and technical considerations for colon cancer surgeries. Figures show the vascular anatomy of the colon, oncologic resections of carcinomas in different locations of the colon, anatomic relations between the colon and the retroperitoneal organs, port positioning for laparoscopic colectomy, right colon mobilization and mesenteric dissection in laparoscopic right hemicolectomy, configuration of an end-to-end stapled colorectal anastomosis, laparoscopic left hemicolectomy and sigmoid resection, and approaches to dissection of the splenic flexure. A video shows a laparoscopic right colectomy, and potential complications of colectomy are listed in a table. This review contains 9 figures, 1 video, 2 tables, and 70 references. Keywords: Colon, Anastomosis, Colectomy, Cancer, Flexure, Tumor, Sigmoid, Mesentry

End-to-side versus side-to-side anastomosis after laparoscopic right hemicolectomy for colon cancer: Short-term outcomes of a randomized controlled trial.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 27-27
Author(s):  
Min Hyun Kim ◽  
Jung Rae Cho ◽  
Heung-Kwon Oh ◽  
Duck-Woo Kim ◽  
Sung-Bum Kang
Keyword(s):  
Colon Cancer ◽  
Enhanced Recovery ◽  
Controlled Trial ◽  
Right Hemicolectomy ◽  
Short Term ◽  
Randomized Controlled ◽  
Enhanced Recovery Program ◽  
Laparoscopic Right Hemicolectomy ◽  
Recovery Program ◽  
Cumulative Recovery

27 Background: A standard anastomotic configuration after right hemicolectomy is not well established, although short-term benefits of end-to-side anastomosis have been reported. This study was designed to assess the superiority of end-to-side anastomosis compared to side-to-side anastomosis after laparoscopic right hemicolectomy for colon cancer under an enhanced recovery program. Methods: Between September 2016 and August 2019, 130 patients (18–80 years) scheduled for laparoscopic right hemicolectomy were randomly assigned (1:1) to undergo end-to-side ( n = 65) or side-to-side ( n = 65) anastomosis. All patients underwent an enhanced recovery program with early diet and mobilization. The primary outcome was the cumulative recovery rate 7 days after surgery, defined as the percentage of patients who met all of the following recovery criteria: tolerated diet for 24h, analgesic-free, safe ambulation, and afebrile status without major complications. Results: The cumulative recovery rate did not differ between end-to-side (92.3%, 60/65) and side-to-side anastomosis (92.3%, 60/65) ( P = 1.000). Both approaches had similar cumulative recovery rates at 4, 5, and 6 days (end-to-side vs. side-to-side: 41.5% vs. 35.4%, P = 0.589; 73.8% vs. 63.1%, P = 0.257; 86.2% vs. 81.5%, P = 0.634; respectively) The median recovery time [interquartile range (IQR)] in the end-to-side and side-to-side groups was 105 [90-124] hours and 113 [84-139] hours, respectively ( P = 0.474), showing no significant difference. Length of stay [IQR] was similar in the end-to-side and side-to-side groups (5 [5–7] vs. 6 [5–7] days; P = 0.376). The 30-day complication rate (16.9% vs. 12.3%, P = 0.620), enhanced recovery program failure rate (10.8% vs. 7.7%, P = 0.763), and 30-day readmission rate (4.6% vs. 3.1%; P = 1.000) were not significantly different between the groups. Conclusions: This is the first randomized controlled trial showing that end-to-side anastomosis is not superior to side-to-side anastomosis in terms of short-term outcomes after laparoscopic right hemicolectomy. Clinical trial information: NCT02897531.

scholarly journals Intra-corporeal delta-shaped anastomosis in laparoscopic right hemicolectomy for right colon cancer: a safe and effective technique

2019 ◽  
Vol 7 (4) ◽  
pp. 272-278
Author(s):  
Hao Su ◽  
Wei-Sen Jin ◽  
Peng Wang ◽  
Mandula Bao ◽  
Xue-Wei Wang ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Surgical Outcomes ◽  
Right Hemicolectomy ◽  
Clinicopathological Characteristics ◽  
Complication Rates ◽  
Right Colon ◽  
Short Term ◽  
Right Colon Cancer ◽  
Laparoscopic Right Hemicolectomy ◽  
Operative Recovery

Abstract Background and objective Intra-corporeal delta-shaped anastomosis (IDA) is an important development in laparoscopic digestive-tract reconstruction. We applied it in laparoscopic right hemicolectomy for right colon cancer and compared the short-term outcomes between the patients treated with IDA and conventional extracorporeal anastomosis (EA). Methods Between 1 January 2016 and 1 October 2017, 36 and 50 patients who underwent IDA and EA, respectively, were included. Data on clinicopathological characteristics, surgical outcomes, post-operative recovery and complications were collected and compared between the two groups. Results Surgical outcomes and clinicopathological characteristics were similar between the two groups except the length of incision, which was significantly shorter in the IDA group than in the EA group (4.6 ± 0.6 vs 5.6 ± 0.7 cm, P < 0.001). The time to ground activities, fluid diet intake and post-operative hospitalization did not differ between the groups; however, the time to first flatus was significantly shorter in the IDA group than in the EA group (2.8 ± 0.5 vs 3.2 ± 0.8 days, P = 0.004). The post-operative visual analogue scale for pain was lower in the IDA group than in the EA group on post-operative Day 1 (4.0 ± 0.7 vs 4.5 ± 1.0, P = 0.002) and post-operative Day 3 (2.7 ± 0.6 vs 3.4 ± 0.6, P < 0.001). The surgical complication rates were 8.3 and 16.0% in the IDA and EA groups (P = 0.470), respectively. No complications such as anastomotic bleeding, stenosis and leakage occurred in any patient. Conclusions IDA is safe and feasible and shows more satisfactory short-term outcomes than EA.

Management of Hepatic Metastases From Colorectal Cancer

2015 ◽  
Author(s):  
David M. Nagorney ◽  
Rory Smoot
Keyword(s):  
United States ◽  
Colon Cancer ◽  
Colorectal Anastomosis ◽  
Hepatic Metastases ◽  
Vascular Anatomy ◽  
The United States ◽  
Sigmoid Resection ◽  
Right Hemicolectomy ◽  
Partial Colectomy ◽  
Laparoscopic Right Hemicolectomy

Colon cancer is the third most commonly diagnosed cancer in the United States. Partial colectomy is beneficial for the majority of these patients; more than 250,000 of these procedures are performed in the United States annually, with colon cancer being the most common indication. Although these procedures are commonly performed, there is considerable associated morbidity and mortality. This review details the indications for surgery, the preoperative planning, and technical considerations for colon cancer surgeries. Figures show the vascular anatomy of the colon, oncologic resections of carcinomas in different locations of the colon, anatomic relations between the colon and the retroperitoneal organs, port positioning for laparoscopic colectomy, right colon mobilization and mesenteric dissection in laparoscopic right hemicolectomy, configuration of an end-to-end stapled colorectal anastomosis, laparoscopic left hemicolectomy and sigmoid resection, and approaches to dissection of the splenic flexure. A video shows a laparoscopic right colectomy, and potential complications of colectomy are listed in a table. This review contains 9 figures, 1 video, 1 table, and 69 references.

The Association of Vitamin D3 With Early Anastomotic Leakage in Patients Undergoing Hemicolectomy Surgery

2021 ◽  
pp. 155335062110624
Author(s):  
Hojat Layeg ◽  
Vahide K. Meshki ◽  
Mohammad Y. Karami ◽  
Seyed Amin Moosavi ◽  
Ehsan Kafili ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Anastomotic Leakage ◽  
Vitamin D3 ◽  
Right Hemicolectomy ◽  
Cancer Surgery ◽  
Stapled Anastomosis ◽  
Right Colon ◽  
Right Colon Cancer ◽  
Colon Cancer Surgery ◽  
Sufficient Vitamin

Background Anastomotic leak (AL) is one of the most important postoperative complications after hemicolectomy with stapled anastomosis. This study aimed to evaluate the association of preoperative vitamin D3 with early anastomotic leakage after right colon cancer surgery with stapled anastomosis. Method In this prospective cohort study, 535 patients who underwent right colon cancer surgery (right hemicolectomy) with stapled anastomosis were enrolled. A subset of 315 patients was included in the study after meeting the inclusion criteria. Preoperative vitamin D level was measured and analyzed for association with early AL using univariable and multivariable logistic regression analyses. Result This study included 315 cases; among them, 18 (5.71%) patients developed early AL. Vitamin D3 was significantly higher among patients without early AL ( P < .001). Low vitamin D3 status was reported among 111 patients (35.2%) and 204 (64.8%) of patients did not have low vitamin D3 status (sufficient level = 30-100 ng/mL). Sufficient vitamin D3 levels before right colon cancer surgery with stapled anastomosis was associated inversely with early AL (crude OR = .89, 95% CI = .85-.94, P < .001 and adjusted OR = .89, 95% CI = .82-.98, P = .02). Conclusion The vitamin D3 level has a protective association with early AL. As a result, low vitamin D3 status may be a risk factor for early AL development, suggesting that it can be one of the predictors of early AL occurrence.

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