P.08.14 LONG TERM EFFICACY OF VACUUM-ASSISTED THERAPY (ENDO-SPONGE) IN ANASTOMOTIC LEAKAGE FOLLOWING ANTERIOR RECTAL RESECTION

2012 ◽  
Vol 44 ◽  
pp. S139
Author(s):  
A. Buzzi ◽  
A. Mussetto ◽  
I. Tampieri ◽  
M.L. Brancaccio ◽  
T. Casetti
Keyword(s):  
Anastomotic Leakage ◽  
Rectal Resection ◽  
Term Efficacy ◽  
Anterior Rectal Resection

scholarly journals Prediction of anastomotic leakage after anterior rectal resection

2019 ◽  
Vol 35 (3) ◽  
Author(s):  
Shubang Cheng ◽  
Bolin He ◽  
Xueyi Zeng
Keyword(s):  
Rectal Cancer ◽  
Prediction Model ◽  
Anastomotic Leakage ◽  
Roc Curve ◽  
Rectal Resection ◽  
Preoperative Chemoradiotherapy ◽  
Tumor Differentiation ◽  
Intraoperative Bleeding ◽  
Anterior Rectal Resection ◽  
Validation Set

Objective: Anastomotic Leakage (AL) is one of the most common complications after resection of rectal cancer. Recognition of the incidence and risk factors related to AL is important. This study aimed develops a model that can predict anastomotic leakage after anterior rectal resection. Methods: Data from 188 patients undergoing anterior resection of rectal cancer were collected for retrospective analysis. Patients were randomly divided in the development set and validation set at a 1:1 ratio. We first included age, sex, preoperative chemoradiotherapy, tumor size, degree of tumor differentiation, stage, TNM stage, lymph vascular invasion, distance, anastomotic method, diabetes, intraoperative time, intraoperative bleeding and smoking as candidates for variable selection with a LASSO method. A ROC curve was constructed with the validation set to assess the accuracy of the prediction model. Results: AL occurred in 20 of 188 patients (10.6%). Preoperative chemoradiotherapy (p=0.04), medium degree of tumor differentiation (p=0.04), anastomotic method (p<0.01), intraoperative bleeding≥400ml (p<0.01), smoking (p<0.01), diabetes (p<0.01) were significantly related to AL. The area under the ROC curve of the prediction model is 0.952. Conclusions: This study developed a model that can predict anastomotic leakage after anterior rectal resection, which may aid the selection of preventive ileostomy and postoperative management. doi: https://doi.org/10.12669/pjms.35.3.252 How to cite this:Cheng S, He B, Zeng X. Prediction of anastomotic leakage after anterior rectal resection. Pak J Med Sci. 2019;35(3):830-835.  doi: https://doi.org/10.12669/pjms.35.3.252 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Risk of Outlet Obstruction Associated With Defunctioning Loop Ileostomy in Rectal Cancer Surgery

2021 ◽  
Vol 1 (5) ◽  
pp. 465-470
Author(s):  
HIROYA ENOMOTO ◽  
KATSUHITO SUWA ◽  
NANA TAKEUCHI ◽  
YOSHITO HANNYA ◽  
YUHEI TSUKAZAKI ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Odds Ratio ◽  
Rectal Resection ◽  
Univariate Analysis ◽  
Outlet Obstruction ◽  
Muscle Thickness ◽  
Rectus Abdominis ◽  
Rectus Abdominis Muscle ◽  
Anterior Rectal Resection

Background: The outlet obstruction (OO) rate is 5.4-18.4% after defunctioning ileostomy (DI) following rectal cancer resection to reduce the incidence and severity of anastomotic leakage; OO affects a patient’s quality of life and prolongs hospitalization. Patients and Methods: A retrospective analysis was performed of patients who underwent anterior rectal resection and DI for rectal cancer. Results: Among 100 patients undergoing anterior rectal resection with DI for rectal cancer, 28 (28%) developed OO. Anastomotic leakage and a rectus abdominis muscle thickness ≥10 mm on preoperative computed tomography were significantly associated with the risk of OO in univariate analysis. Multivariate analysis also demonstrated that anastomotic leakage (odds ratio=4.320, 95% confidence interval=1.280-14.60, p=0.019) and rectus abdominis muscle thickness ≥10 mm (odds ratio=3.710, 95% confidence intervaI=1.280-10.70, p=0.016) were significantly risk factors for OO. Conclusion: When OO is observed, an anastomotic leakage should be suspected, especially if there is a high rectus abdominis muscle thickness.

Long-term functional follow-up after anterior rectal resection for cancer

2016 ◽  
Vol 32 (1) ◽  
pp. 83-88 ◽  
Author(s):  
Alessandro Sturiale ◽  
Jacopo Martellucci ◽  
Letizia Zurli ◽  
Carla Vaccaro ◽  
Luigi Brusciano ◽  
...  
Keyword(s):  
Rectal Resection ◽  
Anterior Rectal Resection

scholarly journals A Single Centre Retrospective Evaluation of Laparoscopic Rectal Resection with TME for Rectal Cancer: 5-Year Cancer-Specific Survival

2011 ◽  
Vol 2011 ◽  
pp. 1-5
Author(s):  
Raoul Quarati ◽  
Massimo Summa ◽  
Fabio Priora ◽  
Valeria Maglione ◽  
Ferruccio Ravazzoni ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Survival Rate ◽  
Minimally Invasive ◽  
Rectal Resection ◽  
Minimally Invasive Approach ◽  
Single Centre ◽  
Term Survival ◽  
Invasive Approach ◽  
Anterior Rectal Resection

Laparoscopic colon resection has established its role as a minimally invasive approach to colorectal diseases. Better long-term survival rate is suggested to be achievable with this approach in colon cancer patients, whereas some doubts were raised about its safety in rectal cancer. Here we report on our single centre experience of rectal laparoscopic resections for cancer focusing on short- and long-term oncological outcomes. In the last 13 years, 248 patients underwent minimally invasive approach for rectal cancer at our centre. We focused on 99 stage I, II, and III patients with a minimum follow-up period of 5 years. Of them 43 had a middle and 56 lower rectal tumor. Laparoscopic anterior rectal resection was performed in 71 patients whereas laparoscopic abdomino-perineal resection in 28. The overall mortality rate was 1%; the overall morbidity rate was 29%. The 5-year disease-free survival rate was 69.7%, The 5-year overall survival rate was 78.8%.

scholarly journals Failure of Colorectal Anastomosis: Risk Factors, Prevention, Diagnosis, Therapeutic Tactics

2019 ◽  
Vol 29 (2) ◽  
pp. 27-34 ◽  
Author(s):  
M. F. Cherkasov ◽  
A. V. Dmitriev ◽  
V. S. Groshilin ◽  
S. V. Pereskokov ◽  
M. A. Kozyrevskiy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Rectal Resection ◽  
Intestinal Anastomosis ◽  
Colorectal Anastomosis ◽  
Long Term Results ◽  
Individual Consideration ◽  
Independent Risk Factors ◽  
Almost All

Aim. To analyse and generalize available literature data on the problem of colorectal anastomotic leakage after rectal resection. Key findings. Over the last decade, there has been an increasing trend towards sphincter-preserving operations in modern colorectal surgery. The widespread use of suturing devices of various diameters allows the formation of ultra-low anastomoses (at the level of the pelvic floor). One of the menacing complications after rectal resection is anastomotic leakage, which frequency can reach 21%. The mortality from anastomotic leakage can reach 40%. The analysed literature sources discuss a variety of risk factors, both preoperative and intraoperative, affecting the healing of the inter-intestinal anastomosis. In almost all studies, the height of the tumour and the anastomosis from the anus, preoperative radiotherapy and male sex are independent risk factors for the development of colorectal anastomotic leakage. Concerning other factors, there are conflicting opinions. The timely use of preventive measures and early diagnosis of colorectal anastomotic leakage can reduce the number and severity of postoperative complications.Conclusion. Individual consideration of risk factors and their adequate assessment in terms of possible complications are decisive in the choice of the extent of surgical intervention, which will undoubtedly improve the immediate and long-term results of the surgical treatment of colorectal cancer. 

scholarly journals A modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection for upper rectal or lower sigmoid colon cancer: a retrospective study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Si Yu ◽  
Yong Ji ◽  
Tedong Luo ◽  
Pengjie Xu ◽  
Zuojun Zhen ◽  
...  
Keyword(s):  
Rectal Resection ◽  
Sigmoid Colon Cancer ◽  
Control Group ◽  
Specimen Extraction ◽  
Modified Technique ◽  
Anterior Rectal Resection ◽  
Transanal Specimen Extraction ◽  
Long Term Follow Up ◽  
The Mean

Abstract Background In recent years, natural orifice specimen extraction surgery (NOSES) has become a field of special interest for colorectal surgeons. Some researchers have reported transanal specimen extraction in the laparoscopic anterior rectal resection, including intersphincteric resection (ISR) and rectal eversion-resection. However, these surgical procedures have certain limitations. Based on the proven expertise in laparoscopic surgery, our center has developed a modified technique of transanal specimen extraction. The aim of this study was to investigate the safety and feasibility of a modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection. Methods From January 2011 to January 2014, the patients with upper rectal or lower sigmoid colon cancer who had undergone laparoscopic anterior rectal resection with specimen extraction by a modified transanal technique were enrolled in the observation group, and the patients who had undergone laparoscopic anterior rectal resection with specimen extraction via an abdominal incision by the same surgeons during the same period were enrolled in the control group. Results A total of 36 patients were included in the observation group and 128 patients were included in the control group. There were no significant differences (P > 0.05) between the two groups in terms of the mean operative time [144 ± 10 min vs. 141 ± 11 min], mean intraoperative blood loss [63 ± 6 ml vs. 61 ± 7 ml], and the mean time to anal exhaust [67 ± 7 h vs. 65 ± 8 h]. However, there were significant differences (P < 0.05) between the two groups in terms of the mean postoperative Visual Analogue Scale (VAS) pain scores [3.4 ± 1.1 vs. 4.5 ± 1.2], mean postoperative hospital stay [6.0 ± 1.1 days ± vs. 7.2 ± 1.2 days], and incidence of postoperative complications (4/36 vs. 15/128). Long-term follow-up results showed that there was no significant difference (P > 0.05) between the two groups in terms of the 3- or 5-year overall survival. Conclusions The modified technique of transanal specimen extraction in the laparoscopic anterior rectal resection fulfilled the principle of no-neoplasm touch technique, with advantages, such as minimal trauma, rapid recovery, and fewer complications. Long-term follow-up results also showed satisfactory oncological outcomes.

scholarly journals Endoluminal Negative Pressure Wound Therapy (E-NPWT) for anastomotic leakage after rectal resection

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Norbert Severin Friedrich Runkel ◽  
Mechthilde Birk
Keyword(s):  
Anastomotic Leakage ◽  
Fibrin Glue ◽  
Rectal Resection ◽  
Damage Control ◽  
Local Treatment ◽  
Case Series ◽  
Closure Rate ◽  
Large Defect ◽  
Surgical Closure ◽  
Anterior Rectal Resection

Background Local management of anastomotic leakage after rectal cancer resection has traditionally consisted of rinsing and drainage. Transanal endoluminal application of NPWT (E-NPWT or endo-VAC or endo-sponge) is an interesting novel concept that has been explored in a few studies and case series over the last decade. We report herein our institutional experience over a three year period during which E-NPWT was the local treatment of choice for all cases with anastomotic leakage after rectal resection.Patients and MethodsThis study retrospectively evaluated the clinical charts of 147 consecutive patients who underwent anterior rectal resection from 2011-2013. A postoperative anastomotic leak occurred in eight (5%) patients from two straight anastomoses, one side-to-end construction, and five colonic pouches. All patients had undergone curative anterior resection with diverting ostomy. Transanal debridement and application of a trimmed foam were performed by rigid or fexibel endoscopy and started without delay after confirmation of diagnosis in seven patients 8-15 days postoperatively. In one patient E-NPWT began after failed fibrin-glue treatment 6 weeks later. The foams were connected to a standard vacuum pump with the pressure set at -70mmHg in a continuous mode. E-NPWT was maintained for a median period of 10 (5-25) days. The treatment intervals were typically 2-3 days.ResultsComplete healing was achieved in three cases during E-NPWT. In the remaining five patients, the defect reduced in size to allow further spontaneous healing. This occurred twice. One persistent sinus was successfully sealed with fibrin glue.  One persisting recto-vaginal fistula required surgical closure. One large defect secondary to ischemic pouch necrosis required secondary pouch explantation and permanent colostomy. The overall ileostomy reversal rate was 75%.ConclusionE-NPWT is feasible and without severe side effects. Early initiation prevents septic progression and results in a high closure rate in patients with pelvic leakage. Although complete healing is not achieved in recto-vaginal fistulas or ischemic necrosis of the neorectum, E-NPWT may play a potential role in bridging and damage control. 

Influence of Obesity on Anastomotic Leakage After Anterior Rectal Resectionperformed Due to Cancer

2015 ◽  
Vol 87 (3) ◽  
Author(s):  
Jerzy Piecuch ◽  
Maciej Wiewióra ◽  
Monika Szrot ◽  
Janusz Jopek ◽  
Albert Krzak ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Rectal Resection ◽  
Group Iii ◽  
Group I ◽  
Anterior Rectal Resection ◽  
Mechanical Suture ◽  
The Relationship

AbstractAnterior resection for rectal cancer carries the risk of serious complications, especially fistulas at the site of anastomosis. Numerous factors have been shown to impact anastomotic leakage. The results of studies on the influence of obesity on the frequency of anastomotic leakage after rectal resection performed due to cancer have been contradictory.The aim of the study was to evaluate the relationship between body mass index (BMI) and frequency of anastomotic leakage after anterior rectal resection performed due to cancer. Material and methods. This retrospective analysis included 222 subsequent patients who had undergone anterior resection due to cancer with an anastomosis formed with a mechanical suture. The patients were divided into 3 groups depending on their BMI quartile as follows: Group I, BMI < 23.8 kg/mResults. Anastomotic leakage occurred in 8 (3.6%) patients. Fistulas occurred in 4 out of 61 patients (6.56%) in group I, which was the highest incidence of fistulas for all 3 groups. In group II, fistulas occurred in 2 out of 55 patients (3.63%), and similarly, in group III, they occurred in 2 out of 106 patients (1.87%). The differences found in the frequency of fistulas between groups were not statistically significant (p=0.31). The logistic regression analysis did not show any relationship between leakage and age (p = 0.55; OR = 1.02; 95% CI: 0.95 - 1.1), sex (p = 0.97; OR = 0.97; 95% CI: 0.22 - 4.25) or BMI (p = 0.27; OR = 0.58; 95% CI: 0.22 - 1.53).Conclusions. The results of our study show that BMI did not have any influence on the frequency of anastomotic leakage after anterior rectal resection performed due to cancer.

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