Locoregional recurrence in patients with anastomotic leakage after anterior resection for rectal carcinoma

Introduction: Low anterior resection (LAR) is a standard surgical procedure for distal rectal carcinoma that allows creation of a colorectal anastomosis, with anal sphincter preservation and permanent colostomy avoidance. Anastomotic leakage (AL) is a potential complication of LAR present in 3% to 20% of cases leading to a significant increase in postoperative morbidity. AL represents a communication between the intra luminal and extra luminal compartments caused by a violation of the integrity of the intestinal wall. The risk factors of this procedure have been discussed and still remain a controversial issue. Prevention is the best management. Patients with predisposing factors should be paid special attention. Aim: Our objective was to identify and analyze the risk factors of anastomotic leakage after low anterior resection of rectal carcinoma. Patients and methods: This study included all patients who underwent low anterior resection for rectal cancer at the Department of Surgery of University Hospital Kaspela between 2011 and 2016. Results: Low anterior resections were performed in 141 patients during the study period. Due to a positive air leak test on 16 patients, a protective ileostomy was created and these patients were eliminated from the study. The sex distribution of the remaining 125 patients was 69 men (55.2%) and 56 women (44.8%). The height of the anastomosis from the dentate line was 3.0 cm on an average (range 2.5 to 4 cm). Conclusion: Anastomotic leakage remains the most feared and serious complication after low anterior resection surgery. The evidence suggests that the main risk factors for anastomotic leakage at low anterior resection are the height of the anastomosis and the high ASA score.

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Can Transanal Tube Placement after Anterior Resection for Rectal Carcinoma Reduce Anastomotic Leakage Rate? A Single-institution Prospective Randomized Study

World Journal of Surgery ◽

10.1007/s00268-011-1053-3 ◽

2011 ◽

Vol 35 (6) ◽

pp. 1367-1377 ◽

Cited By ~ 64

Author(s):

Liang Xiao ◽

Wen-bo Zhang ◽

Peng-cheng Jiang ◽

Xue-feng Bu ◽

Qun Yan ◽

...

Keyword(s):

Anastomotic Leakage ◽

Rectal Carcinoma ◽

Anterior Resection ◽

Randomized Study ◽

Leakage Rate ◽

Tube Placement ◽

Prospective Randomized Study ◽

Single Institution ◽

Anastomotic Leakage Rate ◽

Transanal Tube

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Anterior resection for rectal carcinoma.

BMJ ◽

10.1136/bmj.2.5600.256-a ◽

1968 ◽

Vol 2 (5600) ◽

pp. 256-257

Keyword(s):

Rectal Carcinoma ◽

Anterior Resection

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Incidence and Mortality of Anastomotic Dehiscence Requiring Reoperation After Rectal Carcinoma Resection

International Surgery ◽

10.9738/intsurg-d-13-00059 ◽

2014 ◽

Vol 99 (2) ◽

pp. 112-119 ◽

Cited By ~ 6

Author(s):

Zhi-jie Cong ◽

Liang-hao Hu ◽

Jun-jie Xing ◽

Zheng-qian Bian ◽

Chuan-gang Fu ◽

...

Keyword(s):

Systematic Review ◽

Rectal Carcinoma ◽

Anterior Resection ◽

Rectal Resection ◽

Postoperative Mortality ◽

Anastomotic Dehiscence ◽

Systematic Search ◽

Anterior Rectal Resection ◽

Incidence And Mortality ◽

Definition Of

Abstract Anastomotic dehiscence (AD) requiring reoperation is the most severe complication following anterior rectal resection. We performed a systematic review on studies that describe AD requiring reoperation and its subsequent mortality after anterior resection for rectal carcinoma. A systematic search was performed on published literature. Data on the definition and rate of AD, the number of ADs requiring reoperation, the mortality caused by AD, and the overall postoperative mortality were pooled and analyzed. A total of 39 studies with 24,232 patients were analyzed. The studies varied in incidence and definition of AD. Systematic review of the data showed that the overall rate of AD was 8.6%, and the rate of AD requiring reoperation was 5.4%. The postoperative mortality caused by AD was 0.4%, and the overall postoperative mortality was 1.3%. We found considerable risk and mortality for AD requiring reoperation, which largely contributed to the overall postoperative mortality.

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The association of age with decline in renal function after low anterior resection and loop ileostomy for rectal cancer: a retrospective cohort prognostic factor study

BMC Geriatrics ◽

10.1186/s12877-020-02001-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Amal Rhemouga ◽

Stefan Buettner ◽

Wolf O. Bechstein ◽

Guido Woeste ◽

Teresa Schreckenbach

Keyword(s):

Rectal Cancer ◽

Rectal Carcinoma ◽

Anterior Resection ◽

Low Anterior Resection ◽

Older Patients ◽

Retrospective Cohort ◽

Loop Ileostomy ◽

Linear Regression Analysis ◽

Multivariate Linear Regression Analysis ◽

Group B

Abstract Background Low anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer. We aim to analyze, if older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients. Methods A retrospective cohort study from a database including 151 patients undergoing LAR for rectal carcinoma with DLI was used. Patients were divided in two age groups (Group A: <65 years, n = 79; Group B: ≥65 years, n = 72). For 123 patients undergoing DLI reversal prognostic factors for an impairment of serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) 3 months after DLI reversal was analyzed using a multivariate linear regression analysis. Results SCr before LAR(T0) was significant higher in Group B (P = 0.04). Accordingly, the eGFR at T0 in group B was significantly lower (P < 0.001). No patients need to undergo hemodialysis after LAR or DLI reversal. Age and SCr at T0were able to statistically significant predict an increase in SCr (P<0.001) and eGFR (P=0.001) three months after DLI reversal (The R² for the overall model was .82 (adjusted R² = .68). Conclusion DLI creation may result in a reduction of eGFR in older patients 3 months after DLI closure. Apart from this, patients do not have a higher morbidity after creation and closure of DLI resulting from LAR regardless of their age.

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