Treatment Modalities for Anastomotic Leakage in Rectal Cancer Surgery

AbstractDespite advances in rectal cancer surgery, anastomotic leakage (AL) remains a common complication with a significant impact on patient recovery, health care costs, and oncologic outcomes. The spectrum of clinical severity associated with AL is broad, and treatment options are diverse with highly variable practices across the colorectal community. To be effective, the treatment must match not only the patient's current status but also the type of leak, the surgeon's skill, and the resources available. In this chapter, we will review the current and emergent treatment modalities for AL after rectal cancer surgery.

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Mechanical Bowel Preparation Does Not Affect Clinical Severity of Anastomotic Leakage in Rectal Cancer Surgery

World Journal of Surgery ◽

10.1007/s00268-016-3839-9 ◽

2016 ◽

Vol 41 (5) ◽

pp. 1366-1374 ◽

Cited By ~ 6

Author(s):

Woong Bae Ji ◽

Koo Yong Hahn ◽

Jung Myun Kwak ◽

Dong Woo Kang ◽

Se Jin Baek ◽

...

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Bowel Preparation ◽

Mechanical Bowel Preparation ◽

Cancer Surgery ◽

Clinical Severity ◽

Rectal Cancer Surgery

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Influence of Conversion and Anastomotic Leakage on Survival in Rectal Cancer Surgery; Retrospective Cross-sectional Study

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-018-3931-6 ◽

2018 ◽

Vol 23 (10) ◽

pp. 2007-2018 ◽

Cited By ~ 7

Author(s):

Edgar J. B. Furnée ◽

◽

Tjeerd S. Aukema ◽

Steven J. Oosterling ◽

Wernard A. A. Borstlap ◽

...

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Cross Sectional Study ◽

Cancer Surgery ◽

Rectal Cancer Surgery ◽

Sectional Study ◽

Cross Sectional

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The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02432-x ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Yu Mu ◽

Linxian Zhao ◽

Hongyu He ◽

Huimin Zhao ◽

Jiannan Li

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Meta Analysis ◽

Operation Time ◽

Postoperative Hospital Stay ◽

Cancer Surgery ◽

Rectal Cancer Surgery ◽

Anastomotic Leakage Rate ◽

Protective Ileostomy ◽

Clinically Significant

Abstract Background Protective ileostomy is always applied to avoid clinically significant anastomotic leakage and other postoperative complications for patients receiving laparoscopic rectal cancer surgery. However, whether it is necessary to perform the ileostomy is still controversial. This meta-analysis aims to analyze the efficacy of ileostomy on laparoscopic rectal cancer surgery. Methods Cochrane Library, EMBASE, Web of Science, and PubMed were applied for systematic search of all relevant literature, updated to May 07, 2021. Studies compared patients with and without ileostomy for laparoscopic rectal cancer surgery. We applied Review Manager software to perform this meta-analysis. The quality of the non-randomized controlled trials was assessed using the Newcastle-Ottawa scale (NOS), and the randomized studies were assessed using the Jadad scale. Results We collected a total of 1203 references, and seven studies were included using the research methods. The clinically significant anastomotic leakage rate was significantly lower in ileostomy group (27/567, 4.76%) than that in non-ileostomy group (54/525, 10.29%) (RR = 0.47, 95% CI 0.30–0.73, P for overall effect = 0.0009, P for heterogeneity = 0.18, I2 = 32%). However, the postoperative hospital stay, reoperation, wound infection, and operation time showed no significant difference between the ileostomy and non-ileostomy groups. Conclusion The results demonstrated that protective ileostomy could decrease the clinically significant anastomotic leakage rate for patients undergoing laparoscopic rectal cancer surgery. However, ileostomy has no effect on postoperative hospital stay, reoperation, wound infection, and operation time. The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis.

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Risk factors for anastomotic leakage and stricture following rectal cancer surgery: A retrospective cohort study

Annals of Medical Research ◽

10.5455/annalsmedres.2020.08.889 ◽

2021 ◽

Vol 28 (2) ◽

pp. 352

Author(s):

Mehmet Usta ◽

Arif Cekic

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Cohort Study ◽

Anastomotic Leakage ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Cancer Surgery ◽

Rectal Cancer Surgery

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Leakage after Surgery for Rectum Cancer: Inconsistency in Reporting to the Danish Colorectal Cancer Group

Surgery Research and Practice ◽

10.1155/2015/376540 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

L. Borly ◽

M. B. Ellebæk ◽

N. Qvist

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Anastomotic Leakage ◽

Leakage Rate ◽

Cancer Surgery ◽

Rectal Cancer Surgery ◽

Prognostic Impact ◽

Cancer Specific Survival ◽

Cancer Group ◽

Core Questions

Purpose. Anastomotic leakage accounts for up to 1/3 of all fatalities after rectal cancer surgery. Evidence suggests that anastomotic leakage has a negative prognostic impact on local cancer recurrence and long-term cancer specific survival. The reported leakage rate in 2011 in Denmark varied from 7 to 45 percent. The objective was to clarify if the reporting of anastomotic leakage to the Danish Colorectal Cancer Group was rigorous and unequivocal.Methods. An Internet-based questionnaire was e-mailed to all Danish surgical departments, who reported to Danish Colorectal Cancer Group (DCCG) in 2011. There were 23 questions. Four core questions were whether pelvic collection, fecal appearance in a pelvic drain, rectovaginal fistula, and “watchfull” waiting patients were reported as anastomotic leakage.Results. Fourteen out of 17 departments, who in 2011 according to DDCG performed rectal cancer surgery, answered the questionnaire. This gave a response rate of 82%. In three of four core questions there was disagreement in what should be reported as anastomotic leakage.Conclusion. The reporting of anastomotic leakage to the Danish Colorectal Cancer Group was not rigorous and unequivocal. The reported anastomotic leakage rate in Danish Colorectal Cancer Group should be interpreted with caution.

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