Revisiting the value of drains after low anterior resection for rectal cancer: An analysis of 996 patients.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 45-45
Author(s):  
Rachel M. Lee ◽  
Adriana C. Gamboa ◽  
Michael K. Turgeon ◽  
Sanjana Prasad ◽  
Gifty Kwakye ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leak ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Anal Verge ◽  
Neoadjuvant Chemoradiation ◽  
Leak Rate ◽  
Intraabdominal Abscess ◽  
Anastomotic Leak Rate ◽  
Drain Placement

45 Background: Although potentially associated with increased infections, intraoperative pelvic drains are often placed during low anterior resection (LAR) to evacuate postoperative fluid collections and identify/control potential anastomotic leaks. Our aim was to assess the validity of this practice in a large dataset of patients undergoing LAR for rectal cancer. Methods: Patients from the US Rectal Cancer Consortium (2007-17) who underwent curative-intent LAR for a primary rectal cancer were included. Patients were categorized as receiving a closed suction drain intraoperatively or not. Primary outcomes were superficial surgical site infection(SSI), deep SSI, intraabdominal abscess, anastomotic leak, and need for secondary drain placement. Three subgroup analyses were conducted in patients who received neoadjuvant chemoradiation, had a diverting loop ileostomy (DLI), and had low tumors <6cm from the anal verge. Results: Of 996 pts, average age was 58 yrs, 61% were male, and 67% (n=551) received a drain. Drain patients were more likely to be male (64vs54%), have a smoking history (25vs19%), have received neoadjuvant chemoradiation (73vs61%), have low tumors within 6cm of the anal verge (56vs36%), and have received a DLI (80vs71%) (all p<0.05). Drains were associated with an increased anastomotic leak rate (14vs8%, p=0.041), although there was no difference in the need for a secondary drainage procedure to control the leak (82vs88%, p=0.924). These findings persisted in all subset analyses. Drains were not associated with increased superficial SSI, deep SSI, or intraabdominal abscess in the entire cohort or each subset analysis. Reoperation (12vs10%, p=0.478) and readmission rates (28vs31%, p=0.511) were similar. Conclusions: Although not associated with increased infectious complications, intraoperatively-placed pelvic drains after low anterior resection for rectal cancer are associated with an increase in anastomotic leak rate and no reduction in the need for secondary drain placement or reoperation. Routine drainage should be abandoned.

Mo1755 - Preoperative Oral Antibiotics are Associated with Significantly Lower Anastomotic Leak Rate after Low Anterior Resection in Rectum Cancer Patients

2018 ◽  
Vol 154 (6) ◽  
pp. S-1334
Author(s):  
Hiromichi Miyagaki ◽  
Carl Winkler ◽  
Sandhu K. Jaspreet ◽  
Elie Sutton ◽  
H M C Shantha Kumara ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
Cancer Patients ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Leak Rate ◽  
Oral Antibiotics ◽  
Rectum Cancer ◽  
Anastomotic Leak Rate

Outcomes of Low Anterior Resection Anastomotic Leak after Preoperative Chemoradiation Therapy for Rectal Cancer

2010 ◽  
Vol 76 (7) ◽  
pp. 747-751 ◽  
Author(s):  
Lisa J. Harris ◽  
Benjamin R. Phillips ◽  
Pinckney J. Maxwell ◽  
Gerald A. Isenberg ◽  
Scott D. Goldstein
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leak ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Primary Anastomosis ◽  
Anal Verge ◽  
Lower Rectum ◽  
Institutional Review ◽  
Intestinal Continuity ◽  
Tumor Level

Anastomotic leak remains a major cause of morbidity and mortality after colorectal surgery, especially with low anastomoses. The aim of this study was to assess outcomes of patients who developed an anastomotic leak after low anterior resection of the rectum for rectal cancer. An Institutional Review Board-approved retrospective review of 89 consecutive patients undergoing open low anterior resection with primary anastomosis for cancer of the mid/lower rectum at a single institution between January 2001 and December 2008 was performed. All patients received neoadjuvant chemotherapy and radiation therapy. Proximal diversion was performed in all patients. Perioperative data were collected and analyzed with attention to management and outcomes after development of anastomotic leak. Nine patients (10.1%) developed anastomotic leak. Mean age was 62 years. Mean tumor level was 4.8 cm above the anal verge. Symptomatic anastomotic leak developed in seven (78%) patients. Percutaneous drainage was performed in five (55.6%) patients with an average of 4.4 procedures required for management of anastomotic leak. Five (55.6%) patients required reoperation. Only two procedures (25%) involved laparotomy. No operative procedures were performed emergently. There were no mortalities. Excluding one patient who received completion proctectomy for local recurrence, restoration of intestinal continuity was achieved in five (63%) of eight patients. Mean time to stoma closure was 289 days. The potentially lethal complication of anastomotic leak after low anterior resection for rectal cancer can be managed expectantly and electively in patients who are proximally diverted with the expectation of stoma reversal in the long term.

The impact of timing of stoma closure on low anterior resection syndrome in patient who underwent low anterior resection for rectal cancer

2021 ◽  
pp. 126-134
Author(s):  
Hemn Hussain Kaka Ali ◽  
Qalandar Hussein Abdulkarim ◽  
Karzan Seerwan ◽  
Barham M. M .Salih
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Anal Verge ◽  
Loop Ileostomy ◽  
Low Anterior Resection Syndrome ◽  
Anterior Resection Syndrome ◽  
Closure Of Ileostomy ◽  
The Mean ◽  
The Impact

This is a multi-center retrospective study of patients underwent low anterior resection for rectal cancer. Ileostomy had been done to protect low lying Colo-rectal anastomosis, closure of ileostomy had been delayed in some patients due to patient own will, surgical complications (anastomotic leak) or coarse of chemotherapy. This study aimed to find the effect of temporary ileostomy on post-operative bowel defunction which is called Low anterior resection syndrome (LARS), and include; urgency, difficulty in emptying of bowel, and incontinence for feces and flatus.  A total of 50 patients included in this study, the age ranges from the 19 to 80 years old with a mean age of 51.96 years. The total number of males was (33, %66). Majority of patients were overweight (21, 42%). The distance of tumors from the anal verge were less than 10 cm in (31,62%). The mean duration of fecal diversion was 7.17 months. Loop ileostomy were closed before six months in (27,54%). The mean duration of diversion of patients developed no LARS was 6.87 months which is shorter than those of developed LARS (7.31). Lower BMI patients are more prone to develop LARS, while Obese patients are more susceptible to develop major LARS. Nineteen cases developed LARS among those patient’s ileostomy closed before six months, and 15 cases developed LARS in those ileostomies closed after six months.    

Volume-outcome Relationship in Rectal Cancer Surgery

2021 ◽  
Author(s):  
Leandro Siragusa ◽  
Bruno Sensi ◽  
Danilo Vinci ◽  
Marzia Franceschilli ◽  
Giulia Bagaglini ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Operative Time ◽  
Cancer Surgery ◽  
Leak Rate ◽  
Perioperative Outcomes ◽  
Rectal Cancer Surgery ◽  
Anastomotic Leak Rate

Abstract Introduction Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR).Methods A retrospective analysis of all consecutive patients undergoing ARR with primary anastomosis between November 2016 and December 2020 after centralization of rectal cancer cases in an academic Centre. Short outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. The primary outcome was anastomotic leak rate. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes.Results 86 patients were operated in the study period and outcomes compared to those of 101 patients operated during the previous ten years. Difference in volume of surgery was significant between the two periods (p 0.019) and the estimated leak rate was significantly lower in the higher volume unit (p 0.05). Mean operative time, need of conversion, postoperative use of blood transfusion and in-hospital stay (p <0.05) were also significantly reduced in Group A.Conclusion: This study suggests that the shift toward higher volume in rectal cancer surgery is associated to decreased anastomotic leak rate. Potentiation of lower volume surgical units may yield optimal perioperative outcomes.

scholarly journals LARS is Associated with Lower Anastomoses, but not with the Transanal Approach in Patients Undergoing Rectal Cancer Resection

2020 ◽  
Author(s):  
Alexandra Filips ◽  
Tobias Haltmeier ◽  
Andreas Kohler ◽  
Daniel Candinas ◽  
Lukas Brügger ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Functional Outcomes ◽  
Low Anterior Resection ◽  
Regression Coefficient ◽  
Anal Verge ◽  
Transanal Approach ◽  
Cancer Resection ◽  
Rectal Cancer Resection ◽  
The Impact

Abstract Background Low anterior resection syndrome (LARS) is a defecation disorder that frequently occurs after a low anterior resection (LAR) with a total mesorectal excision (TME). The transanal (ta) TME for low rectal pathologies could potentially overcome some of the difficulties encountered with the abdominal approach in a narrow pelvis. However, the impact of the transanal approach on functional outcomes remains unknown. Here, we investigated the effect of the taTME approach on functional outcomes by comparing LARS scores between the LAR and taTME approaches in patients with colorectal cancer. Methods We conducted a retrospective cohort study including 80 patients (n = 40 LAR-TME, n = 40 taTME) with rectal adenocarcinoma. We reviewed medical charts to obtain LARS scores 6 months after the rectal resection or a reversal of the protective ileostomy. Results At the 6-month follow-up, 80% of patients exhibited LARS symptoms (44% minor LARS and 36% major LARS). LARS scores were not significantly associated with the T-stage, N-stage, or neo-adjuvant radiotherapy. The mean distance of the anastomosis from the anal verge was 4.0 ± 2.0 cm. The taTME group had significantly lower anastomoses compared with the LAR-TME group (median 4.0 cm [IQR1.8] vs. median 5.0 cm [IQR 2.0], p < 0.001). Univariable analysis revealed significantly higher LARS scores in the taTME group compared with the LAR-TME group (median LARS scores: 29 vs. 25, p = 0.040). However, multivariable regression analysis, adjusting for neo-adjuvant treatment, anastomosis distance from the anal verge, anastomotic leak rate, and body mass index, revealed no significant effect of taTME on the LARS score (adjusted regression coefficient:  − 2.147, 95%CI:  − 2.130 to 6.169, p = 0.359). We also found a significant correlation between LARS scores and the distance of the anastomosis from the anal verge (regression coefficient:  − 1.145, 95%CI:  − 2.149 to  − 1.141, p = 0.026). Conclusion Fifty percentage of patients in this cohort exhibited some LARS symptoms after a mid- or low-rectal cancer resection. As previously described, LARS scores were negatively correlated with the distance of the anastomosis from the anal verge. TaTME was after adjustment for the height of the anastomosis not associated with higher LARS at 6 months when compared with LAR-TME.

Long‐term significance of an anastomotic leak in patients undergoing an ultra‐low anterior resection for rectal cancer

2019 ◽  
Vol 89 (10) ◽  
pp. 1291-1295 ◽  
Author(s):  
Linda Vu ◽  
Cheryl Penter ◽  
Cameron Platell
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leak ◽  
Anterior Resection ◽  
Low Anterior Resection

Anastomotic Leak Is Not Associated With Oncologic Outcome in Patients Undergoing Low Anterior Resection for Rectal Cancer

2012 ◽  
Vol 256 (6) ◽  
pp. 1034-1038 ◽  
Author(s):  
James D. Smith ◽  
Philip B. Paty ◽  
José G. Guillem ◽  
Larissa K. Temple ◽  
Martin R. Weiser ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leak ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Oncologic Outcome
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