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

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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Prediction of anastomotic leakage after anterior rectal resection

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.3.252 ◽

2019 ◽

Vol 35 (3) ◽

Cited By ~ 2

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.

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

Cancer Diagnosis & Prognosis ◽

10.21873/cdp.10062 ◽

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.

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Ghost ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer (DRKS00013997): protocol for a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-038930 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038930

Author(s):

Felix J Hüttner ◽

Pascal Probst ◽

André Mihaljevic ◽

Pietro Contin ◽

Colette Dörr-Harim ◽

...

Keyword(s):

Rectal Cancer ◽

Anastomotic Leakage ◽

Anterior Resection ◽

Low Anterior Resection ◽

Loop Ileostomy ◽

Pilot Trial ◽

Ileostomy Closure ◽

Ghost Ileostomy ◽

Anterior Rectal Resection ◽

Randomised Controlled

IntroductionAnastomotic leakage is the most important complication in colorectal surgery occurring in up to 20% after low anterior rectal resection. Therefore, a diverting ileostomy is usually created during low anterior resection to protect the anastomosis or rather to diminish the consequences in case of anastomotic leakage. The so-called virtual or ghost ileostomy is a pre-stage ostomy that can be easily exteriorised, if anastomotic leakage is suspected, in order to avoid the severe consequences of anastomotic leakage. On the other hand, an actual ileostomy can be avoided in patients, who do not develop anastomotic leakage.Methods and analysisThe GHOST trial is a randomised controlled pilot trial comparing ghost ileostomy with conventional loop ileostomy in patients undergoing low anterior resection with total mesorectal excision for rectal cancer. After screening for eligibility and obtaining informed consent, a total of 60 adult patients are included in the trial. Patients are intraoperatively randomised to the trial groups in a 1:1 ratio after assuring that none of the intraoperative exclusion criteria are present. The main outcome parameter is the comprehensive complication index as a measure of safety. Further outcomes include specific complications, stoma-related complications, complications of ileostomy closure, frequency of transformation of ghost ileostomy into conventional ileostomy, frequency of terminal ostomy creation, proportion of patients with an ostomy at 6 months after index surgery, anorectal function (Wexner score) and quality of life assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR29 questionnaires. Follow-up for each individual patient will be 6 months.Ethics and disseminationThe GHOST trial has been approved by the Medical Ethics Committee of Heidelberg University (reference number S-694/2017). If the intervention proves to be safe, loop ileostomy could be spared in a large proportion of patients, thus also avoiding stoma-related complications and a second operation (ileostomy closure) with its inherent complications in these patients.Trial registration numberGerman Clinical Trials Registry (DRKS00013997); Universal Trial Number: U1111-1208-9742.

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Clinical Outcomes of Ileostomy Closure before Adjuvant Chemotherapy after Rectal Cancer Surgery: An Observational Study from a Chinese Center

Gastroenterology Research and Practice ◽

10.1155/2021/5592721 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Zhen Sun ◽

Yufeng Zhao ◽

Lu Liu ◽

Jichao Qin

Keyword(s):

Rectal Cancer ◽

Adjuvant Chemotherapy ◽

Anterior Resection ◽

Low Anterior Resection ◽

Ileostomy Closure ◽

Cancer Resection ◽

Group Iii ◽

Rectal Cancer Resection ◽

Group I ◽

Temporary Ileostomy

Background. The optimal timing of temporary ileostomy closure with respect to the time of adjuvant chemotherapy following sphincter-saving surgery for rectal cancer remains unclear. The aim of this study is to investigate the clinical and oncological outcomes of ileostomy closure before, during, and after adjuvant chemotherapy following curative rectal cancer resection. Methods. Patients diagnosed with rectal adenocarcinoma who underwent low anterior resection and temporary loop ileostomy during May 2015 and September 2019 were retrospectively evaluated. Patients undergoing ileostomy closure before adjuvant chemotherapy (Group I) were compared to patients undergoing closure during (Group II) and after (Group III) adjuvant chemotherapy. Results. A total of 225 patients were evaluated for eligibility, and 132 were finally selected and divided into 3 groups (24 in Group I, 53 in Group II, and 55 in Group III). No significant differences were observed in operative time, postoperative hospital stay, postoperative complications, total adjuvant chemotherapy cycles, and low anterior resection syndrome scores among the three groups. There was no significant difference in disease-free survival ( p = 0.834 ) and overall survival ( p = 0.462 ) between the three groups. Conclusion. Temporary ileostomy closure before adjuvant chemotherapy following curative rectal cancer resection can achieve a clinical and oncological safety level equal to stoma closure during or after chemotherapy in selected patients.

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Association between body mass index and 1-year outcome after acute myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1409 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

D.W Kim

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Body Mass Index ◽

Confidence Interval ◽

Body Mass ◽

Cardiac Death ◽

Funding Source ◽

Group Iii ◽

End Point ◽

Group I

Abstract Background Beneficial effects of overweight and obesity on mortality after acute myocardial infarction (AMI) have been described as “Body Mass Index (BMI) paradox”. However, the effects of BMI is still on debate. We analyzed the association between BMI and 1-year major cardiocerebrovascular events (MACCE) after AMI. Methods and findings Among 13,104 AMI patients registered in an Institute of Health in Korea between November 2011 and December 2015, 10,568 patients who eligible for this study were classified into 3 groups according to BMI (Group I; <22 kg/m2, 22 ≤ Group II <26 kg/m2, Group III; ≥26 kg/m2). The primary end point was a composite of cardiac death (CD), myocardial infarction (MI), target vessel revascularization (TVR), and cerebrovascular events at 1 year. Over the median follow-up of 12 months, the composite of primary end point occurred more frequently in the Group I patients than in the Group III patients (primary endpoint: adjusted hazard ratio [aHR], 1.290; 95% confidence interval [CI] 1.024 to 1.625, p=0.031). Especially, cardiac death in MACCE components played a major role in this effect (aHR, 1.548; 95% confidence interval [CI] 1.128 to 2.124, p=0.007). Conclusions Higher BMI appeared to be good prognostic factor on 1-year MACCE after AMI. This result suggests that higher BMI or obesity might confer a protective advantage over the life-quality after AMI. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Research of Korea Centers for Disease Control and Prevention and the Korea Health Technology R&D Project, Ministry of Health & Welfare (HI13C1527), Republic of Korea.

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

Digestive and Liver Disease ◽

10.1016/s1590-8658(12)60385-5 ◽

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

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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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