Diverting Stoma Complications in Rectal Cancer Surgery.

Abstract Background: A consensus regarding diverting stoma (DS) construction in rectal cancer surgery was reached to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we aimed to examine the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer.Methods: Between 2005 and 2017, we included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer. These participants were divided into two groups: DS (+) and DS (-) groups, and the outcomes, including postoperative complications (POCs), were compared.Results and conclusion: The incidence of ileus was higher in the DS (+) group (P<0.01); however, no patient showed anastomotic leakage of grade3. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction -related stoma outlet syndrome occurred in 19 patients (12.4%). There was no intergroup difference in the incidence of grade 3b POCs. However, the most common reason for reoperation was different in the two groups: anastomotic leakage in 91.7% of patients with 3b POCs in the DS (-) group, and SRCs in 85.7% of patients with 3b POCs in the DS (+) group.In patients with DS, there was an increase in the incidence of overall POCs, severe POCs (grade 3), and bowel obstruction, including stoma outlet syndrome, compared to patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

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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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Volume-outcome Relationship in Rectal Cancer Surgery

10.21203/rs.3.rs-276079/v1 ◽

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.

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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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