Failure of Colorectal Anastomosis: Risk Factors, Prevention, Diagnosis, Therapeutic Tactics

Aim. To analyse and generalize available literature data on the problem of colorectal anastomotic leakage after rectal resection. Key findings. Over the last decade, there has been an increasing trend towards sphincter-preserving operations in modern colorectal surgery. The widespread use of suturing devices of various diameters allows the formation of ultra-low anastomoses (at the level of the pelvic floor). One of the menacing complications after rectal resection is anastomotic leakage, which frequency can reach 21%. The mortality from anastomotic leakage can reach 40%. The analysed literature sources discuss a variety of risk factors, both preoperative and intraoperative, affecting the healing of the inter-intestinal anastomosis. In almost all studies, the height of the tumour and the anastomosis from the anus, preoperative radiotherapy and male sex are independent risk factors for the development of colorectal anastomotic leakage. Concerning other factors, there are conflicting opinions. The timely use of preventive measures and early diagnosis of colorectal anastomotic leakage can reduce the number and severity of postoperative complications.Conclusion. Individual consideration of risk factors and their adequate assessment in terms of possible complications are decisive in the choice of the extent of surgical intervention, which will undoubtedly improve the immediate and long-term results of the surgical treatment of colorectal cancer.

Download Full-text

Short-Term and Long-Term Outcomes in Mid and Low Rectal Cancer With Robotic Surgery

Frontiers in Oncology ◽

10.3389/fonc.2021.603073 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jingwen Chen ◽

Zhiyuan Zhang ◽

Wenju Chang ◽

Tuo Yi ◽

Qingyang Feng ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Robotic Surgery ◽

Anastomotic Leakage ◽

Operation Time ◽

Low Rectal Cancer ◽

Long Term Outcomes ◽

Independent Risk Factors ◽

Male Sex

ObjectiveTo investigate the risk factors for postoperative complications and anastomotic leakage after robotic surgery for mid and low rectal cancer and their influence on long-term outcomes.MethodsA total of 641 patients who underwent radical mid and low rectal cancer robotic surgery at Zhongshan Hospital Fudan University from January 2014 to December 2018 were enrolled in this study. The clinicopathological factors of the patients were collected. The risk factors for short-term outcomes of complications and anastomotic leakage were analyzed, and their influences on recurrence and overall survival were studied.ResultsOf the 641 patients, 516 (80.5%) underwent AR or LAR procedures, while 125 (19.5%) underwent the NOSES procedure. Only fifteen (2.3%) patients had stoma diversion. One hundred and seventeen patients (17.6%) experienced surgical complications. Anastomotic leakage occurred in 44 patients (6.9%). Eleven patients (1.7%) underwent reoperation within 90 days after surgery. Preoperative radiotherapy did not significantly increase anastomotic leakage in our study (7.4% vs. 6.8%, P = 0.869). The mean postoperative hospital stay was much longer with complication (10.4 vs. 7.1 days, P<0.05) and leakage (12.9 vs. 7.4 days, P < 0.05). Multivariate analysis showed that male sex (OR = 1.855, 95% CI: 1.175–2.923, P < 0.05), tumor distance 5 cm from the anus (OR = 1.563, 95% CI: 1.016–2.404, P < 0.05), and operation time length (OR = 1.563, 95% CI: 1.009–2.421, P < 0.05) were independent risk factors for complications in mid and low rectal cancer patients. The same results for anastomotic leakage: male sex (OR = 2.247, 95% CI: 1.126–4.902, P < 0.05), tumor distance 5 cm from the anus (OR = 2.242, 95% CI: 1.197–4.202, P < 0.05), and operation time length (OR = 2.114, 95% CI: 1.127–3.968, P < 0.05). The 3-year DFS and OS were 82.4% and 92.6% with complication, 88.4% and 94.0% without complication, 88.6% and 93.1% with leakage, and 87.0% and 93.8% without leakage, respectively. The complication and anastomotic leakage showed no significant influences on long-term outcomes.ConclusionBeing male, having a lower tumor location, and having a prolonged operation time were independent risk factors for complications and anastomotic leakage in mid and low rectal cancer. Complications and anastomotic leakage might have no long-term impact on oncological outcomes for mid and low rectal cancer with robotic surgery.

Download Full-text

Risk Factor Analysis of Orthotopic Heart Transplantation

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230301100109 ◽

2003 ◽

Vol 11 (1) ◽

pp. 33-36 ◽

Cited By ~ 5

Author(s):

Tadashi Omoto ◽

Kazutomo Minami ◽

Dietmar Böthig ◽

Ulrich Schütt ◽

Gero Tenderich ◽

...

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Early Mortality ◽

Ischemic Heart ◽

Long Term Results ◽

Donor Age ◽

Ischemic Time ◽

Independent Risk Factors

From March 1989 to December 1999, 1,013 heart transplantations were carried out in this center. Univariate analysis of potential risk factors for early death was followed by stepwise logistic regression to determine independent risk factors. Long-term results were assessed by the Kaplan-Meier method. Multivariate comparisons of long-term results were performed using Cox's proportional hazards model. Early mortality was 8.6%. Actuarial survival was 78.1%, 69.4%, and 53.1% at 1, 5, and 10 years, respectively. Mean total ischemic time was 194 minutes. Independent risk factors of early mortality were female recipient, donor age over 50 years, and ischemic heart disease in the recipient. The precise mechanism of the increased early mortality in female recipients should be studied in the future. Although older donor age was a predictor of early mortality, because of the donor shortage, older hearts should not be excluded from the donor pool. Survival was better in patients with dilative cardiomyopathy than in those with ischemic heart disease.

Download Full-text

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

Download Full-text

Risk Factors for Anastomotic Leakage after Laparoscopic Intracorporeal Colorectal Anastomosis with a Double Stapling Technique

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2009.09.021 ◽

2009 ◽

Vol 209 (6) ◽

pp. 694-701 ◽

Cited By ~ 125

Author(s):

Jin Soo Kim ◽

Sun Yeon Cho ◽

Byung Soh Min ◽

Nam Kyu Kim

Keyword(s):

Risk Factors ◽

Anastomotic Leakage ◽

Colorectal Anastomosis ◽

Double Stapling Technique ◽

Stapling Technique ◽

Double Stapling

Download Full-text

Abstract T P231: Does Intraventricular Hemorrhage Lead to a Normal Pressure Hydrocephalus-Like Syndrome?

Stroke ◽

10.1161/str.45.suppl_1.tp231 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Andrew J Kruger ◽

Matthew Flaherty ◽

Padmini Sekar ◽

Mary Haverbusch ◽

Charles J Moomaw ◽

...

Keyword(s):

Risk Factors ◽

Normal Pressure Hydrocephalus ◽

Barthel Index ◽

Intraventricular Hemorrhage ◽

Normal Pressure ◽

Stroke Study ◽

Increased Risk ◽

Independent Risk Factors ◽

Poor Outcomes

Background: Intracerebral hemorrhage (ICH) has the highest short and long-term morbidity and mortality rates of stroke subtypes. While increased intracranial pressure due to the presence of intraventricular hemorrhage (IVH) may relate to early poor outcomes, the mechanism of reduced 3-month outcome with IVH is unclear. We hypothesized that IVH may cause symptoms similar to normal pressure hydrocephalus (NPH), specifically urinary incontinence and gait disturbance. Methods: We used interviewed cases from the Genetic and Environmental Risk Factors for Hemorrhagic Stroke Study (7/1/08-12/31/12) that had 3-month follow-ups available. CT images were analyzed for ICH volume and location, and IVH presence and volume. Incontinence and dysmobility were defined by Barthel Index at 3 months. We chose a Barthel Index score of bladder less than 10 and mobility less than 15 to define incontinence and dysmobility, respectively. Multivariate analysis was used to assess independent risk factors for incontinence and dysmobility. ICH and IVH volumes were log transformed because of non-normal distributions. Results: Barthel Index was recorded for 308 ICH subjects, of whom 106 (34.4%) had IVH. Presence of IVH was independently associated with both incontinence (OR 2.7; 95% CI 1.4-5.2; p=.003) and dysmobility (OR 2.5; 95% CI 1.4-4.8; p=.003). The Table shows that increasing IVH volume was also independently associated with both incontinence and dysmobility after controlling for ICH location, ICH volume, age, baseline mRS, and admission GCS. Conclusion: Our data show that patients with IVH after ICH are at an increased risk for developing the NPH-like symptoms of incontinence and dysmobility. This may explain the worse long-term outcomes of patients who survive ICH with IVH than those who had ICH alone. Future studies are needed to confirm this finding, and to determine the effect of IVH interventions such as shunt or intraventricular thrombolysis.

Download Full-text

Independent risk factors for long-term mortality in patients with severe infection

Critical Care ◽

10.1186/cc14096 ◽

2015 ◽

Vol 19 (Suppl 1) ◽

pp. P16

Author(s):

J Francisco ◽

I Aragão ◽

T Cardoso

Keyword(s):

Risk Factors ◽

Severe Infection ◽

Independent Risk Factors ◽

Long Term Mortality

Download Full-text

Exploring optimal examination to detect occult anastomotic leakage after rectal resection in patients with diverting stoma

10.21203/rs.2.18766/v3 ◽

2020 ◽

Author(s):

Daichi Kitaguchi ◽

Tsuyoshi Enomoto ◽

Yusuke Ohara ◽

Yohei Owada ◽

Katsuji Hisakura ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Anastomotic Leakage ◽

Rectal Resection ◽

False Negative ◽

Water Soluble ◽

Stapled Anastomosis ◽

Stoma Closure ◽

Radiological Result ◽

Diverting Stoma

Abstract Background When considering “early stoma closure”, both standardized inclusion/exclusion criteria and standardized methods to assess anastomosis are necessary to reduce the risk of occult anastomotic leakage (AL). However, in the immediate postoperative period, neither have the incidence and risk factors of occult AL in patients with diverting stoma (DS) been clarified nor have methods to assess anastomosis been standardized. The aim of this study was to elucidate the incidence and risk factors of occult AL in patients who had undergone rectal resection with DS and to evaluate the significance of computed tomography (CT) following water-soluble contrast enema (CE) to detect occult anastomotic leakage. Methods This was a single institutional prospective observational study of patients who had undergone rectal resection with the selective use of DS between May and October 2019. Fifteen patients had undergone CE and CT to assess for AL on postoperative day (POD) 7, and CT was performed just after CE. Univariate analysis was performed to assess the relationship between preoperative variables and the incidence of occult AL on POD 7 Results The incidence of occult AL on postoperative day 7 was 6 of 15 (40%). Hand-sewn anastomosis, compared with stapled anastomosis, was a significant risk factor. Five more cases with occult AL that could not be detected with CE could be detected on CT following CE; CE alone had a 33% false-negative radiological result rate. Conclusions Hand-sewn anastomosis appeared to be a risk factor for occult AL, and CE alone had a high false-negative radiological result rate. When considering the introduction of early stoma closure, stapled anastomosis and CT following CE could be an appropriate inclusion criterion and preoperative examination, respectively.

Download Full-text

The impact of the recurrent laryngeal nerve injury on prognosis after McKeown esophagectomy for ESCC

10.21203/rs.3.rs-88872/v1 ◽

2020 ◽

Author(s):

Rirong Qu ◽

Dehao Tu ◽

Wei Ping ◽

Qi Wang ◽

Ni Zhang ◽

...

Keyword(s):

Risk Factors ◽

Recurrent Laryngeal Nerve ◽

Recurrent Laryngeal Nerve Injury ◽

Laryngeal Nerve ◽

Term Survival ◽

Laryngeal Nerve Injury ◽

Independent Risk Factors ◽

Mckeown Esophagectomy ◽

The Impact

Abstract Background: The objective of this study was to assess the impact of the recurrent laryngeal nerve injury (RLNI) after esophagectomy on prognosis.Methods: Retrospectively collected data from 297 patients with esophageal squamous cell carcinoma who underwent McKeown esophagectomy at our department from April 2014 to May 2018, were analyzed.Results: RLNI occurred in 31.9% of the patients. Left-side RLNI occurred 2.8 times more often than right-side RLNI. Among the cases in which assessment of the vocal cords was continued, 8.4% involved permanent injury. There were no significant differences among clinicopathological data between patients with RLNI and without. Compared with patients without RLNI,patients with RNLI have longer operation time,more number of bronchoscopy suctions, longer postoperation hospital stay, and higher incidence of postoperative complications. T stage, N stage, RLN LN metastasis were independent risk factors for the prognosis, but RLNI is not independent risk factors for long-term survival. Conclusion: RLNI is a serious complication that will affect the short-term prognosis of patients and reduce the quality of life of patients. It should be avoided as much as possible during surgery, but it may not have negative impact on the long-term survival.

Download Full-text