scholarly journals Predicting the risk and diminishing the consequences of anastomotic leakage after anterior resection for rectal cancer

2010 ◽  
Vol 57 (3) ◽  
pp. 47-50 ◽  
Author(s):  
B.J. Moran
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Anal Verge ◽  
Intestinal Anastomosis ◽  
Defunctioning Stoma ◽  
Increased Risk ◽  
Diverting Stoma ◽  
Risk Of Cancer

INTRODUCTION: Anastomotic leakage is one of the most serious early complications of any intestinal anastomosis. The morbidity and mortality are high and patients may be at increased risk of cancer recurrence. In colorectal surgery the risks are particularly high following low anterior resection. Factors which increase and decrease the risks are discussed. METHODS: A review of the main published risk factors for anastomotic leakage after anterior resection for rectal cancer together with the authors personal experience is reported. A review of a recent large randomized trial of a defunctioning stoma versus no stoma is outlined. RESULTS: The main factor influencing anastomotic leakage is the height of the anastomosis above the anal verge with the lower the anastomosis the higher the risk. All anastomoses within 7 cm of the anal verge are at increased risk which includes all patients who have had a total mesorectal excision. Neoadjuvant therapy (in particular long course radiotherapy or chemoradiotherapy) increases the risk. Male sex, older age, smoking, alcohol in excess, short course radiotherapy, obesity, general fitness, immunosuppression have been reported in some series as increasing the risk. A temporary diverting stoma decreases the consequences of leakage and reduces the need for emergency re-operation. Anastomotic leakage is associated with an increased postoperative death rate, reoperative rates, need for a permanent stoma and possibly an increase in local recurrence and decreased cancer specific and overall survival. CONCLUSION: Anastomotic leakage is a serious early complication following surgery for rectal cancer. The height of the anastomosis and neoadjuvant therapy are the main predictors of an increased risk. A diverting stoma diminishes the consequences of risk and reduces the need for emergency re-operation.

scholarly journals Ultralow anterior resection with implantation of gentamicin-collagen sponge and no defunctioning stoma: anastomotic leakage and local cancer relapse

2019 ◽  
Vol 53 (1) ◽  
pp. 77-84 ◽  
Author(s):  
Tomasz Michalik ◽  
Rafał Matkowski ◽  
Przemyslaw Biecek ◽  
Jozef Forgacz ◽  
Bartlomiej Szynglarewicz
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Local Relapse ◽  
Collagen Sponge ◽  
Safe Procedure ◽  
Defunctioning Stoma ◽  
Ultralow Anterior Resection ◽  
Increased Risk ◽  
Low Incidence

Abstract Background Anterior resection with total mesorectal excision (TME) of ultralow rectal cancer may result in the increased risk of the anastomotic leakage (AL). The aim of this study was to evaluate the usefulness of the gentamicin-collagen sponge (GCS) for the protection against symptomatic AL and investigate association between AL and local relapse (LR). Patients and methods A series of 158 patients with ultralow rectal cancer was studied. All the patients underwent R0 sphincter-saving TME with anastomosis wrapping using GCS. In none of the cases a temporary protective stoma was constructed. Results AL rate was 3.2% (5/158) while median time to AL diagnosis was 5 days following surgery (range 3-15). There was no postoperative and leakage-related mortality. Patient age > 75 years and smoking were independent risk factors related to significantly increased AL rate: 12.5% vs. 0.8% (P = 0.0004) and 5.7% vs. 0% P = 0.043), respectively. LR was observed in 12% of cases. It was highly significantly more common and developed earlier in patients who have had AL when compared with non-AL group: 80% vs. 9% (P = 0.00001) and 8.5 vs. 17 months (P = 0.014), respectively. Conclusions Anastomosis wrapping with GCS after anterior resection with TME is a safe procedure resulting in the low incidence of anastomotic leakage which may be also associated with decreased risk of local relapse.

scholarly journals Temporary Diverting Stoma Improves Recovery of Anastomotic Leakage after Anterior Resection for Rectal Cancer

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuchen Wu ◽  
Hongtu Zheng ◽  
Tianan Guo ◽  
Adili Keranmu ◽  
Fangqi Liu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Diverting Stoma

scholarly journals Retrospective study of active drainage in the management of anastomotic leakage after anterior resection for rectal cancer

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110659
Author(s):  
Xiaojie Tan ◽  
Mei Zhang ◽  
Lai Li ◽  
He Wang ◽  
Xiaodong Liu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Retrospective Study ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Spontaneous Resolution ◽  
Defunctioning Ileostomy ◽  
Diverting Stoma ◽  
Hospitalization Costs ◽  
Emergent Laparotomy ◽  
Drainage Group

Objective Anastomotic leakage (AL) is the most serious postoperative complication following anterior resection for rectal cancer. We aimed to investigate the efficacy of active drainage for the management of AL. Methods This was a retrospective study using information from a database of patients who underwent colorectal resection without a defunctioning ileostomy at our center between September 2013 and January 2021. We identified 122 cases with definitive AL who did not require revision emergent laparotomy. Among these patients, we evaluated those who received active drainage to replace the original passive drainage. Results There were 62 cases in the active drainage group and 60 cases in the passive drainage group. The active drainage group had a shorter mean AL spontaneous resolution time (26.9 ± 3.3 vs. 32.2 ± 4.8 days) and lower average hospitalization costs (82,680.6 vs. 92,299.3 renminbi (RMB)) compared with the passive drainage group, respectively. Moreover, seven patients in the passive drainage group subsequently underwent diverting stoma to resolve the Al, while all ALs resolved spontaneously after replacing the passive drainage with active drainage. Conclusions Our study suggests that active drainage may accelerate the spontaneous resolution of AL.

Anastomotic Leakage after Anterior Resection for Rectal Cancer with Mesorectal Excision: Incidence, Risk Factors, and Management

2015 ◽  
Vol 81 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Antonio Pio Tortorelli ◽  
Sergio Alfieri ◽  
Alejandro Martin Sanchez ◽  
Fausto Rosa ◽  
Valerio Papa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Anal Verge ◽  
Univariate Analysis ◽  
Postoperative Mortality ◽  
Incidence Risk ◽  
Clinical Consequences

We investigated risk factors and prognostic implications of symptomatic anastomotic leakage after anterior resection for rectal cancer, and the influence of a diverting stoma. Our retrospective review of prospective collected data analyzed 475 patients who underwent anterior resection for rectal cancer. Uni- and multivariate analysis was made between anastomotic leakage and patient, tumor, and treatment variables, either for the overall group (n = 475) and in the midlow rectal cancer subgroup (n = 291). Overall rate of symptomatic leakage was 9 per cent (43 of 475) with no related postoperative mortality. At univariate analysis, significant factors for leak were a tumor less than 6 cm from the anal verge (13.7 vs 6.6%; P = 0.011) and intraoperative transfusions (16.9 vs 4.3%; P = 0.001). Similar results were observed in the midlow rectal cancer subgroup. At multivariate analysis, no parameter resulted in being an independent prognostic factor for risk of leakage. In patients with a leakage, a temporary enterostomy considerably reduced the need for reoperation (12.5 vs 77.8%; P < 0.0001) and the risk of a permanent stoma (18.7 vs 28.5%; P = 0.49). The incidence of anastomotic failure increases for lower tumors, whereas it is not influenced by radiotherapy. Defunctioning enterostomy does not influence the leak rate, but it mitigates clinical consequences.

scholarly journals THE TRANSANAL REINFORCEMENT OF LOW COLORECTAL ANASTOMOSIS: FIRST EXPERIENCE AND PERSPECTIVES

2016 ◽  
pp. 15-21 ◽  
Author(s):  
M. V. Alekseev ◽  
Yu. A. Shelygin ◽  
E. G. Rybakov
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Colorectal Anastomosis ◽  
Careful Selection ◽  
Diverting Stoma ◽  
Selection Of Patients ◽  
Selection Of

AIM. It was to evaluation the effect of using of transanal reinforcement of low colorectal anastomosis to the frequency of anastomotic leakage. MATERIALS AND METHODS. The study included six patients who underwent a low anterior resection for rectal cancer and the transanal reinforcement anastomosis. Preventive stomas not formed. RESULTS. The study contains an analysis of the immediate results of patients treatment. The leakage of the anastomosis was developed in 3 of 6 patents. This required break down of the anastomosis in one and the formation of diverting stoma in two patients. CONCLUSION. The first experience of the transanal reinforcement for low colorectal anastomosis is unsuccessful because of leakage appeared in every second patient. More careful selection of patients for this method is required.

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