scholarly journals Value of protective stoma in rectal cancer surgery

2016 ◽  
Vol 69 (3-4) ◽  
pp. 73-78 ◽  
Author(s):  
Ivana Fratric ◽  
Zoran Radovanovic ◽  
Dragana Radovanovic ◽  
Ferenc Vicko ◽  
Tomislav Petrovic ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Surgical Complications ◽  
Rectal Resection ◽  
Surgical Complication ◽  
Primary Anastomosis ◽  
Rectal Surgery ◽  
Rectal Cancer Surgery ◽  
Double Stapling ◽  
Protective Stoma

Introduction. Anastomotic leakage is the most serious surgical complication in rectal surgery. The aim of this study was to find out whether a protective stoma was capable of lowering the rate of clinical anastomotic leakage and to evaluate the rate of anastomotic leakages requiring re-surgery. Material and Methods. A retrospective study included a sample of 149 consecutive patients with rectal cancer who had undergone elective rectal resection with primary anastomosis. After total mesorectal excision, the anastomosis was created using either the single stapling or double stapling anastomotic technique. Anastomotic integrity was verified by transanal air insufflations with the pelvis filled with saline. A protective covering colostomy was added in selected cases and according to the surgeon?s preference. Results. A protective stoma was created in 31% of patients. Clinical anastomotic leakage occurred in 6.7% of patients (10/149). Anastomotic leakage occurred in 8.5% of the patients with a protective stoma (4/47) and in 5.9% of those without a protective stoma (6/102), which was not statistically significant. Surgery lasted significantly longer when a stoma had to be created than in case when it was not needed (p=0.024). The overall rate of re-surgery due to postoperative surgical complications was 5.3% and in three cases this happened because of anastomotic leakage. All patients with a protective stoma and clinical anastomotic leakage were treated conservatively, compared to 50% of patients without a protective stoma who suffered anastomotic leakage and had to be operated. Conclusion. A stoma cannot prevent but it can surely minimize surgical complications related to anastomotic leakage and it does reduce the rate of re-surgery.

scholarly journals Procalcitonin: the ideal predictor of anastomotic leakage. But, when?

2021 ◽  
Vol 8 (5) ◽  
pp. 1418
Author(s):  
Mehmet Ali Çaparlar ◽  
Yasin Uçar ◽  
Şeref Dokcu ◽  
İsmail Hasırcı ◽  
Mehmet Eşref Ulutaş ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Bacterial Infections ◽  
Rectal Surgery ◽  
Rectal Cancer Surgery ◽  
Surgical Incision ◽  
Abdominal Infection ◽  
Incision Site ◽  
Significant Difference

Background: Rectal cancer ranks 3rd among the most common malignancies in both sexes. Abdominal infections that can be seen after rectal cancer surgery are the most feared postoperative complications, as they can also be the harbinger of anastomotic leakage. According to its localization, the rate of anastomotic leak varies between 4% and 29.5%. Procalcitonin (PCT) is an increasing parameter in bacterial infections and sepsis. Therefore, it is used to monitor the infection and the effectiveness of the treatment. Our study we aimed to evaluate the effect of PCT on early diagnosis of anastomotic leakage in rectal surgery and the correlation between PCT and CRP and WBC levels.Methods: File records of 50 patients who were operated on for rectal cancer and had anastomosis between 2016 and 2019 were retrospectively analyzed. Demographic features, operation information, preoperative and postoperative clinical features of the patients were recorded. The WBC, CRP and procalcitonin values of the patients were measured on the preoperative and postoperative 1st and 5th days. Patients were divided into two groups as PC values<2 ng/ml and ≥2 ng/ml. Patients with surgical site infections were found. The relationship between hospital stay and PCT levels and those with surgical incision site infection and those with intra-abdominal infection was examined. The correlation between PCT values and CRP and WBC values of the patients was evaluated.Results: There was no significant difference in PCT values in infections at the surgical incision site. However, it was observed that the PCT values of patients with surgical infection in the abdomen were significantly higher than those without (p=0.005). It was observed that the PCT level was high and the duration of hospital stay was observed to be prolonged in patients with infections in the surgical incision area and in the abdomen.Conclusions: PCT can be used as a biochemical parameter in terms of abdominal infection and anastomotic leaks. It is recommended to be checked especially on the fifth postoperative day and to investigate for anastomotic leakage if it is seen to reach the highest value.

scholarly journals Influence of Conversion and Anastomotic Leakage on Survival in Rectal Cancer Surgery; Retrospective Cross-sectional Study

2018 ◽  
Vol 23 (10) ◽  
pp. 2007-2018 ◽  
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

scholarly journals The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis

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.

scholarly journals Leakage after Surgery for Rectum Cancer: Inconsistency in Reporting to the Danish Colorectal Cancer Group

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.

Early transanal closure after vacuum‐assisted drainage for anastomotic leakage in rectal cancer surgery – a video vignette

2020 ◽  
Vol 22 (8) ◽  
pp. 973-974 ◽  
Author(s):  
K. Talboom ◽  
J. Kesteren ◽  
D. J. A. Sonneveld ◽  
P. J. Tanis ◽  
W. A. Bemelman ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Video Vignette

O187 ANASTOMOTIC TECHNIQUES AND ASSOCIATED MORBIDITY IN TOTAL MINIMALLY-INVASIVE TRANSTHORACIC ESOPHAGECTOMY – RESULTS FROM THE ESOBENCHMARK DATABASE

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
W Schroeder ◽  
D Raptis ◽  
H Schmidt ◽  
S Gisbertz ◽  
J Moons ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Surgical Complication ◽  
Multivariable Analysis ◽  
Current Status ◽  
Transthoracic Esophagectomy ◽  
Purse String ◽  
Comprehensive Complication Index ◽  
Double Stapling ◽  
Anastomotic Techniques

Abstract Background Total minimally-invasive transthoracic esophagectomy (ttMIE) faces increasing application in surgical treatment of esophageal cancer. For esophago-gastric reconstruction, different anastomotic techniques are currently used, but their impact on postoperative anastomotic leakage and morbidity has not been investigated. The aim of this retrospective multicenter analysis was to describe anastomotic techniques used for ttMIE and to analyze the associated morbidity. Patients and Methods Patients were selected from a basic dataset, collected over a 5-year period from 13 international surgical high-volume centers. Endpoints were anastomotic leakage rate and postoperative morbidity in correlation to anastomotic techniques, measured by the CD classification and the Comprehensive Complication Index® (CCI). Results Five anastomotic techniques were identified in 966 patients after ttMIE: Intrathoracic end-to-side circular-stapled technique in 427 patients (double-stapling n=90, purse-string n=337), intrathoracic (n=109) or cervical (n=255) side-to-side linear-stapled, and cervical end-to-side hand-sewn (n=175). Leakage rates were similar in intrathoracic and cervical anastomoses (15.9% vs. 17.2%, P=0.601), but overall complications (56.7%% vs. 63.7%, P=0.029) and median 90-day CCI (21 (IQR 0-36) vs. 29 (IQR 0-40), P=0.019) favored intrathoracic reconstructions. Leakage rates after intrathoracic end-to-side double-stapling (23.3%) and cervical end-to-side hand-sewn (25.1%) techniques were significantly higher compared with intrathoracic side-to-side linear (15.6%), end-to-side purse-string (13.9%) and cervical side-to-side linear-stapled esophago-gastrostomies (11.8%) (P<0.001). Multivariable analysis confirmed anastomotic technique as independent predictor of leakage after ttMIE. Conclusion Results of this analysis present the current status of the technical evolution of ttMIE with anastomotic leakage as predominant surgical complication. However, technique-related morbidity requires cautious interpretation considering the long learning curve of this complex surgical procedure.

scholarly journals The Role of transanal (Ta) dissection in the management of difficult primary and recurrent rectal cancer

2019 ◽  
Vol 6 (1) ◽  
pp. e000305 ◽  
Author(s):  
Valérie Courval ◽  
Sébastien Drolet ◽  
Alexandre Bouchard ◽  
Philippe Bouchard
Keyword(s):  
Rectal Cancer ◽  
Primary Anastomosis ◽  
Rectal Surgery ◽  
Laparoscopic Approach ◽  
Recurrent Rectal Cancer ◽  
Mesorectal Excision ◽  
Final Pathology ◽  
Arterial Bleeding ◽  
History Of ◽  
Difficult Cases

BackgroundThe objective of this study was to review the postoperative and short-term oncological outcomes of our first cohort of patients having had a transanal (Ta) approach for primary or recurrent rectal cancer.MethodsA retrospective chart review was performed on all cases of Ta dissection occurring between 2013 and 2016. We reviewed data concerning case selection, tumour characteristics, perioperative and postoperative data and final pathology.ResultsA total of 24 males were operated for primary (92% (22/24)) or recurrent rectal cancer (8.3% (2/24)). Four patients (16.7% (4/24)) had a history of previous rectal surgery and two had a history of previous Ta total mesorectal excision (TME). A majority of patients were obese, with 58.3% (14/24) having a body mass index >30. The laparoscopic approach was used in the majority of cases (95.8% (23/24)). Most patients had a low anterior resection (95.8% (23/24)). Sixteen patients received a temporary ileostomy (66.7% (16/24)). Three patients suffered perioperative complications (including colonic ischaemia, rectal perforation and arterial bleeding). Five patients (21.7% (5/23)) had an anastomotic leak treated with Ta drainage in two patients. Final pathology revealed negative margins in 95.8% (23/24). TME was considered complete in 87.5% (21/24) overall and in 95% (21/22) when considering only primary cancer cases.ConclusionAccording to our cohort of selected difficult cases, Ta dissection approach helped achieve complete mesorectal excision in complex primary rectal cancer but also allowed for rectal resection in patients with previous rectal surgery. This technique also helped perform a primary anastomosis in these difficult cases.

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