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 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 Surgical-related risk factors associated with anastomotic leakage after resection for rectal cancer: a meta-analysis

2019 ◽  
Vol 50 (1) ◽  
pp. 20-28
Author(s):  
Xiao-Tong Wang ◽  
Lei Li ◽  
Fan-Biao Kong ◽  
Xiao-Gang Zhong ◽  
Wei Mai
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Blood Transfusion ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Meta Analysis ◽  
Random Effect ◽  
Operation Time ◽  
Defunctioning Stoma ◽  
Related Risk

Abstract Objectives Anastomotic leakage (AL) after anterior resection always leads to longer hospital stays, decreased quality of life and even increased mortality. Despite extensive research, no consensus on the world well-concerned surgical-related risk factors exists. We therefore conducted a meta-analysis of the available published literature to identify the effects of surgical-related risk factors for AL after anterior resection for rectal cancer, hoping to provide more information and improved guidance for clinical workers managing patients with rectal cancer who are at a high risk for AL. Methods In this study, the relevant articles were systematically searched from EMBASE, MEDLINE, PubMed, WangFang (Database of Chinese Ministry of Science & Technology), Chinese National Knowledge Infrastructure Database and China Biological Medicine Database. The pooled odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Meta-analysis was performed using of RevMan 5.3 software. Results A total of 26 studies met the inclusion criteria and comprised 34238 cases. Analysis of these 26 studies showed that no defunctioning stoma was highly correlated with AL (pooled OR = 1.28, 95%CI: 1.05–1.57, P = 0.01, random effect), and intraoperative blood transfusion was significantly associated with AL (pooled OR = 1.64, 95%CI: 1.34–2.02, P = 0.02, random effect). However, the AL was not associated with type of anastomosis, type of surgery, technique of anastomosis, level of inferior mesenteric artery ligation, operation time and splenic flexure mobilization. Conclusions Depend on this meta-analysis, no defunctioning stoma and intraoperative blood transfusion are the major surgical-related risk factors for AL after resection for rectal cancer. Because of the inherent limitations of the research, future prospective randomized controlled trials will need to confirm this conclusion.

High tie in anterior resection for rectal cancer confers no increased risk of anastomotic leakage

2011 ◽  
Vol 99 (1) ◽  
pp. 127-132 ◽  
Author(s):  
M. Rutegård ◽  
O. Hemmingsson ◽  
P. Matthiessen ◽  
J. Rutegård
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
High Tie ◽  
Increased Risk
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