Nomogram for Benign Anastomotic Stricture After Surgery for Colorectal Cancer

Background Benign anastomotic stricture remains among the most prevalent complications following surgery for colorectal cancer, albeit its incidence is very low. Objective This study is aimed at identifying risk factors of anastomotic stricture as well as generating an effective nomogram for the stricture. Design: This is a retrospective study. Setting: This study was conducted from January, 2015 to December, 2019 in a single tertiary center with colorectal cancer. Patients: A total of 117 colorectal patients after surgery without recurrence including 39 with anastomotic stricture (the distance between anastomotic site and anal margin < = 20 cm) and 78 without the stricture were enrolled in this study. Main outcome measures: Their clinical and pathological data were collected. Multiple logistic regression analysis was conducted for identifying risk factors for anastomotic stricture, and the nomogram prediction model was generated. Results Multivariate analysis of the primary cohort led to identification of LCA (left colon artery) preservation (OR, 0.074; P = 0.0015), protective stoma (OR, 5.353; P = 0.012), anastomotic leakage (OR, 12.027; P = 0.005), and anastomotic distance (OR, 7.578; P = 0.012) as independent risk factors for anastomotic stricture. The following predictive model was derived: Logit (anastomotic stricture) = 0.074* LCA + 5.353* Protective stoma + 12.027* Anastomotic leakage + 7.578* Anastomotic distance. Assessment of the predictive model revealed that the area under curve (AUC) was 0.871, while the cutoff value was 15.444, with a sensitivity of 64.1% and a specificity of 94.8%. Limitations: A retrospective and case-controlled design with a small sample size from one single center is the main Limitation. Conclusions LCA preservation, protective stoma, anastomotic leakage, and anastomotic distance may affect the occurrence of anastomotic stricture following surgery for colorectal cancer. The nomogram model generated in the present study can be valuable in prediction of anastomotic stricture. Registered at Chinese Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR 2100043775).

Short stump and high anastomosis pull-through (SHiP) procedure for delayed coloanal anastomosis with no protective stoma for low rectal cancer

Despite advances in coloanal anastomosis techniques, satisfactory procedures completed without complications remain lacking. We investigated the effectiveness of our recently developed ‘Short stump and High anastomosis Pull-through’ (SHiP) procedure for delayed coloanal anastomosis without a stoma. In this retrospective study, we analysed functional outcomes, morbidity, and mortality rates and local recurrence of 37 patients treated using SHiP procedure, out of the 282 patients affected by rectal cancer treated in our institution between 2012 and 2020. The inclusion criterion was that the rectal cancer be located within 4 cm from the anal margin. One patient died of local and pulmonary recurrence after 6 years, one developed lung and liver metastases after 2 years, and one experienced local recurrence 2.5 years after surgery. No major leak, retraction, or ischaemia of the colonic stump occurred; the perioperative mortality rate was zero. Five patients (13.51%) had early complications. Stenosis of the anastomosis, which occurred in nine patients (24.3%), was the only long-term complication; only three (8.1%) were symptomatic and were treated with endoscopic dilation. The mean Wexner scores at 24 and 36 months were 8.3 and 8.1 points, respectively. At the 36-month check-up, six patients (24%) had major LARS, ten (40%) had minor LARS, and nine (36%) had no LARS. The functional results in terms of LARS were similar to those previously reported after immediate coloanal anastomosis with protective stoma. The SHiP procedure resulted in a drastic reduction in major complications, and none of the patients had a stoma.

Defunctioning Protective Stoma Can Reduce the Rate of Anastomotic Leakage After Low Anterior Resection in Rectal Cancer Patients

Purpose: This study aimed to identify risk factors for anastomotic leakage and to evaluate the impact of protective stoma on the rate of anastomotic leakage and subsequent management.Methods: This retrospective study analyzed data from 4,282 patients who underwent low anterior resection between 2007 and 2014. Among these, 1,367 (31.9%) underwent surgery to create protective diverting stoma and 232 (5.4%) experienced anastomotic leakage. At 6-month timepoints, data were evaluated to identify any correlation between the presence of diverting stoma and the incidence of anastomotic leakage. In addition, clinicopathological parameters were investigated to identify risk factors for anastomotic leakage.Results: Diverting stomas significantly reduced the rate of anastomotic leakage (hazard ratio, 0.334; 95% confidence interval, 0.212–0.525; P<0.001], which was reciprocally correlated with the rate of diverting stoma formation (P=0.039). Patients with a diverting stoma had a significantly lower incidence of generalized peritonitis (P<0.001) and therefore significantly reduced need for laparotomy (82.7% vs. 39.1%, P<0.001).Conclusion: The selective use of diverting stoma in high-risk patients decreases the rate of anastomotic leakage. Diverting stoma also affects the type of leakage and reduces the need for emergency laparotomy by approximately 40%.

Value of protective stoma in rectal cancer surgery

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.