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Goyal A, Mathew A, Joseph P, Kaushal G, Rakesh NR, Dhar P. Reconstructive techniques following low anterior resection for carcinoma of the rectum. Minerva Surg 2024; 79:59-72. [PMID: 38381031 DOI: 10.23736/s2724-5691.23.10115-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Multiple reconstructive techniques have been described for reconstruction after a low anterior resection for carcinoma rectum. Colonic J pouch (CJP), Side to end anastomosis (SEA), transverse coloplasty pouch (TCP) and Straight Colo-rectal/anal anastomosis were the most widely studied. EVIDENCE ACQUISITION PubMed, Embase and Cochrane data base were searched for randomized, non-randomized studies and systematic reviews from inception of the databases till July 31st, 2023. EVIDENCE SYNTHESIS Considerable heterogeneity existed among different study findings. Reservoir techniques, including CJP, SEA, and TCP, exhibited reduced stool frequency, decreased urgency, and improved continence status compared to SCA, particularly in the short term. CJP maintained this advantage into the intermediate term. Other functional outcomes were similar among the techniques. However, these functional improvements did not translate into enhanced Quality of Life (QoL). TCP was associated with an elevated risk of anastomotic leaks. Other surgical outcomes remained comparable across all four techniques. Sexual outcomes also exhibited no significant variation. Some studies suggested that the size of the side limb in CJP or SEA may not significantly impact functional outcomes, implying that neorectum capacity may not be the primary determinant of improved function. The precise physiological mechanism underlying these findings remains unknown. CONCLUSIONS In the short and intermediate terms, reservoir techniques demonstrated superior functional outcomes, but long-term performance was comparable among all techniques. Notably, enhanced functional outcomes did not translate to improved Quality of Life. TCP, while effective, is linked to an increased risk of anastomotic complications, necessitating cautious utilization.
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Affiliation(s)
- Anuj Goyal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
| | - Anvin Mathew
- Department of Surgical Gastroenterology, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, India -
| | - Princy Joseph
- National Health Systems and Research Center, New Delhi, India
| | - Gourav Kaushal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bathinda, India
| | - Nirjhar R Rakesh
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
| | - Puneet Dhar
- Department of Surgical Gastroenterology, Amrita Hospitals, Faridabad, India
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Liu H, Xiong M, Zeng Y, Shi Y, Pei Z, Liao C. Comparison of complications and bowel function among different reconstruction techniques after low anterior resection for rectal cancer: a systematic review and network meta-analysis. World J Surg Oncol 2023; 21:87. [PMID: 36899350 PMCID: PMC9999608 DOI: 10.1186/s12957-023-02977-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Anastomosis for gastrointestinal reconstruction has been contentious after low anterior resection of rectal cancer for the past 30 years. Despite the abundance of randomized controlled trials (RCTs) on colon J-pouch (CJP), straight colorectal anastomosis (SCA), transverse coloplast (TCP), and side-to-end anastomosis (SEA), most studies are small and lack reliable clinical evidence. We conducted a systematic review and network meta-analysis to evaluate the effects of the four anastomoses on postoperative complications, bowel function, and quality of life in rectal cancer. METHODS We assessed the safety and efficacy of CJP, SCA, TCP, and SEA in adult patients with rectal cancer after surgery by searching the Cochrane Library, Embase, and PubMed databases to collect RCTs from the date of establishment to May 20, 2022. Anastomotic leakage and defecation frequency were the main outcome indicators. We pooled data through a random effects model in a Bayesian framework and assessed model inconsistency using the deviance information criterion (DIC) and node-splitting method and inter-study heterogeneity using the I-squared statistics (I2). The interventions were ranked according to the surface under the cumulative ranking curve (SUCRA) to compare each outcome indicator. RESULTS Of the 474 studies initially evaluated, 29 were eligible RCTs comprising 2631 patients. Among the four anastomoses, the SEA group had the lowest incidence of anastomotic leakage, ranking first (SUCRASEA = 0.982), followed by the CJP group (SUCRACJP = 0.628). The defecation frequency in the SEA group was comparable to those in the CJP and TCP groups at 3, 6, 12, and 24 months postoperatively. In comparison, the defecation frequency in the SCA group 12 months after surgery all ranked fourth. No statistically significant differences were found among the four anastomoses in terms of anastomotic stricture, reoperation, postoperative mortality within 30 days, fecal urgency, incomplete defecation, use of antidiarrheal medication, or quality of life. CONCLUSIONS This study demonstrated that SEA had the lowest risk of complications, comparable bowel function, and quality of life compared to the CJP and TCP, but further research is required to determine its long-term consequences. Furthermore, we should be aware that SCA is associated with a high defecation frequency.
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Affiliation(s)
- Huabing Liu
- Medical College, Nanchang University, Nanchang, 330006, China.,Department of Gastrointestinal Surgery, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, 330006, China
| | - Ming Xiong
- Medical College, Nanchang University, Nanchang, 330006, China.,Department of Gastrointestinal Surgery, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, 330006, China
| | - Yu Zeng
- Medical College, Nanchang University, Nanchang, 330006, China.,Department of Gastrointestinal Surgery, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, 330006, China
| | - Yabo Shi
- Medical College, Nanchang University, Nanchang, 330006, China.,Department of Gastrointestinal Surgery, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, 330006, China
| | - Zhihui Pei
- Medical College, Nanchang University, Nanchang, 330006, China.,Department of Gastrointestinal Surgery, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, 330006, China
| | - Chuanwen Liao
- Department of Gastrointestinal Surgery, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, 152 Aiguo Road, Nanchang, 330006, China.
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Mathew A, Ramachandra D, Goyal A, Nariampalli Karthyarth M, Joseph P, Raj Rakesh N, Kaushal G, Agrawal A, Bhadoria AS, Dhar P. Reconstructive techniques following low anterior resection for carcinoma of the rectum: meta-analysis. Br J Surg 2023; 110:313-323. [PMID: 36630589 DOI: 10.1093/bjs/znac400] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/21/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Multiple trials have compared reconstruction techniques used following the resection of distal rectal cancers, including straight colorectal anastomosis (SCA), colonic J pouch (CJP), side-to-end anastomosis (SEA), and transverse coloplasty (TCP). The latest meta-analysis on the subject concluded that all the reservoir techniques produce equally good surgical and functional outcomes compared with SCA. Numerous trials have been published in this regard subsequently. Hence, a network analysis (NMA) was performed to rank these techniques. METHODS A literature search of MEDLINE, Embase, and the Cochrane Library from their inception until April 2021 was conducted to identify randomized trials. Functional and surgical outcome data were pooled. ORs and standardized mean differences (MDs) were used as pooled effect size measures. A frequentist NMA model was used. RESULTS Thirty-two trials met the eligibility criteria comprising 3072 patients. CJP showed better functional outcomes, such as low stool frequency and better incontinence score, both in the short term (stool frequency, MD -2.06, P < 0.001; incontinence, MD -1.17, P = 0.007) and intermediate term (stool frequency, MD -0.81, P = 0.021; incontinence MD -0.56, P = 0.083). Patients with an SEA (long-term OR 4.37; P = 0.030) or TCP (long-term OR 5.79; P < 0.001) used more antidiarrheal medications constantly. The urgency and sensation of incomplete evacuation favoured CJP in the short term. TCP was associated with a higher risk of anastomotic leakage (OR 12.85; P < 0.001) and stricture (OR 3.21; P = 0.012). CONCLUSION Because of its better functional outcomes, CJP should be the reconstruction technique of choice. TCP showed increased anastomotic leak and stricture rates, warranting judicious use.
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Affiliation(s)
- Anvin Mathew
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
| | - Deepti Ramachandra
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
| | - Anuj Goyal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
| | | | - Princy Joseph
- National Health Systems Resource Centre, New Delhi, India
| | - Nirjhar Raj Rakesh
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
| | - Gourav Kaushal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Bathinda, India
| | - Abhishek Agrawal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
| | - Ajeet Singh Bhadoria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Puneet Dhar
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
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Machowicz J, Wołkowski M, Jabłońska B, Mrowiec S. Ileocolonic anastomosis-comparison of different surgical techniques: A single-center study. Medicine (Baltimore) 2022; 101:e31582. [PMID: 36595875 PMCID: PMC9794342 DOI: 10.1097/md.0000000000031582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Right hemicolectomy (RH) is a common procedure for both benign and malignant colic disease. Different anastomotic types are performed during this procedure. To assess the association between anastomotic type and postoperative complications (PC) in patients undergoing RH. Retrospective analysis of medical records of 72 patients (39 female and 33 male), aged 24 to 93, undergoing open RH in the Department of Gastrointestinal Surgery. Data regarding anastomotic type [end-to-end anastomosis, side-to-side (SSA), end-to-side anastomosis, and side-to-end anastomosis (SEA)], and different clinical factors were collected. There were 21 (29%) end-to-end anastomosis, 25 (35%) SSA, 15 (21%) end-to-side anastomosis, and 11 (15%) SEA in the analyzed group. Adenocarcinoma G2 was the most frequent indication for RH - 30 (42%). Total duration of hospitalization (in days) was the longest (14, 26) after SEA and the shortest (12, 68) after SSA. PC were noted in 17(24%) patients. Wound infection was the most common complication noted in 15(21%) patients. The overall anastomotic leak rate was 7% (5/72). PC were the most frequent after SEA noted in 64% (7/11) including abdominal bleeding and bowel perforation. The overall reoperations rate was 6% (4/72). The overall mortality rate was 4% (3/72). SEA was associated with the highest incidence of postoperative complication however based on this and other studies there are no satisfying conclusions regarding the best choice of anastomosis.
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Affiliation(s)
- Joanna Machowicz
- Student Scientific Society, Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
- * Correspondence: Joanna Machowicz, Department of Gastrointestinal Surgery, Medical University of Silesia, Medyków 14 St. Katowice 40-752, Poland (e-mail: )
| | - Maciej Wołkowski
- Student Scientific Society, Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
| | - Beata Jabłońska
- Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
| | - Sławomir Mrowiec
- Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland
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Kale A, Kuru B, Baydili KN, Cokay D, Basol G, Cansu Gundogdu E, Mat E, Ertugrul I, Altuntas YE, Usta T, Aboalhasan Y, Oral E. Combination of laparoscopic side-to-end colorectal anastomosis and vaginal nose (natural orifice specimen extraction) surgery for colorectal endometriosis: Technique and outcomes. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2022. [DOI: 10.1177/22840265221095772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the effectiveness of combining side-to-end anastomosis and vaginal NOSE (Natural orifice specimen extraction) surgery in colorectal endometriosis. Material and methods: We included 11 patients treated with laparoscopic side-to-end colorectal anastomosis and vaginal NOSE surgery between January 2019 and May 2021. We questioned the visual analog score (VAS) for pain symptoms, the short form-36 (SF-36) for health survey questionnaire, The Female Sexual Function Index (FSFI), EHP-5 for endometriosis health profile, The Hospital Anxiety and Depression Scale (HADS), OAB-V8 for overactive bladder symptoms and Constipation Severity Instrument (CSI). Results: VAS, EHP-5, and SF-36 scores were better at postoperative third and sixth months than preoperative values ( p < 0.05). There were no statistically significant differences in terms of FSFI, OAB-V8, HADS, and the CSI. Conclusions: Laparoscopic side-to-end anastomosis with vaginal NOSE surgery is feasible, scarless, and could be offered to patients with deep symptomatic bowel endometriosis.
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Affiliation(s)
- Ahmet Kale
- Department of Obstetrics and Gynecology, University of Health Science Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Betul Kuru
- Department of Obstetrics and Gynecology, University of Health Science Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Kursat Nuri Baydili
- Department of Biostatistics and Medical Informatics, University of Health Sciences, Hamidiye Medical Faculty, Istanbul, Turkey
| | - Deniz Cokay
- Department of Obstetrics and Gynecology, University of Health Science Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Gulfem Basol
- Department of Obstetrics and Gynecology, University of Health Science Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Elif Cansu Gundogdu
- Department of Obstetrics and Gynecology, University of Health Science Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Emre Mat
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Health Science Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Ismail Ertugrul
- Department of General Surgery, University of Health Science Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Yunus Emre Altuntas
- Department of General Surgery, University of Health Science Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Taner Usta
- Department of Obstetrics and Gynecology, Acibadem University, Altunizade Hospital, Istanbul, Turkey
| | - Yasmin Aboalhasan
- Department of Obstetrics and Gynecology, University of Health Science Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Engin Oral
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
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6
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Khetan VU, Muderspach LI, Miller HA, Licon E, Adams CL, Brunette LL, Pham HQ, Yessaian AA, Roman LD, Matsuo K, Ciccone MA. Side-to-end reanastomosis after low-anterior resection (STELAR): Outcomes, feasibility, and description of procedure performed by a gynecologic oncology service. J Surg Oncol 2022; 126:563-570. [PMID: 35476891 DOI: 10.1002/jso.26907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/02/2022] [Accepted: 04/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Low anterior rectosigmoid resection for a gynecologic disease is usually performed in concert with other procedures and can result in significant morbidity should anastomotic complication occur. This study examined surgical outcomes of side-to-end reanastomosis after low anterior resection (STELAR) performed by gynecologic oncology service. METHODS This is a case series examining consecutive patients who underwent STELAR for gynecologic indications by a single gynecologic oncology group from 2009 to 2018. Prospectively collected institutional surgical database was searched for STELAR, and standard descriptive statistics were used to describe intraoperative and postoperative complications specific to reanastomosis. RESULTS A total of 69 women underwent STELAR, with median age and body mass index of 54 years and 24 kg/m2 , respectively. 63.8% of patients had ovarian cancer and 84.4% had stage III-IV disease. The median estimated blood loss was 875 ml. Four (5.8%) women underwent protective loop colostomy at the time of STELAR. Postoperatively, there was 1 (1.4%) case of abscess formation within 30 days and 1 (1.4%) case of anastomotic leak 5 weeks after STELAR that required reoperation and diversion. No cases of fistula were clinically identified. CONCLUSION Side-to-end reanastomosis may be a safe and feasible procedure to accomplish low rectosigmoid anastomosis in women with gynecologic disease.
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Affiliation(s)
- Varun U Khetan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Laila I Muderspach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Heather A Miller
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Ernesto Licon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Crystal L Adams
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Laurie L Brunette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Huyen Q Pham
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Annie A Yessaian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Marcia A Ciccone
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
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Kato H, Ishida T, Nitori N, Kato A, Tamura T, Imai S, Oyama T, Kato A, Hatori T, Nakadai J, Matsui S, Tsuruta M, Miyazaki M, Itano O. Efficacy of side-to-end anastomosis to prevent anastomotic leakage after anterior resection for rectal cancer. Mol Clin Oncol 2022; 16:44. [PMID: 35003742 DOI: 10.3892/mco.2021.2477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/04/2021] [Indexed: 12/22/2022] Open
Abstract
The present study aimed to investigate whether side-to-end anastomosis could provide an improved surgical outcome, such as lower anastomotic leakage rate, compared with end-to-end anastomosis, following anterior resection for rectal and rectosigmoid cancer. This retrospective study included 162 patients with rectal cancer who underwent elective anterior resection between January 2012 and October 2019 at a single institution. Patients with double cancers or colonic J-pouch were excluded. Anastomotic leakage was defined clinically and radiologically. Side-to-end anastomosis was introduced in the International University of Health and Welfare Mita Hospital in January 2017. Side-to-end anastomosis was performed in 63 patients, while end-to-end anastomosis was performed in 99 patients. Tumors tended to be located lower in the rectum in the side-to-end anastomosis group than in the end-to-end anastomosis group. No significant differences were observed in other patient characteristics. The incidence of anastomotic leakage was significantly lower in the side-to-end anastomosis group than in the end-to-end anastomosis group (3/63, 4.8% vs. 18/99, 18.2%, respectively, P=0.02). No significant differences were observed in the incidence rates of other complications. Univariate and multivariate analyses revealed that a smoking habit (P=0.04) and side-to-end anastomosis (P=0.02) were significantly associated with anastomotic leakage. In conclusion, side-to-end anastomosis using a double-stapling technique following anterior resection for rectal cancer may prevent anastomotic leakage.
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Affiliation(s)
- Hirochika Kato
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan
| | - Takashi Ishida
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan.,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Chiba 286-8520, Japan
| | - Nobuhiro Nitori
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan
| | - Ayu Kato
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan
| | - Takuya Tamura
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan
| | - Shunichi Imai
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan
| | - Takashi Oyama
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan.,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Chiba 286-8520, Japan
| | - Atsushi Kato
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan
| | - Takashi Hatori
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan
| | - Jumpei Nakadai
- Department of Surgery, Saitama City Hospital, Midori-ku, Saitama, Saitama 336-8522, Japan
| | - Shimpei Matsui
- Department of Surgery, Keio University, School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masashi Tsuruta
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Chiba 286-8520, Japan
| | - Masaru Miyazaki
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan.,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Chiba 286-8520, Japan
| | - Osamu Itano
- Department of Digestive Disease Center, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo 108-8329, Japan.,Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Chiba 286-8520, Japan
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8
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Herzberg J, Khadem S, Begemann V, Strate T, Honarpisheh H, Guraya SY. Quality of Life in Patients With Rectal Resections and End-to-End Primary Anastomosis Using a Standardized Perioperative Pathway. Front Surg 2022; 8:789251. [PMID: 35071312 PMCID: PMC8776631 DOI: 10.3389/fsurg.2021.789251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/07/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives: Lower rectal resection is associated with a high rate of postoperative complications and, therefore, adversely impacts the postoperative health-related quality of life (QoL). Though sporadically practiced in different centers, there is no standard perioperative protocol for the management of patients with rectal growths. The aim of this analysis is to evaluate the patient-reported outcomes after low rectal resections followed by an end-to-end-reconstruction and temporary covering ileostomy using a multidisciplinary fail-safe-concept. Methods: Between 2015 and 2020, we evaluated patient reported outcomes after open and laparoscopic rectal resections with end-to-end reconstruction with a primary straight anastomosis using a standardized perioperative pathway All patients with stoma were excluded from the study. The data for the QoL of patients was collected using the established Low Anterior Resection Syndrome (LARS)-score and the EORTC-C30 and CR-29 questionnaires at a single postoperative timepoint. Results: We recruited 78 stoma-free patients for this analysis. Of 78 patients included in the study, 87.2% were operated laparoscopically and the mean global health status was 67.95 points, while a major LARS was detected in 48 (61.5%) patients. No anastomotic leakage (AL) occurred within the study cohort. There was no significant change in the LARS-score or the global health status depending on the follow-up-period. Conclusion: This study shows that good QoL and functional outcomes with no AL are achievable following end-to-end straight anastomosis using a standardized perioperative surgical fail-safe protocol procedure.
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Affiliation(s)
- Jonas Herzberg
- Department of Surgery—Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
- *Correspondence: Jonas Herzberg
| | - Shahram Khadem
- Department of Surgery—Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
| | - Valentin Begemann
- Department of Surgery—Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
| | - Tim Strate
- Department of Surgery—Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
| | - Human Honarpisheh
- Department of Surgery—Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
| | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
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9
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Completely intracorporeal anastomosis in robotic left colonic and rectal surgery: technique and 30-day outcomes. Updates Surg 2021; 73:2137-2143. [PMID: 33993462 DOI: 10.1007/s13304-021-01061-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
As robotic surgery continues to disseminate into the field of colon and rectal surgery, there is a growing interest in the utilization of intracorporeal anastomosis to potentially improve surgical outcomes. The purpoe of this study was to compare feasibility, safety, and short-term outcomes of robotic sigmoid and low anterior resections performed with completely intracorporeal anastomosis (CICA) technique to the traditional extracorporeal assisted anastomosis (ECAA) technique. Consecutive series of patients who underwent elective robotic sigmoid or low anterior resections for benign or malignant disease utilizes either CICA or ECAA between August 2017 and November 2019. Surgical complications were assessed until 30 postoperative days and compared between the two groups. A total of 160 patients were identified; 73 (45.6%) in the CICA group and 87 (54.4%) in the ECAA group. Most of the procedures were performed for malignancy (76%). Estimated blood loss was lower in the CICA group (80.7 mL vs. 110.2 mL; p = 0.048), while operative times were longer (5.9 ± SD hours vs. 4.9 ± SD hours; p = < 0.001). Overall conversion rate was 1.9%, with no conversions in the CICA group. Overall complications occurred in 54 patients (33.8%) with 13 (8.3%) representing major complications. There were no significant differences in 30 day outcomes between the two groups. This study demonstrates the feasibility and safety of robotic sigmoid and low anterior resections with CICA. Outcomes for robotic sigmoid and low anterior resections are encouraging regardless of anastomotic technique (CICA vs ECAA).
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McKechnie T, Sharma S, Daniel R, Eskicioglu C. End-to-end versus end-to-side anastomosis for low anterior resection: A systematic review and meta-analysis of randomized controlled trials. Surgery 2021; 170:397-404. [PMID: 33541747 DOI: 10.1016/j.surg.2020.12.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Numerous randomized controlled trials comparing end-to-end and end-to-side anastomoses after low anterior resection have been performed. Rates of anastomotic leakage and overall postoperative morbidity, as well as reported quality of postoperative bowel function, vary across individual studies. As such, this study meta-analyzes pooled data comparing end-to-end and end-to-side anastomosis after low anterior resection in terms of anastomotic leak rate and postoperative bowel function. METHODS A search of Medline, EMBASE, and Cochrane Central Register of Controlled Trials was performed. Articles were included if they were randomized controlled trials that compared end-to-end and end-to-side anastomosis after low anterior resection for benign or malignant disease. The primary outcome was anastomotic leak rate. A pairwise meta-analysis was performed using inverse variance random effects. RESULTS From 1,452 citations, 6 randomized controlled trials with 270 patients undergoing end-to-end anastomosis (45.9% female, mean age: 63.5 years) and 268 patients undergoing end-to-side anastomosis (52.4% female, mean age: 64.0 years) met inclusion criteria. Patients undergoing end-to-side anastomosis had a significantly lower rate of anastomotic leak (RR 0.37, 95% CI 0.15-0.93, P = .04, I2=0%). There were no differences in rate of anastomotic stenosis (RR 1.03, 95% CI 0.21-5.19, P = .97) or overall postoperative morbidity (RR 0.60, 95% CI 0.33-1.07, P = .08). Narrative review of postoperative bowel function demonstrated evidence of improved Wexner scores for 6 months postoperatively in patients undergoing end-to-side anastomosis. CONCLUSION End-to-side anastomosis significantly reduces the risk of anastomotic leak after low anterior resection. Additional prospective trials are warranted to confirm the findings of this review and to contribute to the growing evidence-base aimed at optimization of bowel function after low anterior resection.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. https://twitter.com/tylermckechnie
| | - Sahil Sharma
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. https://twitter.com/SharmaS_14
| | - Ryan Daniel
- University of Toronto, Temerty Faculty of Medicine, Toronto, ON, Canada. https://twitter.com/ryandaniel82
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada; Division of General Surgery, Department of Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
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Ganapathi SK, Subbiah R, Rudramurthy S, Kakkilaya H, Ramakrishnan P, Chinnusamy P. Laparoscopic anterior resection: Analysis of technique over 1000 cases. J Minim Access Surg 2021; 17:356-362. [PMID: 33605924 PMCID: PMC8270051 DOI: 10.4103/jmas.jmas_132_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: Laparoscopic rectal surgery has moved from being experimental to getting established as a mainstream procedure. We aimed at analysing how rectal cancer surgery has evolved at our institute. Methods: A retrospective review of 1000 consecutive patients who underwent laparoscopic anterior resection for rectal adenocarcinoma over a period of 15 years (January 2005 to December 2019) was performed. Technical modifications were made with splenic flexure mobilisation, intersphincteric dissection and anastomotic technique. The data collected included type of surgery, duration of surgery, conversion to open, anastomotic leak, defunctioning stoma and duration of hospital stay. The first 500 and the next 500 cases were compared. Results: The study patients were predominantly males comprising 68% (n = 680). The mean age of the patients was 58.3 years (range: 28–92 years). Majority of the procedures performed were high anterior resection (n = 402) and low anterior resection (LAR) (n = 341) followed by ultra-LAR (ULAR) (n = 208) and ULAR + colo-anal anastomosis (n = 49). A total of 42 patients who were planned for laparoscopic surgery needed conversion to open procedure. Forty-one patients (4.1%) had an anastomotic leak. The mean duration of stay was 5.3 + 2.8 days. The rate of conversion to open procedure had reduced from 5.4% to 3.0%. The rate of defunctioning stoma had reduced by >50% in the recent group. The anastomotic leak rate had reduced from 5.0% to 3.2%. The average duration of stay had reduced from 5.8 days to 4.9 days. Conclusion: This is one of the largest single-centre experiences of laparoscopic anterior resection. We have shown the progressive benefits of an evolving approach to laparoscopic anterior resection.
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Affiliation(s)
- Senthil Kumar Ganapathi
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Rajapandian Subbiah
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Sathiyamoorthy Rudramurthy
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Harish Kakkilaya
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Parthasarathi Ramakrishnan
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
| | - Palanivelu Chinnusamy
- Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
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12
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D'Amico F, Wexner SD, Vaizey CJ, Gouynou C, Danese S, Peyrin-Biroulet L. Tools for fecal incontinence assessment: lessons for inflammatory bowel disease trials based on a systematic review. United European Gastroenterol J 2020; 8:886-922. [PMID: 32677555 DOI: 10.1177/2050640620943699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fecal incontinence is a disabling condition affecting up to 20% of women. OBJECTIVE We investigated fecal incontinence assessment in both inflammatory bowel disease and non-inflammatory bowel disease patients to propose a diagnostic approach for inflammatory bowel disease trials. METHODS We searched on Pubmed, Embase and Cochrane Library for all studies on adult inflammatory bowel disease and non-inflammatory bowel disease patients reporting data on fecal incontinence assessment from January 2009 to December 2019. RESULTS In total, 328 studies were included; 306 studies enrolled non-inflammatory bowel disease patients and 22 studies enrolled inflammatory bowel disease patients. In non-inflammatory bowel disease trials the most used tools were the Wexner score, fecal incontinence quality of life questionnaire, Vaizey score and fecal incontinence severity index (in 187, 91, 62 and 33 studies). Anal manometry was adopted in 41.2% and endoanal ultrasonography in 34.0% of the studies. In 142 studies (46.4%) fecal incontinence evaluation was performed with a single instrument, while in 64 (20.9%) and 100 (32.7%) studies two or more instruments were used. In inflammatory bowel disease studies the Wexner score, Vaizey score and inflammatory bowel disease quality of life questionnaire were the most commonly adopted tools (in five (22.7%), five (22.7%) and four (18.2%) studies). Anal manometry and endoanal ultrasonography were performed in 45.4% and 18.2% of the studies. CONCLUSION Based on prior validation and experience, we propose to use the Wexner score as the first step for fecal incontinence assessment in inflammatory bowel disease trials. Anal manometry and/or endoanal ultrasonography should be taken into account in the case of positive questionnaires.
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Affiliation(s)
- Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston USA
| | | | - Célia Gouynou
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
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13
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Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision. Surg Endosc 2019; 33:79-87. [PMID: 29967994 PMCID: PMC6336756 DOI: 10.1007/s00464-018-6276-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Transanal total mesorectal excision (TaTME) is a safe alternative to laparoscopic TME for mid and low rectal cancer. TaTME allows improved visualization of the surgical planes and margins, and may potentially improve oncological outcomes. However, functional results after total mesorectal excision (TME) are variable and there are currently only a few published studies that include functional data related to the outcomes of TaTME. METHODS Fifty-four consecutive patients were included in this study: one group included 27 patients who underwent laparoscopic low anterior and the other included 27 patients who underwent TaTME. All patients were asked to complete five questionnaires related to quality of life (QOL) and function [EQ-5D-3L, EORTC-QLQ C30, EORTC-QLQ C29, Low Anterior Resection Syndrome score (LARS), and International Prostate Symptom Score IPSS]. All TaTME patients were operated on at The Gelderse Vallei Hospital by a single surgeon and had a follow-up of at least 6.6 months. RESULTS The EORTC-QLQ C30 and EQ-5D-3L questionnaires showed comparable outcomes in terms of QOL between the two groups. Almost all items evaluated by the EORTC-QLQ C29, including sexual outcomes, were similar between the two groups. One item concerning fecal incontinence, however, was scored worse for TaTME. There were no significant differences between the groups in terms of LARS symptoms or urinary function. CONCLUSIONS Patients undergoing laparoscopic or transanal TME showed comparable functional and QOL outcomes. Although the TaTME technique is still evolving, this study indicates that this technique is a safe alternative to laparoscopic surgery in terms of functional outcomes for mid and low rectal cancers.
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Hain E, Maggiori L, Zappa M, Prost À la Denise J, Panis Y. Anastomotic leakage after side-to-end anastomosis for rectal cancer: does leakage location matter? Colorectal Dis 2018; 20. [PMID: 29316129 DOI: 10.1111/codi.14005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 12/01/2017] [Indexed: 02/08/2023]
Abstract
AIM To assess outcome according to location of anastomotic leakage (AL) after side-to-end stapler or manual low colorectal or coloanal anastomosis following laparoscopic total mesorectal excision (TME) for rectal cancer. METHODS All patients presenting with symptomatic or asymptomatic AL after TME and side-to-end low anastomosis for rectal cancer performed from 2005 to 2014 were identified from our prospective database. CT-scans with contrast enema were reviewed to assess location of AL origin. RESULTS Among 279 patients who underwent TME with side-to-end anastomosis from 2005 to 2014, 70 patients presented with AL and were included: 43 (61%) patients with AL on the circular anastomosis (CAL) were compared to 27 (39%) with AL on the transverse stapling line of the colonic stump (TAL). CAL and TAL were associated with similar rates of symptomatic AL (63% versus 48%, respectively; p=0.339), severe postoperative morbidity rate (33% versus 18%; p=0.313), and long-term outcomes, including definitive stoma rate (10 versus 11%; p=0.622), and major low anterior resection syndrome rate (56% vs 57%; p=0.961). CONCLUSION Our study showed that whatever the location of AL on a side-to-end low colorectal or coloanal anastomosis after TME for cancer, both short and long-term outcomes are similar. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Magaly Zappa
- Department of Radiology, Beaujon Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Université Denis Diderot Paris VII, Clichy, France
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