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Yoshinaka H, Shimomura M, Egi H, Shimizu W, Adachi T, Ikada S, Nakahara M, Saitoh Y, Toyota K, Yoshimitsu M, Akabane S, Yano T, Hattori M, Ohdan H. Non-invasive measurement of intestinal tissue oxygen saturation for evaluation of reconstructed blood flow in rectal cancer surgery: HiSCO-09 study. Br J Surg 2023; 110:1769-1773. [PMID: 37768096 DOI: 10.1093/bjs/znad315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Hisaaki Yoshinaka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Manabu Shimomura
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroyuki Egi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Wataru Shimizu
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomohiro Adachi
- Department of Surgery, Hiroshima City North Medical Centre Asa Citizens Hospital, Hiroshima, Japan
| | - Satoshi Ikada
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | | | | | - Kazuhiro Toyota
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Centre, Higashihiroshima, Japan
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Shintaro Akabane
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takuya Yano
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Minoru Hattori
- School of Medicine, Center for Medical Education, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Renna MS, Grzeda MT, Bailey J, Hainsworth A, Ourselin S, Ebner M, Vercauteren T, Schizas A, Shapey J. Intraoperative bowel perfusion assessment methods and their effects on anastomotic leak rates: meta-analysis. Br J Surg 2023; 110:1131-1142. [PMID: 37253021 PMCID: PMC10416696 DOI: 10.1093/bjs/znad154] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/24/2023] [Accepted: 04/29/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Anastomotic leak is one of the most feared complications of colorectal surgery, and probably linked to poor blood supply to the anastomotic site. Several technologies have been described for intraoperative assessment of bowel perfusion. This systematic review and meta-analysis aimed to evaluate the most frequently used bowel perfusion assessment modalities in elective colorectal procedures, and to assess their associated risk of anastomotic leak. Technologies included indocyanine green fluorescence angiography, diffuse reflectance spectroscopy, laser speckle contrast imaging, and hyperspectral imaging. METHODS The review was preregistered with PROSPERO (CRD42021297299). A comprehensive literature search was performed using Embase, MEDLINE, Cochrane Library, Scopus, and Web of Science. The final search was undertaken on 29 July 2022. Data were extracted by two reviewers and the MINORS criteria were applied to assess the risk of bias. RESULTS Some 66 eligible studies involving 11 560 participants were included. Indocyanine green fluorescence angiography was most used with 10 789 participants, followed by diffuse reflectance spectroscopy with 321, hyperspectral imaging with 265, and laser speckle contrast imaging with 185. In the meta-analysis, the total pooled effect of an intervention on anastomotic leak was 0.05 (95 per cent c.i. 0.04 to 0.07) in comparison with 0.10 (0.08 to 0.12) without. Use of indocyanine green fluorescence angiography, hyperspectral imaging, or laser speckle contrast imaging was associated with a significant reduction in anastomotic leak. CONCLUSION Bowel perfusion assessment reduced the incidence of anastomotic leak, with intraoperative indocyanine green fluorescence angiography, hyperspectral imaging, and laser speckle contrast imaging all demonstrating comparable results.
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Affiliation(s)
- Maxwell S Renna
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of General Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Mariusz T Grzeda
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - James Bailey
- Department of General Surgery, University of Nottingham, Nottingham, UK
| | - Alison Hainsworth
- Department of General Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Hypervision Surgical Ltd, London, UK
| | | | - Tom Vercauteren
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Hypervision Surgical Ltd, London, UK
| | - Alexis Schizas
- Department of General Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Jonathan Shapey
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Hypervision Surgical Ltd, London, UK
- Department of Neurosurgery, King’s College Hospital, London, UK
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Bekki T, Shimomura M, Adachi T, Miguchi M, Ikeda S, Yoshimitsu M, Kohyama M, Nakahara M, Kobayashi H, Toyota K, Shimizu Y, Sumitani D, Saito Y, Takakura Y, Ishizaki Y, Kodama S, Fujimori M, Hattori M, Shimizu W, Ohdan H. Predictive factors associated with anastomotic leakage after resection of rectal cancer: a multicenter study with the Hiroshima Surgical study group of Clinical Oncology. Langenbecks Arch Surg 2023; 408:199. [PMID: 37204489 DOI: 10.1007/s00423-023-02931-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Several factors have been reported as risk factors for anastomotic leakage after resection of rectal cancer. This study aimed to evaluate the risk factors for anastomotic leakage, including nutritional and immunological indices, following rectal cancer resection. METHODS This study used a multicenter database of 803 patients from the Hiroshima Surgical study group of Clinical Oncology who underwent rectal resection with stapled anastomosis for rectal cancer between October 2016 and April 2020. RESULTS In total, 64 patients (8.0%) developed postoperative anastomotic leakage. Five factors were significantly associated with the development of anastomotic leakage after rectal cancer resection with stapled anastomosis: male sex, diabetes mellitus, C-reactive protein/albumin ratio ≥ 0.07, prognostic nutritional index < 40, and low anastomosis under peritoneal reflection. The incidence of anastomotic leakage was correlated with the number of risk factors. The novel predictive formula based on odds ratios in the multivariate analysis was useful for identifying patients at high risk for anastomotic leakage. Diverting ileostomy reduced the ratio of anastomotic leakage ≥ grade III after rectal cancer resection. CONCLUSIONS Male sex, diabetes mellitus, C-reactive protein/albumin ratio ≥ 0.07, prognostic nutritional index < 40, and low anastomosis under peritoneal reflection are possible risk factors for developing anastomotic leakage after rectal cancer resection with the stapled anastomosis. Patients at high risk of anastomotic leakage should be assessed for the potential benefits of diverting stoma.
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Affiliation(s)
- Tomoaki Bekki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-Ku, Hiroshima, Hiroshima, Japan
| | - Manabu Shimomura
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-Ku, Hiroshima, Hiroshima, Japan.
| | - Tomohiro Adachi
- Department of Surgery, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Masashi Miguchi
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Satoshi Ikeda
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Mohei Kohyama
- Department of Surgery, Hiroshima General Hospital, Hatsukaichi, Japan
| | | | | | - Kazuhiro Toyota
- Department of Gastroenterological Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan
| | - Yosuke Shimizu
- Department of Surgery, National Hospital Organization Kure Medical Center/ Chugoku Cancer Center, Institute for Clinical Research, Kure, Japan
| | | | - Yasufumi Saito
- Department of Surgery, Chugoku Rosai Hospital, Kure, Japan
| | - Yuji Takakura
- Department of Surgery, Chuden Hospital, Hiroshima, Japan
| | - Yasuyo Ishizaki
- Department of Surgery, National Hospital Organization Hiroshima-Nishi Medical Center, Otake, Japan
| | - Shinya Kodama
- Department of Surgery, Yoshida General Hospital, Akitakata, Japan
| | - Masahiko Fujimori
- Department of Surgery, Kure City Medical Association Hospital, Kure, Japan
| | - Minoru Hattori
- Advanced Medical Skills Training Center, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan
| | - Wataru Shimizu
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-Ku, Hiroshima, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-Ku, Hiroshima, Hiroshima, Japan
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Castro Ruiz C, Zizzo M, Pavesi E, Ugoletti L, Mariani L. Letter to the Editor: "Prediction of anastomotic leakage after left-sided colorectal cancer surgery: a pilot study utilizing quantitative near-infrared spectroscopy". Surg Today 2022:10.1007/s00595-022-02517-4. [PMID: 35478263 DOI: 10.1007/s00595-022-02517-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/10/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Carolina Castro Ruiz
- Department of General Surgery, Chirurgia Area Nord. Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Arcispedale Santa Maria Nuova Di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italia
| | - Erica Pavesi
- Department of General Surgery, Chirurgia Area Nord. Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Lara Ugoletti
- Department of General Surgery, Chirurgia Area Nord. Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Mariani
- Department of General Surgery, Chirurgia Area Nord. Azienda Unità Sanitaria Locale-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
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