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Mizumoto R, Miyoshi N, Hayashi R, Kato S, Minami S, Takeda M, Sekido Y, Hata T, Hamabe A, Ogino T, Tei M, Kagawa Y, Uemura M, Doki Y, Eguchi H. Usefulness of a powered circular stapler compared with a manual circular stapler in patients undergoing colorectal cancer surgery: A retrospective cohort study and systematic review. Oncol Lett 2024; 28:507. [PMID: 39233820 PMCID: PMC11369852 DOI: 10.3892/ol.2024.14640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/16/2024] [Indexed: 09/06/2024] Open
Abstract
Postoperative complications related to anastomosis, including postoperative anastomotic bleeding and anastomotic leakage, remain a serious issue. The effect of anastomotic devices on suture complications during intestinal anastomosis remains unclear. The present study examined the utility of automated anastomotic devices for reducing anastomotic complication risks. A retrospective cohort study of colorectal cancer surgeries in which an anastomosis device was used at Osaka University Hospital (Suita, Japan) between January 2018 and December 2022 was conducted. Cases of emergency surgery, inflammatory bowel disease and simultaneous surgery for other cancers were excluded. Experienced gastrointestinal surgeons performed manual anastomosis using the ETHICON Circular Stapler CDH or EEA Circular Stapler, and automatic anastomosis using the ECHELON CIRCULAR Powered Stapler, with no observed operator bias. Additionally, a meta-analysis that included other study results was performed. The outcomes included postoperative complications, mainly anastomotic leakage. The study included 414 patients: 183 in the manual circular stapler group and 231 in the powered circular stapler (PCS) group. Although this retrospective study found no statistically significant association between the anastomotic device used and anastomotic complications, an increased risk ratio was observed in the manual group compared with the automatic group when restricted to elderly patients. Similarly, a meta-analysis found a significantly higher anastomotic complication risk in the manual group compared with the automatic group (random-effects model; odds ratio, 0.376; 95% confidence interval, 0.232-0.610; P<0.0001). The findings of the present study suggested that a PCS is useful for reducing the anastomotic complication risk in patients undergoing colorectal cancer surgery.
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Affiliation(s)
- Rie Mizumoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
- Department of Gastroenterological Surgery, Osaka University Hospital, Suita, Osaka 565-0871, Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
- Department of Gastroenterological Surgery, Osaka University Hospital, Suita, Osaka 565-0871, Japan
| | - Rie Hayashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Shinya Kato
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Soichiro Minami
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Mitsunobu Takeda
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yuki Sekido
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Tsuyoshi Hata
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Atsushi Hamabe
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Takayuki Ogino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, Sakai, Osaka 591-8025, Japan
| | - Yoshinori Kagawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Osaka 558-8558, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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Shayimu P, Awula M, Wang CY, Jiapaer R, Pan YP, Wu ZM, Chen Y, Zhao ZL. Serum nutritional predictive biomarkers and risk assessment for anastomotic leakage after laparoscopic surgery in rectal cancer patients. World J Gastrointest Surg 2024; 16:3142-3154. [DOI: 10.4240/wjgs.v16.i10.3142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/08/2024] [Accepted: 08/28/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Anastomotic leakage (AL) is one of the severest complications after laparoscopic surgery for middle/low rectal cancer, significantly impacting patient outcomes. Identifying reliable predictive factors for AL remains a clinical challenge. Serum nutritional biomarkers have been implicated in surgical outcomes but are underexplored as predictive tools for AL in this setting. Our study hypothesizes that preoperative serum levels of prealbumin (PA), albumin (ALB), and transferrin (TRF), along with surgical factors, can accurately predict AL risk.
AIM To determine the predictive value of preoperative serum nutritional biomarkers for rectal cancer AL following laparoscopic surgery.
METHODS In the retrospective cohort study carried out at a tertiary cancer center, we examined 560 individuals who underwent laparoscopic procedures for rectal cancer from 2018 to 2022. Preoperative serum levels of PA, ALB, and TRF were measured. We employed multivariate logistic regression to determine the independent risk factors for AL, and a predictive model was constructed and evaluated using receiver operating characteristic curve analysis.
RESULTS AL occurred in 11.96% of cases, affecting 67 out of 560 patients. Multivariate analysis identified PA, ALB, and TRF as the independent risk factor, each with an odds ratio of 2.621 [95% confidence interval (CI): 1.582-3.812, P = 0.012], 3.982 (95%CI: 1.927-4.887, P = 0.024), and 2.109 (95%CI: 1.162-2.981, P = 0.031), respectively. Tumor location (< 7 cm from anal verge) and intraoperative bleeding ≥ 300 mL also increased AL risk. The predictive model demonstrated an excellent accuracy, achieving an area under the receiver operating characteristic curve of 0.942, a sensitivity of 0.844, and a specificity of 0.922, demonstrating an excellent ability to discriminate.
CONCLUSION Preoperative serum nutritional biomarkers, combined with surgical factors, reliably predict anastomotic leakage risk after rectal cancer surgery, highlighting their importance in preoperative assessment.
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Affiliation(s)
- Paerhati Shayimu
- Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Maitisaidi Awula
- Department of General Surgery, Yutian County People’s Hospital, Hotan 848499, Xinjiang Uygur Autonomous Region, China
| | - Chang-Yong Wang
- Department of General Surgery, Yutian County People’s Hospital, Hotan 848499, Xinjiang Uygur Autonomous Region, China
| | - Rexida Jiapaer
- Department of Ultrasound, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Yi-Peng Pan
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, Zhejiang Province, China
| | - Zhi-Min Wu
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550003, Guizhou Province, China
| | - Yi Chen
- Department of Breast and Thyroid Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Ze-Liang Zhao
- Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
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Garoufalia Z. The promise of indocyanine green in colorectal surgery. Lancet Gastroenterol Hepatol 2024; 9:897-898. [PMID: 39151437 DOI: 10.1016/s2468-1253(24)00235-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA.
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Jung JO, Dieplinger G, Bruns C. [Predictability of anastomotic leaks in visceral surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00104-024-02175-x. [PMID: 39316182 DOI: 10.1007/s00104-024-02175-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/25/2024]
Abstract
Anastomotic leakage in visceral surgery is associated with a large number of known and also unknown or even unmeasurable parameters. Furthermore, the associations between the individual factors are intertwined and complex. According to current data a preoperative prediction is not reliably possible and should be distinguished from intraoperative or postoperative prediction models. Most studies on this topic do not exceed an area under the curve (AUC) of 0.70. A thorough understanding of statistics and prediction models is necessary to correctly interpret the published works. Due to the relatively low incidence rate of anastomotic leakage from a statistical point of view, large datasets are required for adequate prediction. Multimodal data and complex algorithms can potentially handle big data more accurately and improve predictability; however, these models have so far not been applied in the clinical routine.
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Affiliation(s)
- Jin-On Jung
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor-, und Transplantationschirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Georg Dieplinger
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor-, und Transplantationschirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Christiane Bruns
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor-, und Transplantationschirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Catarci M, Guadagni S, Masedu F, Guercioni G, Ruffo G, Viola MG, Borghi F, Scatizzi M, Patriti A, Baiocchi GL. Intraoperative left-sided colorectal anastomotic testing in clinical practice: a multi-treatment machine-learning analysis of the iCral3 prospective cohort. Updates Surg 2024; 76:1715-1727. [PMID: 38767835 DOI: 10.1007/s13304-024-01883-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Current evidence about intraoperative anastomotic testing after left-sided colorectal resections is still controversial. The aim of this study was to analyze the impact of Indocyanine Green fluorescent angiography (ICG-FA) and air-leak test (ALT) over standard assessment on anastomotic leakage (AL) rates according to surgeon's perception of anastomosis perfusion and/or integrity in clinical practice. METHODS A database of 2061 patients who underwent left-sided colorectal resections was selected from patients enrolled in a prospective multicenter study. It was retrospectively analyzed through a multi-treatment machine-learning model considering standard visual assessment (NW; No. = 899; 43.6%) as the reference treatment arm, compared to ICG-FA alone (WP; No. = 409; 19.8%), ALT alone (WI; No. = 420; 20.4%) or both (WPI; No. = 333; 16.2%). Twenty-four covariates potentially affecting the outcomes were included and balanced into the model within the subgroups. The primary endpoint was AL, the secondary endpoints were overall morbidity (OM), major morbidity (MM), reoperation for AL, and mortality. All the results were reported as odds ratio (OR) with 95% confidence intervals (95%CI). RESULTS The WPI subgroup showed significantly higher AL risk (OR 1.91; 95% CI 1.02-3.59; p 0.043), MM risk (OR 2.35; 95% CI 1.39-3.97; p 0.001), and reoperation for AL risk (OR 2.44; 95% CI 1.12-5.31; p 0.025). No other significant differences were recorded. CONCLUSIONS This study showed that the surgeons' perception of both anastomotic perfusion and integrity (WPI subgroup) was associated to a significantly higher risk of AL and related morbidity, notwithstanding the extensive use of both ICG-FA and ALT testing.
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Affiliation(s)
- Marco Catarci
- General Surgery Unit, Sandro Pertini Hospital, ASL Roma 2, Via dei Monti Tiburtini, 385, 00157, Rome, Italy.
| | - Stefano Guadagni
- General Surgery Unit, University of L'Aquila, L'Aquila, Italy
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Francesco Masedu
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | | | - Giacomo Ruffo
- General Surgery Unit, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | | | - Felice Borghi
- Oncologic Surgery Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata & Serristori Hospital, Florence, Italy
| | - Alberto Patriti
- Department of Surgery, S. Salvatore Hospital, AST Marche 1, Pesaro e Fano, PU, Italy
| | - Gian Luca Baiocchi
- General Surgical Unit, Department of Clinical and Experimental Sciences, University of Brescia at the ASST Cremona, Cremona, Italy
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Lehr K, Lange UG, Hipler NM, Vilchez-Vargas R, Hoffmeister A, Feisthammel J, Buchloh D, Schanze D, Zenker M, Gockel I, Link A, Jansen-Winkeln B. Prediction of anastomotic insufficiency based on the mucosal microbiome prior to colorectal surgery: a proof-of-principle study. Sci Rep 2024; 14:15335. [PMID: 38961176 PMCID: PMC11222535 DOI: 10.1038/s41598-024-65320-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/19/2024] [Indexed: 07/05/2024] Open
Abstract
Anastomotic leakage (AL) is a potentially life-threatening complication following colorectal cancer (CRC) resection. In this study, we aimed to unravel longitudinal changes in microbial structure before, during, and after surgery and to determine if microbial alterations may be predictive for risk assessment between sufficient anastomotic healing (AS) and AL prior surgery. We analysed the microbiota of 134 colon mucosal biopsies with 16S rRNA V1-V2 gene sequencing. Samples were collected from three location sites before, during, and after surgery, and patients received antibiotics after the initial collection and during surgery. The microbial structure showed dynamic surgery-related changes at different time points. Overall bacterial diversity and the abundance of some genera such as Faecalibacterium or Alistipes decreased over time, while the genera Enterococcus and Escherichia_Shigella increased. The distribution of taxa between AS and AL revealed significant differences in the abundance of genera such as Prevotella, Faecalibacterium and Phocaeicola. In addition to Phocaeicola, Ruminococcus2 and Blautia showed significant differences in abundance between preoperative sample types. ROC analysis of the predictive value of these genera for AL revealed an AUC of 0.802 (p = 0.0013). In summary, microbial composition was associated with postoperative outcomes, and the abundance of certain genera may be predictive of postoperative complications.
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Affiliation(s)
- Konrad Lehr
- Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Section of Molecular Gastroenterology and Microbiota-Associated Diseases, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Undine Gabriele Lange
- Clinic and Polyclinic for Visceral, Transplant, Thoracic and Vascular Surgery, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Noam Mathias Hipler
- Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Section of Molecular Gastroenterology and Microbiota-Associated Diseases, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Ramiro Vilchez-Vargas
- Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Section of Molecular Gastroenterology and Microbiota-Associated Diseases, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Albrecht Hoffmeister
- Clinic and Polyclinic for Oncology, Gastroenterology, Hepatology and Pneumology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Jürgen Feisthammel
- Clinic and Polyclinic for Oncology, Gastroenterology, Hepatology and Pneumology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Dorina Buchloh
- Clinic for General and Visceral Surgery, Protestant Deaconess House Leipzig, Leipzig, Germany
| | - Denny Schanze
- Institute of Human Genetics, Faculty of Medicine, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Zenker
- Institute of Human Genetics, Faculty of Medicine, Otto Von Guericke University Magdeburg, Magdeburg, Germany
| | - Ines Gockel
- Clinic and Polyclinic for Visceral, Transplant, Thoracic and Vascular Surgery, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Alexander Link
- Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Section of Molecular Gastroenterology and Microbiota-Associated Diseases, Otto Von Guericke University Magdeburg, Magdeburg, Germany.
| | - Boris Jansen-Winkeln
- Clinic and Polyclinic for Visceral, Transplant, Thoracic and Vascular Surgery, Faculty of Medicine, University of Leipzig, Leipzig, Germany.
- Clinic for General, Visceral, Thoracic and Vascular Surgery, Clinic St. Georg Leipzig, Leipzig, Germany.
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Yue Y, Zhang X, Qu Y, Zhao X, Ding F, Li J, Zheng B. Effectiveness of anastomotic reinforcement sutures in reducing anastomotic leakage risk after laparoscopic rectal cancer surgery: a pooled and integration analysis. Front Oncol 2024; 14:1337870. [PMID: 38894871 PMCID: PMC11183793 DOI: 10.3389/fonc.2024.1337870] [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] [Received: 12/28/2023] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Background and objectives Anastomotic leakage (AL) is one of the most serious complications after laparoscopic anus-preserving surgery for rectal cancer, which significantly prolongs the patient's hospital stay, leads to dysfunction, and even increases the patient's perioperative morbidity and mortality, and little is known about the effectiveness of anastomotic reinforcement sutures to prevent AL. Thus, this study was conducted to evaluate the efficacy of anastomotic reinforcement sutures as a means to prevent AL during laparoscopic surgery for rectal cancer. Methods A comprehensive and systematic search was performed in the literature database by combining subject and free terms up to 10 October 2023. The overall literature included was integrated and analyzed using Stata 12.0 software and Review Manager version 5.4 software to assess the effect of anastomotic reinforcement sutures on the incidence of AL. Results A total of 2,452 patients from 14 studies were included, and an integrated analysis showed that the use of anastomotic reinforcement sutures significantly reduced the incidence of AL [odds ratio (OR) = 0.26; 95% confidence interval (CI), 0.18-0.37; P < 0.00001; I2 = 0%]. However, the findings confirmed whether or not the anastomosis reinforced with sutures did not affect the incidence of anastomotic stenosis (OR = 0.69; 95% CI, 0.37-1.32; P = 0.27; I2 = 0%). We performed subgroup analyses of the results of the study, the randomized controlled studies (OR = 0.31; 95% CI, 0.15-0.65; P < 0.001) as well as retrospective studies (OR = 0.28; 95% CI, 0.19-0.41; P < 0.001), 3-0 sutures (OR = 0.28; 95% CI, 0.17-0.45; P < 0.001) versus 4-0 sutures (OR = 0.26; 95% CI, 0.13-0.53; P < 0.001), barbed wire sutures (OR = 0.26; 95% CI, 0.14-0.48; P < 0.001) versus non-barbed wire sutures (OR = 0.30; 95% CI, 0.20-0.46; P < 0.001), interrupted (OR = 0.30, 95% CI, 0.20-0.46; P < 0.001) versus continuous sutures (OR = 0.29, 95% CI, 0.16-0.51; P < 0.001) to the anastomosis, full-thickness suture (OR = 0.29; 95% CI, 0.16-0.51; P < 0.001) versus sutured with the seromuscular layer (OR = 0.27; 95% CI, 0.14-0.53; P < 0.001), anastomotic sutured in one (OR = 0.27; 95% CI, 0.14-0.53; P < 0.001) versus non-one circle (OR = 0.30; 95% CI, 0.20-0.44; P < 0.001), and reinforcing sutures to the dog-ear area (OR = 0.26; 95% CI, 0.14-0.50; P < 0.001) versus the non-dog-ear area (OR = 0.30; 95% CI, 0.20-0.45; P < 0.001), which have suggested that there is no significant difference between each other and that all of them reduce the incidence of AL. Conclusions This study provides evidence that performing reinforcement suturing of the anastomosis during laparoscopic rectal surgery significantly lowers the incidence of postoperative AL but has no significant effect on anastomotic stenosis. It is important to note that further randomized controlled studies are required to confirm this conclusion. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022368631.
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Affiliation(s)
- Yumin Yue
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Xiaolong Zhang
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Yaqi Qu
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Xu Zhao
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Fanghui Ding
- General Surgery Department, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bobo Zheng
- Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an, China
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Hu Y, Ren J, Lv Z, Liu H, Qiu X. Procalcitonin and C-reactive protein as early predictors in patients at high risk of colorectal anastomotic leakage. J Int Med Res 2024; 52:3000605241258160. [PMID: 38867514 PMCID: PMC11179477 DOI: 10.1177/03000605241258160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE To assess the diagnostic value of C-reactive protein (CRP) and procalcitonin (PCT) for anastomotic leakage (AL) following colorectal surgery. METHODS We retrospectively analyzed data for patients who underwent colorectal surgery at our hospital between November 2019 and December 2023. CRP and PCT were measured postoperatively to compare patients with/without AL, and changes were compared between low- and high-risk groups. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic accuracy of CRP and PCT to identify AL in high-risk patients. RESULTS Mean CRP was 142.53 mg/L and 189.57 mg/L in the low- and high-risk groups, respectively, on postoperative day (POD)3. On POD2, mean PCT was 2.75 ng/mL and 8.16 ng/mL in low- and high-risk patients, respectively; values on POD3 were 3.53 ng/mL and 14.86 ng/mL, respectively. The areas under the curve (AUC) for CRP and PCT on POD3 were 0.71 and 0.78, respectively (CRP cut-off: 235.64 mg/L; sensitivity: 96%; specificity: 89.42% vs PCT cut-off: 3.94 ng/mL; sensitivity: 86%; specificity: 93.56%; AUC: 0.78). The AUC, sensitivity, and specificity for the combined diagnostic ability of CRP and PCT on POD3 were 0.92, 90%, and 100%, respectively (cut-off: 0.44). CONCLUSIONS Combining PCT and CRP on POD3 enhances the diagnostic accuracy for AL.
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Affiliation(s)
- Yilong Hu
- Department of General Surgery, Nanjing Yimin Hospital, Nanjing, China
| | - Junjie Ren
- Department of General Surgery, Nanjing Yimin Hospital, Nanjing, China
| | - Zhixin Lv
- Department of General Surgery, Nanjing Yimin Hospital, Nanjing, China
| | - He Liu
- Department of General Surgery, Nanjing Yimin Hospital, Nanjing, China
| | - Xiewu Qiu
- Department of General Surgery, Nanjing Yimin Hospital, Nanjing, China
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9
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Rodriguez SLR, Montoro DFS, De la Cruz Ku G, del Rocio Luna Munoz C, Bustamante CRR. Risk factors of anastomotic leak in colorectal cancer: a multicentric study in a Latin American country. Ecancermedicalscience 2024; 18:1696. [PMID: 38774568 PMCID: PMC11108052 DOI: 10.3332/ecancer.2024.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Indexed: 05/24/2024] Open
Abstract
Introduction The anastomotic leak (AL) is one of the most feared complications of colorectal surgery, since it is associated with a high rate of morbidity, mortality, length of hospital stay and cost of care. Our aim was to determine the risk factors associated with anastomosis leak in colorectal cancer patients who underwent surgical resection with anastomosis. Methods A multicentre observational, analytical, retrospective and case-control study was carried out. For each case, two controls were included from three national hospitals from Lima, Peru during the period 2021-2022. To determine the degree of association, multivariate logistic regression model was carried out. Results A total of 360 patients were included, 120 from each hospital. The mean age of the population was 68.03 ± 14.21 years old. The majority were 65 years old or older (66.1%), 52.8% were female, and 63.3% had clinical stage III. The 40% of the patients had albumin levels lower than 3.5 g/dL. Regarding the surgery, 96.4% were elective, 68.9% underwent open approach, and 80.8% had an operative time of more than 180 minutes. Most of them had right colon cancer (50.8%). In the multivariate analysis, a significant association was found with the age variable (OR = 2.48; 95%CI:1.24-4.97), clinical tumour level (OR = 2.71; 95%CI:1.34-5.48), American Society of Anesthesiologists (ASA) Score (OR = 3.23; 95%CI:1.10-9.50), preoperative serum albumin (OR = 22.2; 95%CI:11.5-42.9). Conclusion The most important independent risk factors associated with AL among patients with colorectal cancer were pre-operative such as lower preoperative serum albumin levels, followed by a higher ASA Score, clinical-stage III-IV, and an age ≥65 years old.
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Cira K, Janett SN, Micheler C, Heller S, Obermeier A, Friess H, Burgkart R, Neumann PA. The mesenteric entry site as a potential weak point in gastrointestinal anastomoses - findings from an ex-vivo biomechanical analysis. Langenbecks Arch Surg 2024; 409:124. [PMID: 38615148 PMCID: PMC11016002 DOI: 10.1007/s00423-024-03318-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Gastrointestinal disorders frequently necessitate surgery involving intestinal resection and anastomosis formation, potentially leading to severe complications like anastomotic leakage (AL) which is associated with increased morbidity, mortality, and adverse oncologic outcomes. While extensive research has explored the biology of anastomotic healing, there is limited understanding of the biomechanical properties of gastrointestinal anastomoses, which was aimed to be unraveled in this study. METHODS An ex-vivo model was developed for the biomechanical analysis of 32 handsewn porcine end-to-end anastomoses, using interrupted and continuous suture techniques subjected to different flow models. While multiple cameras captured different angles of the anastomosis, comprehensive data recording of pressure, time, and temperature was performed simultaneously. Special focus was laid on monitoring time, location and pressure of anastomotic leakage (LP) and bursting pressures (BP) depending on suture techniques and flow models. RESULTS Significant differences in LP, BP, and time intervals were observed based on the flow model but not on the suture techniques applied. Interestingly, anastomoses at the insertion site of the mesentery exhibited significantly higher rates of leakage and bursting compared to other sections of the anastomosis. CONCLUSION The developed ex-vivo model facilitated comparable, reproducible, and user-independent biomechanical analyses. Assessing biomechanical properties of anastomoses offers an advantage in identifying technical weak points to refine surgical techniques, potentially reducing complications like AL. The results indicate that mesenteric insertion serves as a potential weak spot for AL, warranting further investigations and refinements in surgical techniques to optimize outcomes in this critical area of anastomotic procedures.
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Affiliation(s)
- Kamacay Cira
- Department of Surgery, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, 81675, Munich, Bavaria, Germany
| | - Saskia Nicole Janett
- Department of Surgery, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, 81675, Munich, Bavaria, Germany
| | - Carina Micheler
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Institute for Machine Tools and Industrial Management, TUM School of Engineering and Design, Technical University of Munich, Munich, Germany
| | - Stephan Heller
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Andreas Obermeier
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, 81675, Munich, Bavaria, Germany
| | - Rainer Burgkart
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Philipp-Alexander Neumann
- Department of Surgery, Klinikum Rechts Der Isar, TUM School of Medicine and Health, Technical University of Munich, 81675, Munich, Bavaria, Germany.
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Elsayed MI. Tube Stoma for the Management of Ileocolic Anastomotic Leak in a Patient With Metastatic Colon Cancer. Cureus 2024; 16:e52314. [PMID: 38357040 PMCID: PMC10866551 DOI: 10.7759/cureus.52314] [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] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
This case involves a 53-year-old male who was diagnosed with stenotic ascending colon cancer and peritoneal metastatic deposits. He was initially planned for cytoreductive surgery and heated intraperitoneal chemotherapy (CRS and HIPEC), along with resection of the primary tumor in the form of right hemicolectomy. Intraoperatively, the disease was found to be more extensive than anticipated. Consequently, the plan was modified to include debulking right hemicolectomy with hand-sewn ileocolic anastomosis and extensive peritoneal procedures. Postoperatively, he experienced an anastomotic leak, leading to another laparotomy. However, due to anatomical challenges, creating a stoma was considered unsafe. Therefore, innovative interventions were performed, including controlling the anastomotic defect with a 30Fr Foley catheter without disrupting the anastomosis. A collaborative effort from various medical teams facilitated the patient's discharge home after an extended stay in the critical care unit (CCU).
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12
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Shin HH, Ryu JH. Bio-Inspired Self-Healing, Shear-Thinning, and Adhesive Gallic Acid-Conjugated Chitosan/Carbon Black Composite Hydrogels as Suture Support Materials. Biomimetics (Basel) 2023; 8:542. [PMID: 37999183 PMCID: PMC10669539 DOI: 10.3390/biomimetics8070542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
The occurrence of leakage from anastomotic sites is a significant issue given its potential undesirable complications. The management of anastomotic leakage after gastrointestinal surgery is particularly crucial because it is directly associated with mortality and morbidity in patients. If adhesive materials could be used to support suturing in surgical procedures, many complications caused by leakage from the anastomosis sites could be prevented. In this study, we have developed self-healing, shear-thinning, tissue-adhesive, carbon-black-containing, gallic acid-conjugated chitosan (CB/Chi-gallol) hydrogels as sealing materials to be used with suturing. The addition of CB into Chi-gallol solution resulted in the formation of a crosslinked hydrogel with instantaneous solidification. In addition, these CB/Chi-gallol hydrogels showed enhancement of the elastic modulus (G') values with increased CB concentration. Furthermore, these hydrogels exhibited excellent self-healing, shear-thinning, and tissue-adhesive properties. Notably, the hydrogels successfully sealed the incision site with suturing, resulting in a significant increase in the bursting pressure. The proposed self-healing and adhesive hydrogels are potentially useful in versatile biomedical applications, particularly as suture support materials for surgical procedures.
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Affiliation(s)
- Hyun Ho Shin
- Department of Chemical Engineering, Wonkwang University, Iksan 54538, Jeonbuk, Republic of Korea;
| | - Ji Hyun Ryu
- Department of Chemical Engineering, Wonkwang University, Iksan 54538, Jeonbuk, Republic of Korea;
- Department of Carbon Convergence Engineering, Wonkwang University, Iksan 54538, Jeonbuk, Republic of Korea
- Smart Convergence Materials Analysis Center, Wonkwang University, Iksan 54538, Jeonbuk, Republic of Korea
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13
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Rasa HK, Erdemir A. Our Experience With Left Colon and Rectal Cancer Surgery and the Impact of Preoperative Sarcopenia on Complication Rates. Cureus 2023; 15:e45209. [PMID: 37720118 PMCID: PMC10500379 DOI: 10.7759/cureus.45209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Evidence about the importance of sarcopenia in patients operated on for gastrointestinal cancers and that it may have both early and long-term impacts is expanding. In our study, we aimed to evaluate the impact of sarcopenia on the outcomes of the patients we operated on for left colon and rectum cancer. METHODS We retrospectively evaluated the electronic records of 38 patients operated on for left colon and rectal cancer between 2010 and 2020, and demographic variables, clinical stages, laboratory tests, body mass index (BMI), psoas muscle index (PMI), pathological stages, and Dindo Clavien complication scores were interpreted. We also assigned our patients into two groups according to their preoperative PMI values. We compared the first group of 12 patients with preoperative sarcopenia with the second group of 26 patients without preoperative sarcopenia. RESULTS Of the 38 patients who underwent curative surgery for left colon and rectal cancer, 20 were female and 18 were male. The median age of the group was 59.9 years. The most common tumour localization was in the rectosigmoid region in 17 patients, and the tumour in 6 patients was in the left colon. Therapy had been initiated with neoadjuvant treatment in 19 patients. At the preoperative evaluation, sarcopenia was present in 12 patients. Thirty-four patients underwent robot-assisted surgery. Postoperative pathologies were reported as stage 3 in 15 patients. Complications were reported in 17 patients, and nine were minor (Dindo-Clavien score < 3), but in eight patients, they were moderate to severe (Dindo-Clavien score ≥ 3). When the first group, 12 patients with preoperative sarcopenia, and the second group, 26 patients without preoperative sarcopenia, were compared, the patients with sarcopenia were found to be older (p=0.001), and male patients were in the majority (p=0.017). The postoperative follow-up of 12 patients with preoperative sarcopenia revealed that 7 (58.8%) had complications. Complications were observed in 10 (38.4%) patients in the second group. When the two groups were compared, the risk of developing complications was significantly higher in the sarcopenia group (p=0.016). Only one patient in the first group had moderate to severe complications, but seven patients without sarcopenia had moderate to severe complications. CONCLUSION Our study revealed that many patients we have operated on for left colon and rectal cancer have preoperative sarcopenia for which we should care. The sarcopenia rate was higher in males and elderly patients, and the risk of overall postoperative complications increased significantly in patients with preoperative sarcopenia. In consequence, the results of our study provide evidence that preoperative sarcopenia status is an important parameter to determine the risk status of the patient, and patients with preoperative sarcopenia should be monitored more closely. Thus, we may be able to diagnose and intervene early in the complications.
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Affiliation(s)
- Huseyin K Rasa
- General Surgery, Anadolu Medical Center Hospital, Kocaeli, TUR
| | - Ayhan Erdemir
- General Surgery, Anadolu Medical Center Hospital, Kocaeli, TUR
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