1
|
Zhang M, Liu Z, Sun P, Hu X, Zhou H, Jiang Z, Tang J, Liu Q, Wang X. Preliminary surgical outcomes of laparoscopic right hemicolectomy with transrectal specimen extraction: a propensity score matching study of 120 cases (with video). Gastroenterol Rep (Oxf) 2023; 11:goad036. [PMID: 37398927 PMCID: PMC10313420 DOI: 10.1093/gastro/goad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/01/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Background Compared with conventional laparoscopic surgery, natural orifice specimen extraction surgery (NOSES) has many advantages. Laparoscopic right colectomy with transvaginal specimen extraction has been reported, but the safety and feasibility of transrectal specimen extraction in male patients with ascending colon cancer remain to be verified. This study aimed to preliminarily evaluate the feasibility and safety of laparoscopic right hemicolectomy with transrectal specimen extraction. Methods The study was conducted at a single tertiary medical center in China. A total of 494 consecutive patients who underwent laparoscopic right colectomy between September 2018 and September 2020 were included. Transrectal specimen extraction was performed in 40 male patients (the NOSES group). Patients in the NOSES group were matched to the conventional laparoscopic group using propensity score matching at a 1:2 ratio. Short-term and long-term outcomes between the two groups were compared and evaluated. Results Forty patients in the NOSES group and 80 patients in the conventional laparoscopic group were matched for analysis. Baseline characteristics were balanced after propensity matching. The operative features, including operating time, intraoperative bleeding, and the number of harvested lymph nodes, were statistically comparable in both groups. In terms of post-operative recovery, patients in the NOSES group showed preferable outcomes, as evidenced by less post-operative pain and faster return to flatus, defecation, and discharge. The post-operative complications rate, according to the Clavien-Dindo classification system, was similar in both groups. No differences in overall survival or disease-free survival were observed between the two groups. Conclusions Laparoscopic right colectomy with transrectal specimen extraction is oncologically safe. Compared with conventional laparoscopic right colectomy, it can reduce post-operative pain, accelerate post-operative recovery, shorten the hospital stay, and achieve better cosmetic effect.
Collapse
Affiliation(s)
| | | | - Peng Sun
- Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Guangdong, P. R. China
| | - Xiyue Hu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P. R. China
| | - Xishan Wang
- Corresponding author. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. No. 17 Panjiayuannanli Road, Chaoyang District, Beijing 100021, China. Tel: +86-10-87787110;
| |
Collapse
|
2
|
Tonini V, Zanni M. Impact of anastomotic leakage on long-term prognosis after colorectal cancer surgery. World J Gastrointest Surg 2023; 15:745-756. [PMID: 37342854 PMCID: PMC10277951 DOI: 10.4240/wjgs.v15.i5.745] [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: 01/19/2023] [Revised: 03/21/2023] [Accepted: 04/12/2023] [Indexed: 05/26/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies in the world. Despite significant improvements in surgical technique, postoperative complications still occur in a fair percentage of patients undergoing colorectal surgery. The most feared complication is anastomotic leakage. It negatively affects short-term prognosis, with increased post-operative morbidity and mortality, higher hospitalization time and costs. Moreover, it may require further surgery with the creation of a permanent or temporary stoma. While there is no doubt about the negative impact of anastomotic dehiscence on the short-term prognosis of patients operated on for CRC, still under discussion is its impact on the long-term prognosis. Some authors have described an association between leakage and reduced overall survival, disease-free survival, and increased recurrence, while other Authors have found no real impact of dehiscence on long term prognosis. The purpose of this paper is to review all the literature about the impact of anastomotic dehiscence on long-term prognosis after CRC surgery. The main risk factors of leakage and early detection markers are also summarized.
Collapse
Affiliation(s)
- Valeria Tonini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Bologna, Italy
| | - Manuel Zanni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Bologna, Italy
| |
Collapse
|
3
|
Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going? Curr Oncol 2023; 30:3111-3137. [PMID: 36975449 PMCID: PMC10047700 DOI: 10.3390/curroncol30030236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Anastomotic leakage (AL) remains one of the most severe complications following colorectal cancer (CRC) surgery. Indeed, leaks that may occur after any type of intestinal anastomosis are commonly associated with a higher reoperation rate and an increased risk of postoperative morbidity and mortality. At first, our review aims to identify specific preoperative, intraoperative and perioperative factors that eventually lead to the development of anastomotic dehiscence based on the current literature. We will also investigate the role of several biomarkers in predicting the presence of ALs following colorectal surgery. Despite significant improvements in perioperative care, advances in surgical techniques, and a high index of suspicion of this complication, the incidence of AL remained stable during the last decades. Thus, gaining a better knowledge of the risk factors that influence the AL rates may help identify high-risk surgical patients requiring more intensive perioperative surveillance. Furthermore, prompt diagnosis of this severe complication may help improve patient survival. To date, several studies have identified predictive biomarkers of ALs, which are most commonly associated with the inflammatory response to colorectal surgery. Interestingly, early diagnosis and evaluation of the severity of this complication may offer a significant opportunity to guide clinical judgement and decision-making.
Collapse
|
4
|
Hsu CC, Hsu YJ, Chern YJ, Jong BK, Liao CK, Hsieh PS, Tsai WS, You JF. Potential short-term outcome advantage of low vs. high ligation of inferior mesenteric artery for sigmoid and rectal cancer: propensity score matching analysis. BMC Surg 2023; 23:33. [PMID: 36755252 PMCID: PMC9909897 DOI: 10.1186/s12893-023-01932-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Whether to ligate the inferior mesenteric artery at its root during anterior resection for sigmoid colon or rectal cancer is still under debate. This study compared the surgical outcomes, postoperative recovery, and anastomotic leakage between high and low ligation of the inferior mesenteric artery through a subgroup analysis. METHODS This was a retrospective analysis of prospectively collected data. All patients who underwent colorectal resection for rectosigmoid cancer between December 2016 and December 2019 were enrolled. According to the surgical ligation level of the inferior mesenteric artery, the patients were categorized into either the high or low ligation group. The investigated population was matched using the propensity score method. RESULTS Overall, 894 patients with sigmoid or rectal cancer underwent elective anterior resection with high (577 patients) or low (317 patients) ligation of the inferior mesenteric artery. After the propensity score matching, 245 patients in each group were compared. High ligation of the inferior mesenteric artery was associated with higher incidence of anastomotic leakage (14.9% vs. 5.6%, P = 0.041) for mid- to low-rectum tumors and a higher incidence of complications (8.6% vs. 3.3%, P = 0.013) of grades 1-2 according to the Clavien-Dindo classification system. CONCLUSION Compared with high ligation, low ligation of the inferior mesenteric artery resulted in lower likelihood of morbidity and mortality in rectal and sigmoid cancers. Moreover, low ligation was less likely to result in anastomosis leakage in mid- to low-rectal cancers.
Collapse
Affiliation(s)
- Chia-Chen Hsu
- grid.145695.a0000 0004 1798 0922Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305 Taiwan
| | - Yu-Jen Hsu
- grid.145695.a0000 0004 1798 0922Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305 Taiwan
| | - Yih-Jong Chern
- grid.145695.a0000 0004 1798 0922Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305 Taiwan
| | - Bor-Kang Jong
- grid.145695.a0000 0004 1798 0922Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305 Taiwan
| | - Chun-Kai Liao
- grid.145695.a0000 0004 1798 0922Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305 Taiwan
| | - Pao-Shiu Hsieh
- grid.145695.a0000 0004 1798 0922Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305 Taiwan
| | - Wen-Sy Tsai
- grid.145695.a0000 0004 1798 0922Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305 Taiwan
| | - Jeng-Fu You
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan.
| |
Collapse
|
5
|
Ammendola M, Ammerata G, Filice F, Filippo R, Ruggiero M, Romano R, Memeo R, Pessaux P, Navarra G, Montemurro S, Currò G. Anastomotic Leak Rate and Prolonged Postoperative Paralytic Ileus in Patients Undergoing Laparoscopic Surgery for Colo-Rectal Cancer After Placement of No-Coil Endoanal Tube. Surg Innov 2023; 30:20-27. [PMID: 35582732 DOI: 10.1177/15533506221090995] [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] [Indexed: 01/21/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common gastrointestinal tumor in men and the third in women. Left-hemicolectomy (LC) and low anterior resection (LAR) are considered the gold standard curative treatment. In this retrospective study, we evaluated the presence or absence of post-operative complications, in all patients who underwent Video-laparoscopic (VLS) LAR/LC with No Coil trans-anal tube positioning, and compared the data with the current literature on the topic. METHODS Thirty-nine patients diagnosed with CRC of the descending colon, splenic flexure, sigma, and rectum were recruited. LC was performed for sigmoid and descending colon cancers, while LAR was applied for tumors of the upper two-thirds of the rectum. The No Coil trans-anal tube (SapiMed Spa, Alessandria, Italy) was placed in all patients of the study at the end of surgical treatment. RESULTS Eighteen patients received a LAR-VLS (46%) and 21 patients received a LC-VLS (54%). The average length of hospital stay after surgery was 7 days. PPOI occurred in only one in 39 patients (2.6%) who had undergone LAR-VLS. As for complications, in no patient of the study did AL (0%) occur. CONCLUSION In patients undergoing LAR-VLS and LC-VLS, we performed colorectal anastomosis and in the same surgical operation we introduced the No-Coil device. Although this is a preliminary study and subject to further investigation, we believe that the No Coil tube positioning may reduce the time of presence of first flatus and feces and the risk of AL.
Collapse
Affiliation(s)
- Michele Ammendola
- Science of Health Department, Digestive Surgery Unit, RinggoldID:9325University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Giorgio Ammerata
- Science of Health Department, Digestive Surgery Unit, RinggoldID:9325University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Francesco Filice
- Science of Health Department, Digestive Surgery Unit, RinggoldID:9325University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Rosalinda Filippo
- Science of Health Department, Digestive Surgery Unit, RinggoldID:9325University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Michele Ruggiero
- Science of Health Department, Digestive Surgery Unit, RinggoldID:9325University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Roberto Romano
- Science of Health Department, Digestive Surgery Unit, RinggoldID:9325University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Riccardo Memeo
- Hepato-Biliary and Pancreatic Surgical Unit, "F. Miulli" Hospital, Bari, Italy
| | - Patrick Pessaux
- Department of General, Digestive and Endocrine Surgery,IHU-Strasbourg, Institute of Image-Guided Surgery, IRCAD, Research Institute Against Cancer of the Digestive System, University Hospital of Strasbourg, Strasbourg, France
| | - Giuseppe Navarra
- Department of Human Pathology of Adult and Evolutive Age, Surgical Oncology Division, "G. Martino" Hospital, University of Messina, Messina, Italy
| | - Severino Montemurro
- Science of Health Department, Digestive Surgery Unit, RinggoldID:9325University "Magna Graecia" Medical School, Catanzaro, Italy
| | - Giuseppe Currò
- Science of Health Department, General Surgery Unit, University "Magna Graecia" Medical School, Catanzaro, Italy
| |
Collapse
|
6
|
Prabhakaran S, Prabhakaran S, Lim WM, Guerra G, Heriot AG, Kong JC. Anastomotic Leak in Colorectal Surgery: Predictive Factors and Survival. POLISH JOURNAL OF SURGERY 2022; 95:56-64. [PMID: 38084042 DOI: 10.5604/01.3001.0016.1602] [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] [Indexed: 01/27/2023]
Abstract
<br><b>Introduction:</b> Anastomotic leak (AL) is a serious complication following colorectal surgery.</br> <br><b>Aim:</b> The aim of this study was to identify factors associated with the development of AL and to analyze its impact on survival.</br> <br><b>Materials and methods:</b> All consecutive adult colorectal cancer resections performed between 2007 and 2020 with curative intent and anastomosis formation were included from a prospectively maintained database. The primary outcome measure was the rate of AL. The secondary outcome measure was 5-year overall survival (OS).</br> <br><b>Results:</b> There were 6837 eligible patients. The rate of AL was 2.2% and 4.0% in patients with colon and rectal cancer, respectively. AL was a significant independent predictor of reduced 5-year OS in patients who underwent curative surgery for rectal cancer (odds ratio 2.293, p = 0.009). Emergency surgery (p = 0.015), surgery at a public hospital (p = 0.002), and an open surgical approach (p = 0.021) were all associated with a significantly higher risk of AL in patients with colon cancer, with higher rates of AL noted in left colectomies as compared to right hemicolectomies (4.4% <i>vs.</i> 1.3%, p < 0.001). In rectal cancer patients, AL was associated with neoadjuvant chemoradiotherapy (p = 0.038) and male gender (p = 0.002). The anastomosis formation technique (hand-sewn <i>vs.</i> stapled) did not impact the rate of AL (p = 0.116 and p = 0.198 with colon and rectal cancer, respectively).</br> <br><b>Discussion:</b> Clinicians should be cognizant of the predictive factors for AL and should consider early intervention for at-risk patients.</br>.
Collapse
Affiliation(s)
| | - Sowmya Prabhakaran
- Department of Colorectal Surgery, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria, Australia
| | - Wei Mou Lim
- Division of Cancer Surgery, Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia The Sir Peter MacCallum Centre Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Glen Guerra
- Division of Cancer Surgery, Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia The Sir Peter MacCallum Centre Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Joseph C Kong
- Division of Cancer Surgery Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Jiang Y, Chen H, Kong M, Sun D, Sheng H. Association between circular stapler size and anastomotic leakage after laparoscopic low anterior resection for rectal cancer. J Cancer Res Ther 2022; 18:1931-1936. [PMID: 36647952 DOI: 10.4103/jcrt.jcrt_676_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Anastomotic leakage (AL) is one of the most severe and frequent complications occurring after laparoscopic low anterior resection (LAR) for rectal cancer. This study aimed to examine the association between circular stapler size and AL after laparoscopic LAR. Methods This retrospective single-institution study involved 181 patients with rectal cancer who underwent laparoscopic LAR performed by a single surgical team between July 2016 and June 2021. The characteristics of the patients were analyzed. Risk factors for AL were identified via univariate and multivariate analyses. Additionally, a further propensity score matching (PSM) analysis was performed to reduce the selection bias. Results Among the 181 patients who underwent laparoscopic LAR for rectal cancer, 17 (9.4%) developed clinical AL. In the univariate and multivariate analyses, male sex, incomplete intestinal obstruction, and the usage of a 32-mm stapler during the surgery were independent risk factors for the occurrence of AL. Furthermore, the PSM analysis confirmed that the incidence of AL with a 32-mm stapler was higher than that with a 29-mm stapler after laparoscopic low anterior resection. However, there was no difference in the incidence of anastomotic bleeding and stenosis. Conclusion Choosing a smaller-diameter circular stapler may reduce the incidence of AL after laparoscopic LARfor rectal cancer without increasing the incidence of anastomotic stenosis.
Collapse
Affiliation(s)
- Yugang Jiang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Hongyuan Chen
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Meng Kong
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dong Sun
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University; Department of Gastrointestinal Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, Shandong, China
| | - Hongguang Sheng
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| |
Collapse
|
8
|
Fornasiero M, Geropoulos G, Kechagias KS, Psarras K, Katsikas Triantafyllidis K, Giannos P, Koimtzis G, Petrou NA, Lucocq J, Kontovounisios C, Giannis D. Anastomotic Leak in Ovarian Cancer Cytoreduction Surgery: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14215464. [PMID: 36358882 PMCID: PMC9653973 DOI: 10.3390/cancers14215464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 11/10/2022] Open
Abstract
Simple Summary Bowel resection is often required to obtain complete removal of ovarian cancer. A major complication of this operation is anastomotic leakage, which has been shown to increase morbidity and mortality in this population. Numerous original research studies have assessed the risk factors for anastomotic leaks. We aimed to conduct a systematic review and meta-analysis to identify statistically significant risk factors. This meta-analysis identified multiple bowel resections as the only significant risk factor. With further research to identify additional risk factors, new management guidelines could be implemented to minimize the risk of anastomotic leaks and improve patient outcomes. Abstract Introduction: Anastomotic leaks (AL) following ovarian cytoreduction surgery could be detrimental, leading to significant delays in commencing adjuvant chemotherapy, prolonged hospital stays and increased morbidity. The aim of this study was to investigate risk factors associated with anastomotic leaks after ovarian cytoreduction surgery. Material and methods: The MEDLINE (via PubMed), Cochrane Library, EMBASE and Scopus bibliographical databases were searched. Original clinical studies investigating risk factors for AL in ovarian cytoreduction surgery were included. Results: Eighteen studies with non-overlapping populations reporting on patients undergoing cytoreduction surgery for ovarian cancer (n = 4622, including 344 cases complicated by AL) were included in our analysis. Patients undergoing ovarian cytoreduction surgery complicated by AL had a significantly higher rate of 30-day mortality but no difference in 60-day mortality. Multiple bowel resections were associated with an increased risk of postoperative AL, while no association was observed with body mass index (BMI), American Society of Anesthesiologists (ASA) score, age, smoking, operative approach (primary versus interval cytoreductive, stapled versus hand-sewn anastomoses and formation of diverting stoma), neoadjuvant chemotherapy and use of hyperthermic intraperitoneal chemotherapy (HIPEC). Discussion: Multiple bowel resections were the only clinical risk factor associated with increased risk for AL after bowel surgery in the ovarian cancer population. The increased 30-day mortality rate in patients undergoing ovarian cytoreduction complicated by AL highlights the need to minimize the number of bowel resections in this population. Further studies are required to clarify any association between neoadjuvant chemotherapy and decreased AL rates.
Collapse
Affiliation(s)
| | - Georgios Geropoulos
- 2nd Propaedeutic Department of Surgery, Aristotle University School of Medicine, Hippokration General Hospital, 546 42 Thessaloniki, Greece
- Department of General and Upper GI Surgery, Victoria Hospital Kirkcaldy, Kirkcaldy KY2 5AH, UK
- Correspondence:
| | - Konstantinos S. Kechagias
- Society of Meta-Research and Biomedical Innovation, London W12 0FD, UK
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK
| | - Kyriakos Psarras
- 2nd Propaedeutic Department of Surgery, Aristotle University School of Medicine, Hippokration General Hospital, 546 42 Thessaloniki, Greece
| | | | - Panagiotis Giannos
- Society of Meta-Research and Biomedical Innovation, London W12 0FD, UK
- Department of Life Sciences, Faculty of Natural Sciences, Imperial College London, London SW7 2AZ, UK
| | | | - Nikoletta A. Petrou
- Department of General Surgery, The Royal Marsden Hospital, London SW3 6JJ, UK
| | - James Lucocq
- Department of Hepaticopancreaticobiliary Surgery, University of Edinburgh, Edinburgh EH8 9YL, UK
| | | | - Dimitrios Giannis
- Department of Surgery, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, Manhasset, NY 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| |
Collapse
|
9
|
Sripathi S, Khan MI, Patel N, Meda RT, Nuguru SP, Rachakonda S. Factors Contributing to Anastomotic Leakage Following Colorectal Surgery: Why, When, and Who Leaks? Cureus 2022; 14:e29964. [DOI: 10.7759/cureus.29964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
|
10
|
Lin H, Yu M, Ye G, Qin S, Fang H, Jing R, Gong T, Luo Y, Zhong M. Intracorporeal reinforcement with barbed suture is associated with low anastomotic leakage rates after laparoscopic low anterior resection for rectal cancer: a retrospective study. BMC Surg 2022; 22:335. [PMID: 36085058 PMCID: PMC9461121 DOI: 10.1186/s12893-022-01782-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background Anastomotic leakage (AL) is one of most severe postoperative complications following low anterior resection (LAR) for rectal cancer, and has an adverse impact on postoperative recovery. The occurence of AL is associated with several factors, while few studies explored the role of intracorporeal barbed suture reinforcement in it. Methods Consecutive cases underwent laparoscopic LAR for rectal cancer from Mar. 2018 to Feb. 2021 in our center were retrospectively collected. Cases were classified into the intracorporeal barbed suture reinforcement group and the control group according to whether performing intracorporeal reinforcement with barbed suture, and AL incidences were compared between two groups. Propensity score matching (PSM) was then performed based on identified risk factors to reduce biases from covariates between two groups. AL incidences in the matched cohort were compared. Results A total of 292 cases entered into the study, and AL incidences were significantly lower in the intracorporeal barbed suture reinforcement group compared with the control group (10.00% vs 2.82%, P = 0.024). Sex, BMI, preoperative adjuvant chemoradiotherapy and anastomotic level were chose for PSM analyses based on previous studies. In the matched cohort, the AL incidences were still significantly lower in the intracorporeal barbed suture reinforcement group (10.57% vs 2.44%, SD = 0.334). Conclusions Intracorporeal barbed suture reinforcement is associated with low AL incidences after laparoscopic LAR for rectal cancer, which is a potential procedure for reducing AL and worthy of application clinically.
Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01782-x.
Collapse
|
11
|
Maione F, Manigrasso M, Chini A, Vertaldi S, Anoldo P, D’Amore A, Marello A, Sorrentino C, Cantore G, Maione R, Gennarelli N, D’Angelo S, D’Alesio N, De Simone G, Servillo G, Milone M, De Palma GD. The Role of Indocyanine Near-Infrared Fluorescence in Colorectal Surgery. Front Surg 2022; 9:886478. [PMID: 35669252 PMCID: PMC9163431 DOI: 10.3389/fsurg.2022.886478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
Purposes The aim of this study was to evaluate the importance of Indocyanine Green in control of anastomosis perfusion and on anastomotic leakage rates during laparoscopic and robotic colorectal procedures. Methods A retrospective review of patients who underwent elective minimally invasive surgery for colorectal cancer from 1 January 2018 to 31 December 2020 was performed. All patients underwent Near-Infrared Fluorescence-Indocyanine Green system in two moments: before performing the anastomosis and after completing the anastomotic procedure. Primary outcomes were the rate of intraoperative change in the surgical resection due to an inadequate vascularization and the rate of postoperative anastomotic leakage. Secondary outcomes were the postoperative complications, both medical and surgical (intra-abdominal bleeding, anastomotic leakage). Results Our analysis included 93 patients. Visible fluorescence was detected in 100% of the cases. In 7 patients (7.5%), the planned site of resection was changed due to inadequate perfusion. The mean extension of the surgical resection in these 7 patients was 2.2 ± 0.62. Anastomotic leakage occurred in 2 patients (2.1%). Other complications included 8 postoperative bleedings (8.6%) and 1 pulmonary thromboembolism. Conclusions The intraoperative use of Near-Infrared Fluorescence-Indocyanine Green in colorectal surgery is safe, feasible, and associated with a substantial reduction in postoperative anastomotic leakage rate.
Collapse
Affiliation(s)
- Francesco Maione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
- Correspondence: Francesco Maione ; Alessia Chini
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Alessia Chini
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
- Correspondence: Francesco Maione ; Alessia Chini
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Pietro Anoldo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Anna D’Amore
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Alessandra Marello
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Carmen Sorrentino
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Grazia Cantore
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Rosa Maione
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Nicola Gennarelli
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Salvatore D’Angelo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Nicola D’Alesio
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Giuseppe De Simone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Giuseppe Servillo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | | |
Collapse
|
12
|
Liu Y, Yu P, Li H, Xia L, Li X, Zhang M, Cui Z, Chen J. Preservation of the left colic artery in modified laparoscopic anterior rectal resections without auxiliary abdominal incisions for transanal specimen retrieval. BMC Surg 2022; 22:148. [PMID: 35449101 PMCID: PMC9026620 DOI: 10.1186/s12893-022-01593-0] [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: 07/09/2021] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Laparoscopic low anterior rectal resection is the most widely used surgical procedure for middle and low rectal cancer. The aim of this study was to investigate the feasibility and safety of the extracorporeal placement of the anvil in preserving the left colic artery in laparoscopic low anterior rectal resection without auxiliary incisions for transanal specimen retrieval in this research. Methods Clinical data and follow-up data of patients undergoing laparoscopic low anterior rectal resection from January 2017 to October 2020 were collected. The resections were modified such that the resisting nail holder was extracorporeally placed for the transanal exenteration of the specimen without using auxiliary abdominal incisions while preserving the left colic artery. By analyzing the data of anastomotic stenosis, anastomotic bleeding and anastomotic fistulas after surgery, the advantages and disadvantages of this surgical method for patients were clarified. Results A total of 22 patients were enrolled. Five of 22 patients simultaneously underwent double-barrel terminal ileostomy. The postoperative exhaust time was 2–7 (median, 3) days. Postoperative anastomotic bleeding occurred in one patient, postoperative anastomotic fistula occurred in four patients, and postoperative anastomotic stenosis occurred in six patients. There were four patients with postoperative distant metastasis, of which three had concomitant local recurrence. Seventeen patients had no obvious symptoms or signs of recurrent metastases during follow-up appointments, and one died of liver failure. Conclusions Modified laparoscopic low anterior rectal resection, which resects the specimen through anus eversion by inserting the anvil extracorporeally while preserving the left colic artery, is safe and feasible for patients with low rectal cancer.
Collapse
Affiliation(s)
- Yulin Liu
- Department of General Surgery, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Peng Yu
- Department of Gastrointestinal Surgery, The Second People's Hospital of Lianyungang, Liaocheng, China
| | - Han Li
- Department of General Surgery, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Lijian Xia
- Department of General Surgery, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Xiangmin Li
- Department of General Surgery, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Meijuan Zhang
- Department of General Surgery, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China
| | - Zhonghui Cui
- Department of General Surgery, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China. .,Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, People's Republic of China.
| | - Jingbo Chen
- Department of General Surgery, Key Laboratory of Metabolism and Gastrointestinal Tumor, Key Laboratory of Laparoscopic Technology, Shandong Medicine and Health Key Laboratory of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, People's Republic of China. .,Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, 16766 Jingshi Road, Jinan, 250014, Shandong, People's Republic of China.
| |
Collapse
|
13
|
Zhang J, Jiang L, Zhu X. A Novel Nomogram for Prediction of Early Postoperative Complications of Total Gastrectomy for Gastric Cancer. Cancer Manag Res 2021; 13:7579-7591. [PMID: 34629904 PMCID: PMC8495149 DOI: 10.2147/cmar.s333172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/21/2021] [Indexed: 12/29/2022] Open
Abstract
Background Accurate prediction of postoperative complications is especially important for the formulation of treatment plans for patients with total gastrectomy (TG) for gastric cancer (GC). The purpose of this study was to establish a risk assessment model for early postoperative complications. Methods This retrospective study involved 363 patients with GC who underwent TG from January 2019 to December 2020. The influencing factors were explored by univariate and multivariable logistic regression; then, a nomogram was established and verified by internal verification. Results Linear stapler (OR=2.501, P=0.030), age (OR=1.052, P =0.024), blood transfusion (yes) (OR=2.450, P =0.021), one-time consumables for surgery (or=1.000, P =0.022), number of total lymph nodes (OR=1.060, P =0.011) and number of positive lymph nodes (OR=1.054, P =0.029) were independent risk factors for early postoperative complications in TG, and nomogram model was constructed. The C-index of primary cohort, modeling cohort and validation cohort was 0.787, 0.754 and 0.912. The calibration curves showed good accuracy. Conclusion This study used the indicators available before and during surgery to establish a nomogram model for early postoperative complications of total gastrectomy for gastric cancer, which found that linear stapler (LS), blood transfusion, one-time consumables for surgery, number of total lymph nodes and number of positive lymph nodes were factors.
Collapse
Affiliation(s)
- Jiawen Zhang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Linhua Jiang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Xinguo Zhu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| |
Collapse
|
14
|
Qi X, Liu M, Xu K, Gao P, Tan F, Yao Z, Zhang N, Yang H, Zhang C, Xing J, Cui M, Su X. Risk factors of symptomatic anastomotic leakage and its impacts on a long-term survival after laparoscopic low anterior resection for rectal cancer: a retrospective single-center study. World J Surg Oncol 2021; 19:187. [PMID: 34172053 PMCID: PMC8235623 DOI: 10.1186/s12957-021-02303-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background Postoperative symptomatic anastomotic leakage (AL) is a serious complication after low anterior resection (LAR) for rectal cancer. AL can potentially affect short-term patient outcomes and long-term prognosis. This study aimed to explore the risk factors and long-term survival of symptomatic AL after laparoscopic LAR for rectal cancer. Methods From May 2009 to May 2015, 298 consecutive patients who underwent laparoscopic LAR for rectal cancer with or without a defunctioning stoma were included in this study. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for symptomatic AL. Survival analysis was performed using Kaplan–Meier curves, and log-rank tests were used for group comparisons. Results Among the 298 patients enrolled in this study, symptomatic AL occurred in eight (2.7%) patients. The univariate analysis showed that age of ≤65 years (P = 0.048), neoadjuvant therapy (P = 0.095), distance from the anal verge (P = 0.078), duration of operation (P = 0.001), and pathological tumor (T) category (P = 0.004) were associated with symptomatic AL. The multivariate analysis demonstrated that prolonged duration of operation (P = 0.010) was an independent risk factor for symptomatic AL after laparoscopic LAR for rectal cancer. No statistically significant differences were observed in the 3-year (P = 0.785) and 5-year (P = 0.979) overall survival rates. Conclusions A prolonged duration of operation increased the risk of symptomatic AL after laparoscopic LAR for rectal cancer. An impact of symptomatic AL on a long-term survival was not observed in this study; however, further studies are required. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000033413) on May 31, 2020.
Collapse
Affiliation(s)
- Xinyu Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Maoxing Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Kai Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Pin Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Fei Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Zhendan Yao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Nan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Hong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Chenghai Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Jiadi Xing
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China
| | - Ming Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China.
| | - Xiangqian Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China.
| |
Collapse
|
15
|
Du R, Zhou J, Tong G, Chang Y, Li D, Wang F, Ding X, Zhang Q, Wang W, Wang L, Wang D. Postoperative morbidity and mortality after anterior resection with preventive diverting loop ileostomy versus loop colostomy for rectal cancer: A updated systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:1514-1525. [PMID: 33622575 DOI: 10.1016/j.ejso.2021.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/07/2021] [Accepted: 01/29/2021] [Indexed: 12/24/2022] Open
Abstract
The purpose of this meta-analysis was to evaluate the perioperative morbidity after anterior resection with diverting loop ileostomy (LI) versus colostomy (LC) and its reversal for rectal cancer. The studies on the application of loop ileostomy versus loop colostomy in anterior resection published from January 2000 to January 2020 were searched in the databases of Pubmed, Embase, Cochrane library, and Clinical trials. All randomized controlled trials (RCTs) and cohort studies were included according to inclusion criteria. Eight studies (2 RCTs and 6 cohort studies) totaling 1451 patients (821 LI and 630 LC) were included in the meta-analysis. The morbidity related to stoma formation and closure did not demonstrate significant differences. Significantly more LCs were complicated by stoma prolapse & retraction (OR:0.26,95%CI:0.11-0.60,P = 0.001), parastomal hernia (OR = 0.52,95%CI:0.30-0.88, P = 0.01), surgical site infection (SSI) (OR = 0.24,95%CI:0.11-0.49,P < 0.0001) and incisional hernias (OR = 0.39,95%CI:0.19-0.83,P = 0.01) than by LIs. Patients with LI demonstrated significantly more complications related to the stoma, such as dehydration (OR = 0.52,95%CI:0.30-0.88, P = 0.01) and ileus (OR = 2.23,95%CI:1.12-4.43, P = 0.02) than patients with LC. While after the subgroup analysis of different publication years, LI could reduce the risk of the morbidity after stoma formation in previous years group (P = 0.04) with a lower heterogeneity (I2 = 37%); LC could reduce the incidence of parastomal dermatitis in recent years group (P < 0.0001) without heterogeneity in each subgroup (I2 = 0%). Cumulative meta-analysis detected significant turning points in dehydration, SSI, and ileus. This meta-analysis recommends diverting LI in the anterior resection for rectal cancer, but there is a risk of dehydration, irritant dermatitis, and ileus.
Collapse
Affiliation(s)
- Rui Du
- Graduate School, Dalian Medical University, West Section of Lvshun South Road No. 9, Dalian 116044, China
| | - Jiajie Zhou
- Graduate School, Dalian Medical University, West Section of Lvshun South Road No. 9, Dalian 116044, China
| | - Guifan Tong
- Graduate School, Dalian Medical University, West Section of Lvshun South Road No. 9, Dalian 116044, China
| | - Yue Chang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Boyang Lake Road No. 10, Tianjin 301617, China
| | - Dongliang Li
- Clinical Medical College, Yangzhou University, Huaihai Road No.7, Yangzhou 225001, China
| | - Feng Wang
- Graduate School, Dalian Medical University, West Section of Lvshun South Road No. 9, Dalian 116044, China
| | - Xu Ding
- Clinical Medical College, Yangzhou University, Huaihai Road No.7, Yangzhou 225001, China
| | - Qi Zhang
- Clinical Medical College, Yangzhou University, Huaihai Road No.7, Yangzhou 225001, China
| | - Wei Wang
- Clinical Medical College of Yangzhou University, General Surgery Institute of Yangzhou-Yangzhou University, Northern Jiangsu People's Hospital, Nantong Road No.98, Yangzhou 225001, China
| | - Liuhua Wang
- Clinical Medical College of Yangzhou University, General Surgery Institute of Yangzhou-Yangzhou University, Northern Jiangsu People's Hospital, Nantong Road No.98, Yangzhou 225001, China
| | - Daorong Wang
- Clinical Medical College of Yangzhou University, General Surgery Institute of Yangzhou-Yangzhou University, Northern Jiangsu People's Hospital, Nantong Road No.98, Yangzhou 225001, China.
| |
Collapse
|
16
|
Shiwakoti E, Song J, Li J, Wu S, Zhang Z. Drainage smell and peritonitis are efficient indicators of anastomotic leakage after laparoscopic rectal cancer resection. J Int Med Res 2020; 48:300060520970766. [PMID: 33213241 PMCID: PMC7686604 DOI: 10.1177/0300060520970766] [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] [Indexed: 11/16/2022] Open
Abstract
Objective Anastomotic leakage (AL) is a frequent complication after laparoscopic rectal
cancer resection (LRCR). The main objective of the present study was to
identify accurate indicators of AL after LRCR. Methods A retrospective case-control study was performed of 185 patients who
underwent laparoscopic surgery for rectal cancer between March 2012 and
February 2017 at Beijing Friendship Hospital. Potential indicators of AL
were examined via univariate and multivariate analyses. The performance of
multivariate analysis was evaluated using receiver operating characteristic
(ROC) curves. Results The overall AL rate was 17.84%. Multivariate analysis identified drainage
smell (odds ratio [OR = 35.318, 95% confidence interval [CI] = 7.114 to
175.338) and peritonitis [OR = 17.475, 95% CI = 1.540 to 198.318) as
independent indicators of AL. The area under the ROC curve was 0.720 (95%
CI = 0.606 to 0.835). Conclusion Drainage smell and peritonitis could be reliable and accurate indicators of
AL after LRCR.
Collapse
Affiliation(s)
- Enesh Shiwakoti
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, P.R. China
| | - Jianning Song
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, P.R. China
| | - Jun Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, P.R. China
| | - Shanshan Wu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, P.R. China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, P.R. China
| |
Collapse
|
17
|
Zarzavadjian Le Bian A, Tabchouri N, Denet C, Guilbaud T, Laforest A, Tresallet C, Ferraz JM, Gayet B, Fuks D. Anastomotic Leakage After Laparoscopic Colectomy: Who Will Require Emergency Fecal Diversion? J Laparoendosc Adv Surg Tech A 2020; 31:1040-1045. [PMID: 33121354 DOI: 10.1089/lap.2020.0765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: To identify predictive factors for reoperation because of anastomotic leakage (AL) after colectomy. Methods: Between 2007 and 2016, all patients who developed AL following right or left colectomy in an expert center were included. Patients who were treated surgically (all including fecal diversion) were compared with those who were managed conservatively. Results: Overall, 81 (6.5%) patients developed AL, of which 32 (39%) were managed nonoperatively and 49 (61%) required reoperation. On average, AL was diagnosed on postoperative day 4 (3-8) and mortality reached 4.9% (n = 4). Reoperation included anastomosis resection in 31 (67%) patients of which 26 (100%) had right colectomy and 5 (25%) left colectomy. Reoperation for AL was associated with increased intensive care management (P = .026) and deep abdominal collection (P = .002). T stage >2 and right-sided colectomy were the only independent risk factors associated with the need for reoperation for AL. Stoma reversal was performed in 42 (98%) patients after a median of 4 months. Conclusions: AL after colectomy is more likely to require reoperation with fecal diversion after right-sided colectomy and T > 2 colorectal cancer.
Collapse
Affiliation(s)
- Alban Zarzavadjian Le Bian
- Department of Digestive, Bariatric and Endocrine Surgery-Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris XIII, Bobigny, France
| | - Nicolas Tabchouri
- Department of Digestive, Oncologic, and Metabolic Surgery-Institut Mutualiste Montsouris, Paris, France
| | - Christine Denet
- Department of Digestive, Oncologic, and Metabolic Surgery-Institut Mutualiste Montsouris, Paris, France
| | - Théophile Guilbaud
- Department of Digestive, Oncologic, and Metabolic Surgery-Institut Mutualiste Montsouris, Paris, France
| | - Anaïs Laforest
- Department of Digestive, Oncologic, and Metabolic Surgery-Institut Mutualiste Montsouris, Paris, France
| | - Christophe Tresallet
- Department of Digestive, Bariatric and Endocrine Surgery-Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris XIII, Bobigny, France
| | - Jean-Marc Ferraz
- Department of Digestive, Oncologic, and Metabolic Surgery-Institut Mutualiste Montsouris, Paris, France
| | - Brice Gayet
- Department of Digestive, Oncologic, and Metabolic Surgery-Institut Mutualiste Montsouris, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| | - David Fuks
- Department of Digestive, Oncologic, and Metabolic Surgery-Institut Mutualiste Montsouris, Paris, France.,Faculté de Médecine, Université Paris Descartes, Paris, France
| |
Collapse
|
18
|
Kinugasa T, Nagasu S, Murotani K, Mizobe T, Ochi T, Isobe T, Fujita F, Akagi Y. Analysis of risk factors for anastomotic leakage after lower rectal Cancer resection, including drain type: a retrospective single-center study. BMC Gastroenterol 2020; 20:315. [PMID: 32977772 PMCID: PMC7519527 DOI: 10.1186/s12876-020-01462-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/21/2020] [Indexed: 01/07/2023] Open
Abstract
Background We investigated the correlations between surgery-related factors and the incidence of anastomotic leakage after low anterior resection (LAR) for lower rectal cancer. Methods A total of 630 patients underwent colorectal surgery between 2011 and 2014 in our department. Of these, 97 patients (15%) underwent LAR and were enrolled in this retrospective study. Temporary ileostomy was performed in each patient. Results Anastomotic leakage occurred in 21 patients (21.7%). Univariate analysis showed a significant association between operative duration (p = 0.005), transanal hand-sewn anastomosis (p = 0.014), and operation procedure (p = 0.019) and the occurrence of leakage. Multivariate regression reanalysis showed that underlying disease (p = 0.044), transanal hand-sewn anastomosis (p = 0.019) and drain type (p = 0.025) were significantly associated with the occurrence of leakage. The propensity-score analysis showed that closed drainage were 6.3 times more likely to have anastomotic leakage than open drainage in relation to the amount of postoperative drainage (ml), according to the inverse probability of treatment-weighted analysis. Conclusions Our results indicate that underlying disease, transanal hand-sewn anastomosis, and closed drain may be a risk and predictive factors for anastomotic leakage after LAR for lower rectal cancer. The notable finding was that closed drainage was related to the occurrence of anastomotic leakage and closed drainage was correlated with less volume of postoperative drain discharge than open drain.
Collapse
Affiliation(s)
- Tetsushi Kinugasa
- Department of Surgery, School of Medicine, Kurume University, 67 Asahi Machi, Kurume City, Fukuoka, Japan.
| | - Sachiko Nagasu
- Department of Surgery, School of Medicine, Kurume University, 67 Asahi Machi, Kurume City, Fukuoka, Japan
| | - Kenta Murotani
- Biostatistics Center, Graduate School of Medicine, Kurume University, 67 Asahi Machi, Kurume City, Fukuoka, Japan
| | - Tomoaki Mizobe
- Department of Surgery, School of Medicine, Kurume University, 67 Asahi Machi, Kurume City, Fukuoka, Japan
| | - Takafumi Ochi
- Department of Surgery, School of Medicine, Kurume University, 67 Asahi Machi, Kurume City, Fukuoka, Japan
| | - Taro Isobe
- Department of Surgery, School of Medicine, Kurume University, 67 Asahi Machi, Kurume City, Fukuoka, Japan
| | - Fumihiko Fujita
- Department of Surgery, School of Medicine, Kurume University, 67 Asahi Machi, Kurume City, Fukuoka, Japan
| | - Yoshito Akagi
- Department of Surgery, School of Medicine, Kurume University, 67 Asahi Machi, Kurume City, Fukuoka, Japan
| |
Collapse
|
19
|
Shiwakoti E, Song J, Li J, Wu S, Zhang Z. Prediction model for anastomotic leakage after laparoscopic rectal cancer resection. J Int Med Res 2020; 48:300060520957547. [PMID: 32962496 PMCID: PMC7520932 DOI: 10.1177/0300060520957547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective This study was performed to identify risk factors for anastomotic leakage (AL) and combine these factors to create a prediction model for the risk of AL after laparoscopic rectal cancer resection. Methods This retrospective study involved 185 patients with rectal cancer who underwent laparoscopic resection from March 2012 to February 2017. Five risk factors were analyzed by multivariate analysis. A prediction model was established by combining the risk factors from the multivariate analysis, and the accuracy of the model was evaluated by a receiver operating characteristic curve. Results The overall AL rate was 17.84%. The multivariate analysis identified the following independent risk factors for AL: high body mass index (odds ratio [OR], 3.009; 95% confidence interval [CI], 1.127–7.125), preoperative radiochemotherapy (OR, 3.778; 95% CI, 1.168–12.219), larger tumor size (OR, 2.710; 95% CI, 1.119–6.562), and longer surgical time (OR, 2.476; 95% CI, 1.033–5.932). We established a prediction model that can evaluate the risk of AL by determining the predictive probability. The area under the curve for the model’s predictive performance was 0.70 (95% CI, 0.598–0.795). Conclusion A prediction model was created to predict the risk of AL after laparoscopic rectal cancer resection.
Collapse
Affiliation(s)
- Enesh Shiwakoti
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, P.R. China
| | - Jianning Song
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, P.R. China
| | - Jun Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, P.R. China
| | - Shanshan Wu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, P.R. China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, P.R. China
| |
Collapse
|
20
|
Vigueras Smith A, Sumak R, Cabrera R, Kondo W, Ferreira H. Bowel anastomosis leakage following endometriosis surgery: an evidence based analysis of risk factors and prevention techniques. Facts Views Vis Obgyn 2020; 12:207-225. [PMID: 33123696 PMCID: PMC7580259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Deep endometriosis most commonly involves the rectosigmoid junction and its management often requires a colorectal resection. Anastomotic leakage is a severe complication after resection and affects 1-6% of the cases. OBJECTIVE To evaluate the risk factors related to anastomotic leakage following endometriosis sur-gery, its prevention techniques and the role of protective stomas. METHODS A comprehensive literature review was carried out for English-language publications in Pubmed and Google Scholar. We included all studies including the following MeSH terms and key words: Anastomotic leakage AND bowel surgery OR Endometriosis OR Colorectal surgery OR Bowel endometriosis. Two authors independently made a selection and analysed relevant abstracts according to the aim of this review. RESULTS Risk factors and preventive measures were categorised considering the patient condition, the intra- operative setting and the surgical procedure itself. Level I and II recommendations include modifiable risk factors such as the use of stapled or handsewn anastomosis; intra-operative air leak test to check the integrity of the anastomosis; systematic use of pelvic and trans-anal drainage; application of protective or ghost ileostomy in low rectal resections; vaginal closure before the bowel resection; use of oral antibiotics the day before surgery and performing partial mesorectal resection near the bowel wall. Diverting stomas may decrease the morbidity and the clinical consequences of leakage over 65% of low rectal resections but may cause significant adverse effects. CONCLUSION Evidence-based protective actions are crucial to reduce clinical consequences of anastomotic leakage and to minimise the use of protective stomas in endometriosis surgery.
Collapse
Affiliation(s)
- A Vigueras Smith
- Department of Minimally Invasive Surgery Unit of Centro Hospitalar Universitário do Porto, Porto. Portugal
| | - R Sumak
- Department of Minimally Invasive Surgery Unit of Centro Hospitalar Universitário do Porto, Porto. Portugal
| | - R Cabrera
- Department of Gynaecology and Minimally Invasive Unit, Vita Batel Hospital. Curitiba. Brazil
| | - W Kondo
- Department of Gynaecology and Minimally Invasive Unit, Vita Batel Hospital. Curitiba. Brazil
| | - H Ferreira
- Department of Minimally Invasive Surgery Unit of Centro Hospitalar Universitário do Porto, Porto. Portugal
| |
Collapse
|
21
|
Balciscueta Z, Uribe N, Caubet L, López M, Torrijo I, Tabet J, Martín MC. Impact of the number of stapler firings on anastomotic leakage in laparoscopic rectal surgery: a systematic review and meta-analysis. Tech Coloproctol 2020; 24:919-925. [PMID: 32451807 DOI: 10.1007/s10151-020-02240-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several univariate and multivariate studies have already identified the number of stapler firings for laparoscopic rectal transection for rectal cancer as an independent risk factor for anastomotic leakage. The aim of this study was to perform a systematic review and meta-analysis of the anastomotic leakage rate in laparoscopic rectal surgery according to the need of using one or two stapler firings for rectal transection. METHODS PubMed, Ovid, the Cochrane Library database and ClinicalTrials.gov were searched. All of the statistical analyses were performed using Revman software. RESULTS Five studies were included (1267 patients). The overall anastomotic leakage rate was 5.5% [0.7-8.4%]. Anastomotic leak occurred in 3.5% (17/491) of the cases where 1 stapler firing was used versus 6.7% (50/786) of the cases in which 2 firings were needed (50/786). Two stapler firings were significantly associated with an increased risk of anastomotic leakage (OR 2.44, 95% CI 1.34-4.42, p = 0.003, I2 = 1%). CONCLUSIONS Our systematic review and meta-analysis suggest that two firings imply a higher rate of anastomotic leak than a single firing after laparoscopic rectal surgery with a double stapling technique. Coloproctologists should strive to reduce the number of linear stapler firings and try to transect the rectum with a single firing.
Collapse
Affiliation(s)
- Z Balciscueta
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain.
| | - N Uribe
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - L Caubet
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - M López
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - I Torrijo
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - J Tabet
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| | - M C Martín
- Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, C/San Clemente no. 12, 46015, Valencia, Spain
| |
Collapse
|
22
|
Noh GT, Chung SS, Kim KH, Lee RA. Computed tomography based cross-sectional anatomy of the pelvis predicts surgical outcome after rectal cancer surgery. Ann Surg Treat Res 2020; 99:90-96. [PMID: 32802814 PMCID: PMC7406401 DOI: 10.4174/astr.2020.99.2.90] [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: 04/16/2020] [Revised: 05/17/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Narrow pelvis has been considered an adverse factor for postoperative and oncologic outcomes after rectal cancer surgery. The aim of this study was to investigate the validity of using only axial CT scan images to calculate the pelvic cross-sectional area for the prediction of adverse outcomes after rectal cancer surgery. Methods The medical records of patients who underwent rectal cancer surgery were reviewed and analyzed retrospectively. Axial images of CT scan were used to measure the pelvic cross-sectional area. Pelvic surgical site infection (SSI), positive resection margin, and early local recurrence were adopted as end-points to analyze the impact of pelvimetry on surgical outcome. Results The mean pelvic cross-sectional area was 84.3 ± 10.9 cm2. Males had significantly smaller pelvic areas than females (P < 0.001). Comparing pelvic cross-sectional areas according to the surgical outcomes, the results indicated that patients with pelvic SSI and local failure (positive resection margin or local recurrence within 1 year) have significantly smaller cross-sectional-area than SSI and local failure-free patients (P = 0.013 and P = 0.031). A calculated cross-sectional area of 88.8 cm2 was determined as the cutoff value for the prediction of pelvic SSI and/or local failure, which was significant in a validating analysis. Conclusion The pelvic cross-sectional area obtained from a routine axial CT scan image was associated with pelvic SSI, positive resection margin, and early local recurrence. It might be an intuitive, feasible, and easily adoptable method for predicting surgical outcomes.
Collapse
Affiliation(s)
- Gyoung Tae Noh
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Soon Sup Chung
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kwang Ho Kim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ryung-Ah Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| |
Collapse
|
23
|
Kryzauskas M, Bausys A, Degutyte AE, Abeciunas V, Poskus E, Bausys R, Dulskas A, Strupas K, Poskus T. Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery. World J Surg Oncol 2020; 18:205. [PMID: 32795348 PMCID: PMC7427291 DOI: 10.1186/s12957-020-01968-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/23/2020] [Indexed: 02/03/2023] Open
Abstract
Background Anastomotic leakage (AL) significantly impairs short-term outcomes. The impact on the long-term outcomes remains unclear. This study aimed to identify the risk factors for AL and the impact on long-term survival in patients with left-sided colorectal cancer. Methods Nine-hundred patients with left-sided colorectal carcinoma who underwent sigmoid or rectal resection were enrolled in the study. Risk factors for AL after sigmoid or rectal resection were identified, and long-term outcomes of patients with and without AL were compared. Results AL rates following sigmoid and rectal resection were 5.1% and 10.7%, respectively. Higher ASA score (III–IV; OR = 10.54, p = 0.007) was associated with AL in patients undergoing sigmoid surgery on multivariable analysis. Male sex (OR = 2.40, p = 0.004), CCI score > 5 (OR = 1.72, p = 0.025), and T3/T4 stage tumors (OR = 2.25, p = 0.017) were risk factors for AL after rectal resection on multivariable analysis. AL impaired disease-free and overall survival in patients undergoing sigmoid (p = 0.009 and p = 0.001) and rectal (p = 0.003 and p = 0.014) surgery. Conclusion ASA score of III–IV is an independent risk factor for AL after sigmoid surgery, and male sex, higher CCI score, and advanced T stage are risk factors for AL after rectal surgery. AL impairs the long-term survival in patients undergoing left-sided colorectal surgery.
Collapse
Affiliation(s)
- Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Augustinas Bausys
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Vilius Abeciunas
- Faculty of Medicine, Vilnius University, Ciurlionio str. 21, 03101, Vilnius, Lithuania.
| | - Eligijus Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rimantas Bausys
- Faculty of Medicine, Vilnius University, Ciurlionio str. 21, 03101, Vilnius, Lithuania
| | - Audrius Dulskas
- Faculty of Medicine, Vilnius University, Ciurlionio str. 21, 03101, Vilnius, Lithuania
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| |
Collapse
|
24
|
A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma. Gastroenterol Res Pract 2020; 2020:4863542. [PMID: 32351555 PMCID: PMC7174905 DOI: 10.1155/2020/4863542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/21/2020] [Indexed: 02/06/2023] Open
Abstract
Background Anastomotic leakage (AL) is a common and devastating postoperative issue for patients who have undergone anterior resection of rectal carcinoma and can lead to increased short-term morbidity and mortality. Moreover, it might be associated with a worse oncological prognosis of tumors. This study is aimed at exploring the risk factors for symptomatic AL after laparoscopic anterior resection (LAR) for rectal tumors without a preventive diverting stoma. Materials and Methods This case control study retrospectively reviewed the data of 496 consecutive patients who underwent LAR of the rectum without a preventive diverting stoma at the Cancer Hospital, Chinese Academy of Medical Sciences between September 2016 and September 2017. All patients were divided into an AL group and a control group based on the occurrence of postoperative symptomatic AL. Factors regarding patient-related variables, operation-related variables, and tumor-related variables were collected and assessed between the two groups through univariate and multivariate logistic regression analyses to identify independent risk factors for AL. Results In total, 18 (3.6%) patients developed postoperative symptomatic AL. Univariate analysis showed that a synchronous primary malignancy of the left hemicolon (P = 0.047), intraoperative chemotherapy (P = 0.003), and level of anastomosis (P = 0.033) were significantly related with AL. Multivariate analysis was subsequently performed to adjust for confounding biases and confirmed that a synchronous primary malignancy of the left hemicolon (odds ratio (OR), 12.225; 95% confidence interval (CI), 1.764-84.702; P = 0.011), intraoperative chemotherapy (OR, 3.931; 95% CI, 1.334-11.583; P = 0.013), and level of anastomosis (OR, 3.224; 95% CI, 1.124-9.249; P = 0.030) were independent risk factors for symptomatic AL for patients who received LAR for rectal neoplasms without a preventive diverting stoma. Conclusions Synchronous primary malignancy of the left hemicolon, intraoperative chemotherapy, and a low anastomotic level can increase the risks of postoperative symptomatic AL after LAR of the rectum without a protective diverting stoma.
Collapse
|
25
|
Risk and early predictive factors of anastomotic leakage in laparoscopic low anterior resection for rectal cancer. World J Surg Oncol 2019; 17:178. [PMID: 31677643 PMCID: PMC6825709 DOI: 10.1186/s12957-019-1716-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022] Open
Abstract
Background In recent years, laparoscopic surgery has been widely used for rectal cancer. In laparoscopic rectal surgery, a double-stapling technique (DST) anastomosis using a stapling device is considered a relatively difficult procedure. Postoperative anastomotic leakage (AL) is a major complication related to patients’ quality of life and prognosis. Methods This study was a retrospective, single-institution study of 101 rectal cancer patients who underwent laparoscopic low anterior resection (LAR) with DST anastomosis (excluding simultaneous resection of other organs and construction of protective diverting stoma) between February 2008 and November 2017 at the Gifu University Graduate School of Medicine. This study aimed to identify risk and early predictive factors of AL. Results Among 101 patients, symptomatic AL occurred in 13 patients (12.9%), of whom 10 were male and 3 were female. Their median BMI was 22.7 kg/m2 (range, 17.9–26.4 kg/m2). Among the pre- and intraoperative factors, AL was significantly associated with tumor location (lower rectum), distance from the anal verge (< 6 cm), intraoperative blood loss (≥ 50 ml), and the number of linear staples (≥ 2) in univariate analysis. In multivariate analysis, only intraoperative blood loss (≥ 50 ml, odds ratio [OR] 4.59; 95% confidence interval [CI] 1.04–19.52; p = 0.045) was identified as an independent risk factor for AL. Among the postoperative factors, AL was significantly associated with tachycardia-POD1 (≥ 100 bpm), CRP-POD3 (≥ 15 mg/dl), fever on postoperative day (fever-POD) 3 (≥ 38 °C), and first defecation day after surgery (< POD3) in univariate analysis. In multivariate analysis, fever-POD3 (≥ 38 °C, OR 30.97; 95% CI 4.68–311.22; p = 0.0003) and first defecation day after surgery (< POD3, OR 5.82; 95% CI 1.34–31.30; p = 0.019) were identified as early predictive factors for AL. Conclusion In this study, intraoperative blood loss was an indicator of difficulty in a transection and anastomosing procedure, and fever-POD3 and early first defecation day after surgery were independent early predictive factors for AL. Careful surgery using an appropriate technique and standardized procedures with minimal bleeding and careful postoperative management paying attention to fever and defecation may prevent the onset and severity of AL.
Collapse
|
26
|
Sujatha-Bhaskar S, Whealon M, Inaba CS, Koh CY, Jafari MD, Mills S, Pigazzi A, Stamos MJ, Carmichael JC. Laparoscopic loop ileostomy reversal with intracorporeal anastomosis is associated with shorter length of stay without increased direct cost. Surg Endosc 2018; 33:644-650. [PMID: 30361967 DOI: 10.1007/s00464-018-6518-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic ileostomy closure with intracorporeal anastomosis offers potential advantages over open reversal with extracorporeal anastomosis, including earlier return of bowel function and reduced postoperative pain. In this study, we aim to compare the outcome and cost of laparoscopic ileostomy reversal (utilizing either intracorporeal or extracorporeal anastomosis) with open ileostomy reversal. METHODS A retrospective review of sequential patients undergoing elective loop ileostomy reversal between 2013 and 2016 at a single, high-volume institution was performed. Patients were stratified on the basis of operative approach: open reversal, laparoscopic-assisted reversal with extracorporeal anastomosis (LE), and laparoscopic reversal with intracorporeal anastomosis (LI). Linear and logistic regressions were utilized to perform multivariate analysis and determine risk-adjusted outcomes. RESULTS Of 132 sequential cases of loop ileostomy reversal, 50 (38%) underwent open, 49 (37%) underwent LE, and 33 (22%) underwent LI. Demographic data and preoperative comorbidities were similar between the three cohorts. Median length of stay was significantly shorter for LI (52.1 h, p < 0.05) compared to open (69.0 h) and LE (69.6 h). After risk-adjusted analysis, length of stay was significant shorter in LI compared to LE (GM 0.78, 95% CI 0.64-0.93, p < 0.01) and open reversal (GM 0.78, 95% CI 0.66-0.93, p < 0.01). Risk-adjusted 30-day morbidity rates were similar for LI compared to LE (OR 0.43, 95% CI 0.081-2.33, p = 0.33) and open reversal (OR 0.53, 95% CI 0.09-3.125, p = 0.48). Median in-hospital direct cost was similar for LI ($6575.00), LE ($6722.50), and open reversal ($6181.00). CONCLUSION Laparoscopic ileostomy reversal with intracorporeal anastomosis was associated with shorter length of stay without increased overall direct cost. The technique of laparoscopic ileostomy reversal warrants continued study in a randomized clinical trial.
Collapse
Affiliation(s)
- Sarath Sujatha-Bhaskar
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Matthew Whealon
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Colette S Inaba
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Christina Y Koh
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Mehraneh D Jafari
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Steven Mills
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Michael J Stamos
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Joseph C Carmichael
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA.
- Department of Surgery, University of California, Irvine, 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.
| |
Collapse
|
27
|
Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, Bracale U. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol 2018; 24:2247-2260. [PMID: 29881234 PMCID: PMC5989239 DOI: 10.3748/wjg.v24.i21.2247] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/06/2018] [Accepted: 05/18/2018] [Indexed: 02/06/2023] Open
Abstract
Every colorectal surgeon during his or her career is faced with anastomotic leakage (AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.
Collapse
Affiliation(s)
- Antonio Sciuto
- Department of Abdominal Surgery, Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo 71013, Italy
| | - Giovanni Merola
- Department of General Surgery, Casa di Cura Villa Berica, Vicenza 36100, Italy
| | - Giovanni D De Palma
- Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University Hospital of Naples Federico II, Naples 80131, Italy
| | - Maurizio Sodo
- Department of Public Health, University of Naples Federico II, Naples 80131, Italy
| | - Felice Pirozzi
- Department of Abdominal Surgery, Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo 71013, Italy
| | - Umberto M Bracale
- Department of Public Health, University of Naples Federico II, Naples 80131, Italy
| | - Umberto Bracale
- Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University Hospital of Naples Federico II, Naples 80131, Italy
| |
Collapse
|
28
|
Matsuzaki H, Ishihara S, Kawai K, Murono K, Otani K, Yasuda K, Nishikawa T, Tanaka T, Kiyomatsu T, Hata K, Nozawa H, Watanabe T. Smoking and tumor obstruction are risk factors for anastomotic leakage after laparoscopic anterior resection during rectal cancer treatment. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 1:7-14. [PMID: 31583294 PMCID: PMC6768678 DOI: 10.23922/jarc.2016-012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/28/2016] [Indexed: 01/23/2023]
Abstract
Objectives: To clarify the surgical outcomes and risk factors for anastomotic leakage (AL) following laparoscopic anterior resection (Lap-AR) for the treatment of rectal cancer. Methods: We retrospectively reviewed the records of 175 consecutive primary rectal cancer patients who had undergone Lap-AR at our institution between April 2012 and November 2015. Patient, tumor, and surgical variables were analyzed using univariate analyses. Results: Of 175 patients, 116 were men (66.3%). All four patients who had AL (2.3%) were men and current smokers with heavy smoking histories. In three of the AL cases, preoperative total colonoscopy was impossible owing to tumor obstruction, and the other case had concomitant obstructive colitis after oral bowel preparation. Univariate analysis identified tumor size, tumor obstruction, and smoking history as factors significantly associated with AL development. Conclusions: Tumor size, tumor obstruction, and smoking history were risk factors for AL following Lap-AR for the treatment of primary rectal cancer.
Collapse
Affiliation(s)
- Hiroyuki Matsuzaki
- Department of Surgical Oncology, The University of Tokyo, Japan.,Department of Surgery, Ibaraki Prefectural Central Hospital, Japan
| | | | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, Japan
| | - Kensuke Otani
- Department of Surgical Oncology, The University of Tokyo, Japan
| | - Koji Yasuda
- Department of Surgical Oncology, The University of Tokyo, Japan
| | | | - Toshiaki Tanaka
- Department of Surgical Oncology, The University of Tokyo, Japan
| | | | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Japan
| | | |
Collapse
|
29
|
Zhou C, Wu XR, Liu XH, Chen YF, Ke J, He XW, He XS, Hu T, Zou YF, Zheng XB, Liu HS, Hu JC, Wu XJ, Wang JP, Lan P. Male gender is associated with an increased risk of anastomotic leak in rectal cancer patients after total mesorectal excision. Gastroenterol Rep (Oxf) 2018; 6:137-143. [PMID: 29780603 PMCID: PMC5952946 DOI: 10.1093/gastro/gox039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/29/2017] [Accepted: 10/11/2017] [Indexed: 01/07/2023] Open
Abstract
Background The impact of a patient's gender on the development of anastomotic leak (AL) in rectal cancer patients following total mesorectal excision (TME) remains controversial. The aim of this study was to evaluate the association between patients' gender and the risk of AL. Methods All rectal cancer patients following TME with a primary anastomosis during the study period from 2010 to 2014 were examined. Comparisons of the post-operative AL incidence rate between male and female patients were performed. Results Of all patients examined (n = 956), 587 (61.4%) were males and 369 (38.6%) were females. Male patients were more likely to have a history of smoking and drinking alcohol, but less likely to have a history of abdominal surgery compared to female patients. A higher incidence rate of pre-operative bowel obstruction and larger tumor volume in male patients was observed in our study. Of all the patients, 81 (8.5%) developed post-operative AL. More male patients (n = 62, 10.6%) suffered from AL than females (n = 19, 5.1%) (P = 0.003). Multivariate logistic regression analyses confirmed the association between male gender and AL [odds ratio (OR): 2.41, 95% confidence interval (CI): 1.37-4.23, P = 0.002]. Similar results were also obtained in patients who underwent laparoscopic TME (OR: 2.11, 95% CI: 1.15-3.89, P = 0.016). Conclusions Male patents were found to have an increased risk for AL following TME with a primary anastomosis. A temporary protecting stoma may help to protect the anastomosis and lessen the risk for AL especially in male patients.
Collapse
Affiliation(s)
- Chi Zhou
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Xian-Rui Wu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Xuan-Hui Liu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Yu-Feng Chen
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Jia Ke
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Xiao-Wen He
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Xiao-Sheng He
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Tuo Hu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Yi-Feng Zou
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Xiao-Bin Zheng
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Hua-Shan Liu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Jian-Cong Hu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Xiao-Jian Wu
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Jian-Ping Wang
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| | - Ping Lan
- Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong 510065, China
| |
Collapse
|
30
|
Neopterin, kynurenine and tryptophan as new biomarkers for early detection of rectal anastomotic leakage. Wideochir Inne Tech Maloinwazyjne 2018; 13:44-52. [PMID: 29643957 PMCID: PMC5890852 DOI: 10.5114/wiitm.2018.73363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/03/2017] [Indexed: 02/07/2023] Open
Abstract
Introduction At present, there are no strong predictors, nor a useful scoring system, that clearly identifies patients at risk for anastomotic leakage. Aim This study aimed to investigate a new method that assesses this risk by monitoring levels of neopterin, tryptophan, and kynurenine, in bodily fluids. Material and methods This prospective study included patients who underwent elective rectal resection for carcinoma. The basic condition for inclusion was rectal anastomosis using the double-stapling technique. Preoperative levels of neopterin, tryptophan, kynurenine, and their ratios, were assessed with blood and urine samples. These levels were then monitored for 6 postoperative days in venous blood, urine, and abdominal drainage fluid. Results A total of 42 patients were enrolled in the study. Thirty-six patients underwent a laparoscopic resection and 6 patients had an open procedure. No differences were found among neopterin, tryptophan, and kynurenine serum levels. However, the groups were observed to have significant differences in the urinary neopterin/creatinine ratio: the preoperative neopterin/creatinine ratio was 139.5 μmol/mol in the group with leakage, vs 114.8 μmol/mol in the group without complications, p = 0.037. The same results were observed during the postoperative period, p = 0.012. Additionally, the group with complications had a higher mean value of neopterin in drainage fluid, p = 0.048. Conclusions Our study demonstrated that high preoperative levels of urinary neopterin could be interpreted as a risk for anastomotic leakage. Moreover, pathological levels of neopterin in urine and abdominal drainage fluid could be useful for early identification of anastomotic leakage during the postoperative period prior to its clinical development.
Collapse
|
31
|
Sakr A, Emile SH, Abdallah E, Thabet W, Khafagy W. Predictive Factors for Small Intestinal and Colonic Anastomotic Leak: a Multivariate Analysis. Indian J Surg 2016; 79:555-562. [PMID: 29217909 DOI: 10.1007/s12262-016-1556-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/07/2016] [Indexed: 12/30/2022] Open
Abstract
Anastomotic leak (AL) is a serious complication of intestinal surgery with various predisposing factors. This study aims to assess several risk factors associated with AL after small intestinal and colonic anastomoses through a multivariate analysis. Two hundred twenty-four patients (126 males) with intestinal anastomosis of a median age of 44 years were reviewed. Independent factors associated with AL were male gender (OR = 2.59, P = 0.02), chronic liver disease (CLD) (OR = 8.03, P < 0.0001), more than one associated comorbidity (OR = 5.34, P = 0.017), anastomosis conducted as emergency (OR = 2.73, P = 0.012), colonic anastomosis (OR = 2.51, P = 0.017), preoperative leukocytosis (OR = 2.57, P = 0.015), and intraoperative blood transfusion (OR = 2.25, P = 0.037). Predicative factors significantly associated with AL were male gender, CLD, multiple comorbidities, emergent anastomoses, colonic anastomoses, preoperative leukocytosis, and intraoperative blood transfusion.
Collapse
Affiliation(s)
- Ahmad Sakr
- Department General surgery, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Dakahlia Egypt
| | - Sameh Hany Emile
- Department General surgery, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Dakahlia Egypt
| | - Emad Abdallah
- Department General surgery, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Dakahlia Egypt
| | - Waleed Thabet
- Department General surgery, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Dakahlia Egypt
| | - Wael Khafagy
- Department General surgery, Faculty of Medicine, Mansoura University Hospitals, Elgomhuoria Street, Mansoura city, Dakahlia Egypt
| |
Collapse
|
32
|
Kawada K, Sakai Y. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis. World J Gastroenterol 2016; 22:5718-5727. [PMID: 27433085 PMCID: PMC4932207 DOI: 10.3748/wjg.v22.i25.5718] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/30/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.
Collapse
|
33
|
Cong ZJ, Hu LH, Zhong M, Chen L. Diverting stoma with anterior resection for rectal cancer: does it reduce overall anastomotic leakage and leaks requiring laparotomy? Int J Clin Exp Med 2015; 8:13045-13055. [PMID: 26550227 PMCID: PMC4612912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 08/03/2015] [Indexed: 06/05/2023]
Abstract
Anastomotic leakage (AL) after resection for rectal carcinoma accelerates morbidity and mortality rates, extends hospital stay, and increases treatment costs, particularly when requiring laparotomy. The role of a protective diverting stoma (DS) in avoiding leakage has repeatedly been discussed, but prospective randomized studies on this subject are rare and their results contradictory. The MEDLINE database was searched for studies of AL requiring laparotomy and of the associated rate of protective DSs in initial anterior resection (AR) to review these studies systematically. The collected data were used to determine the average rate of AL requiring laparotomy after rectal cancer surgery in the DS group compared with that in the non-DS group. A total of 930 abstracts were retrieved from MEDLINE; 15 articles on AR and 22 on low/ultralow AR (LAR) were included in the review and analysis. The overall rate of AL requiring laparotomy was 6.57% (813/12, 376) in the AR studies and 4.13% (157/3, 802) in the LAR studies. In the AR studies, the pooled AL rate in the DS group was higher than that in the non-DS group (12.30% vs. 9.16%, P < 0.001). However, the pooled rate of AL requiring laparotomy in the DS group was lower than that in the non-DS group (3.69% vs. 7.42%, P < 0.001). In the LAR studies, the pooled AL rate in the DS group was lower than that in the non-DS group (7.74% vs. 9.64%, P = 0.045). The pooled rate of AL requiring laparotomy in the DS group was also lower than that in the non-DS group (2.67% vs. 5.21%, P < 0.001). By contrast, the pooled rate of definitive stomas and mortality caused by AL did not have any statistical difference between the DS and non-DS groups in both AR studies (definitive stomas: 0% vs. 0.65%; mortality: 0.95% vs. 1.19%) and LAR studies (definitive stomas: 1.03% vs. 1.01%; mortality: 0.35% vs. 0.36%). Protective DSs significantly decrease the rate of AL in LAR. AL requiring surgical correction was significantly reduced in the DS group in both AR and LAR studies. Protective DSs did not affect the definitive stomas and mortality rate; this lack of an effect warrants further high-quality clinical trials.
Collapse
Affiliation(s)
- Zhi-Jie Cong
- Department of General Surgery, Colorectal Surgery Team, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
- Digestive Endoscopy Center, Changhai Hospital, Second Military Medical UniversityShanghai, China
| | - Liang-Hao Hu
- Digestive Endoscopy Center, Changhai Hospital, Second Military Medical UniversityShanghai, China
| | - Ming Zhong
- Department of General Surgery, Colorectal Surgery Team, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Lu Chen
- Department of General Surgery, Colorectal Surgery Team, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| |
Collapse
|
34
|
Incidence and mortality of anastomotic dehiscence requiring reoperation after rectal carcinoma resection. Int Surg 2015; 99:112-9. [PMID: 24670019 DOI: 10.9738/intsurg-d-13-00059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Anastomotic dehiscence (AD) requiring reoperation is the most severe complication following anterior rectal resection. We performed a systematic review on studies that describe AD requiring reoperation and its subsequent mortality after anterior resection for rectal carcinoma. A systematic search was performed on published literature. Data on the definition and rate of AD, the number of ADs requiring reoperation, the mortality caused by AD, and the overall postoperative mortality were pooled and analyzed. A total of 39 studies with 24,232 patients were analyzed. The studies varied in incidence and definition of AD. Systematic review of the data showed that the overall rate of AD was 8.6%, and the rate of AD requiring reoperation was 5.4%. The postoperative mortality caused by AD was 0.4%, and the overall postoperative mortality was 1.3%. We found considerable risk and mortality for AD requiring reoperation, which largely contributed to the overall postoperative mortality.
Collapse
|
35
|
Qu H, Liu Y, Bi DS. Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 2015; 29:3608-17. [PMID: 25743996 DOI: 10.1007/s00464-015-4117-x] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/01/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anastomotic leakage (AL) is a serious complication in laparoscopic rectal cancer surgery, and risk factors for AL are not well defined. Herein, we conducted a systematic review to quantify the clinicopathologic factors predictive for AL in patients who underwent laparoscopic anterior resection (LAR) for rectal cancer. METHODS A systematic search of electronic databases (PubMed, Embase, Cochrane CENTRAL, Scopus Database, and Wanfang Database) for studies published until August 2014 was performed. Cohort, case-control studies, and randomized controlled trials that examined clinical risk factors for AL were included. RESULTS Fourteen studies (seven prospective and seven retrospective studies) involving 4580 patients met final inclusion criteria. From the pooled analyses, five demographic factors were found to be significantly associated with the development of AL, including male gender (OR 2.04, 95% CI 1.50-2.77), BMI ≥25 kg/m(2) (OR 1.46, 95% CI 1.00-2.14), ASA score >2 (OR 1.74, 95% CI 1.04-2.93, P = 0.04), tumor size >5 cm (OR 1.63, 95% CI 1.01-2.64, P = 0.05), and preoperative chemotherapy (OR 1.67, 95% CI 1.10-2.55, P = 0.02). Four operative factors were significantly associated with increased risk of AL, including longer operative time (95% CI 1.71-5.77, P = 0.0002), number of stapler firings ≥3 (OR 0.17, 95% CI 0.07-0.41, P < 0.001), intra-operative transfusions/blood loss >100 mL (OR 3.79, 95% CI 2.48-5.49, P < 0.001), and anastomosis level within 5 cm from the anal verge (OR 9.63, 95% CI 3.05-30.43, P = 0.0001), while pelvic drain (OR 0.43, 95% CI 0.19-0.94, P = 0.04) was significantly associated with a lower AL rate. CONCLUSION Our analysis identified several clinicopathologic factors associated with AL in patients who underwent LAR. The knowledge of these risk factors may influence treatment- and procedure-related decisions and possibly reduce the leakage rate.
Collapse
Affiliation(s)
- Hui Qu
- Department of General Surgery, Shandong University Qilu Hospital, No.107 of the West Cultural Road, Jinan, 250012, Shandong, China.
| | - Yao Liu
- Department of Respiratory Medicine, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Dong-song Bi
- Department of General Surgery, Shandong University Qilu Hospital, No.107 of the West Cultural Road, Jinan, 250012, Shandong, China.
| |
Collapse
|
36
|
Whistance RN, Forsythe RO, McNair AGK, Brookes ST, Avery KNL, Pullyblank AM, Sylvester PA, Jayne DG, Jones JE, Brown J, Coleman MG, Dutton SJ, Hackett R, Huxtable R, Kennedy RH, Morton D, Oliver A, Russell A, Thomas MG, Blazeby JM. A systematic review of outcome reporting in colorectal cancer surgery. Colorectal Dis 2014; 15:e548-60. [PMID: 23926896 DOI: 10.1111/codi.12378] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/01/2013] [Indexed: 02/08/2023]
Abstract
AIM Evaluation of surgery for colorectal cancer (CRC) is necessary to inform clinical decision-making and healthcare policy. The standards of outcome reporting after CRC surgery have not previously been considered. METHOD Systematic literature searches identified randomized and nonrandomized prospective studies reporting clinical outcomes of CRC surgery. Outcomes were listed verbatim, categorized into broad groups (outcome domains) and examined for a definition (an appropriate textual explanation or a supporting citation). Outcome reporting was considered inconsistent if results of the outcome specified in the methods were not reported. Outcome reporting was compared between randomized and nonrandomized studies. RESULTS Of 5644 abstracts, 194 articles (34 randomized and 160 nonrandomized studies) were included reporting 766 different clinical outcomes, categorized into seven domains. A mean of 14 ± 8 individual outcomes were reported per study. 'Anastomotic leak', 'overall survival' and 'wound infection' were the three most frequently reported outcomes in 72, 60 and 44 (37.1%, 30.9% and 22.7%) studies, respectively, and no single outcome was reported in every publication. Outcome definitions were significantly more often provided in randomized studies than in nonrandomized studies (19.0% vs 14.9%, P = 0.015). One-hundred and twenty-seven (65.5%) papers reported results of all outcomes specified in the methods (randomized studies, n = 21, 61.5%; nonrandomized studies, n = 106, 66.2%; P = 0.617). CONCLUSION Outcome reporting in CRC surgery lacks consistency and method. Improved standards of outcome measurement are recommended to permit data synthesis and transparent cross-study comparisons.
Collapse
Affiliation(s)
- R N Whistance
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK; Division of Surgery Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Asari SAL, Cho MS, Kim NK. Safe anastomosis in laparoscopic and robotic low anterior resection for rectal cancer: a narrative review and outcomes study from an expert tertiary center. Eur J Surg Oncol 2014; 41:175-85. [PMID: 25468455 DOI: 10.1016/j.ejso.2014.10.060] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 09/25/2014] [Accepted: 10/17/2014] [Indexed: 02/09/2023] Open
Abstract
Anastomotic leak and stricture formation are recognised complications of colorectal anastomoses. Surgical technique has been implicated in its aetiology. The use of innovative anastomotic techniques and technical standardisation may facilitate risk modification. Early detection of complications using novel diagnostic tests can lead to reduction in delay of diagnosis as long as a standard system is used. We review our practice for creation a safe anastomosis for minimal invasive rectal cancer resection. Several technical points discussed and evaluated based on the evidence. We propose several recommendations aiming to standardize the technique and to minimize anastomotic complications.
Collapse
Affiliation(s)
- S A L Asari
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-527, South Korea
| | - M S Cho
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-527, South Korea
| | - N K Kim
- Section of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-527, South Korea.
| |
Collapse
|
38
|
Pommergaard HC, Gessler B, Burcharth J, Angenete E, Haglind E, Rosenberg J. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis 2014; 16:662-71. [PMID: 24655784 DOI: 10.1111/codi.12618] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 03/05/2014] [Indexed: 02/06/2023]
Abstract
AIM Colorectal anastomotic leakage is a serious complication. Despite extensive research, no consensus on the most important preoperative risk factors exists. The aim of this systematic review and meta-analysis was to evaluate risk factors for anastomotic leakage in patients operated with colorectal resection. METHOD The databases MEDLINE, Embase and CINAHL were searched for prospective observational studies on preoperative risk factors for anastomotic leakage. Meta-analyses were performed on outcomes based on odds ratios (OR) from multivariate regression analyses. The Newcastle-Ottawa scale was used for bias assessment within studies, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels. RESULTS This review included 23 studies evaluating 110,272 patients undergoing colorectal resection for cancer. The meta-analyses found that a low rectal anastomosis [OR = 3.26 (95% CI: 2.31-4.62)], male gender [OR = 1.48 (95% CI: 1.37-1.60)] and preoperative radiotherapy [OR = 1.65 (95% CI: 1.06-2.56)] may be risk factors for anastomotic leakage. Primarily as a result of observational design, the quality of evidence was regarded as moderate or low for these risk factors according to the GRADE approach. CONCLUSION Based on the best available evidence, important preoperative risk factors for colorectal anastomotic leakage have been identified. Knowledge on risk factors may influence treatment and procedure-related decisions, and possibly reduce the leakage rate.
Collapse
Affiliation(s)
- H C Pommergaard
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | | | | | | | | | | |
Collapse
|
39
|
Roos D, Dijksman LM, Tijssen JG, Gouma DJ, Gerhards MF, Oudemans-van Straaten HM. Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery. Br J Surg 2014; 100:1579-88. [PMID: 24264779 DOI: 10.1002/bjs.9254] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Studies on selective decontamination of the digestive tract (SDD) in elective gastrointestinal surgery have shown decreased rates of postoperative infection and anastomotic leakage. However, the prophylactic use of perioperative SDD in elective gastrointestinal surgery is not generally accepted. METHODS A systematic review of randomized clinical trials (RCTs) was conducted to compare the effect of perioperative SDD with systemic antibiotics (SDD group) with systemic antibiotic prophylaxis alone (control group), using MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. Endpoints included postoperative infection, anastomotic leakage, and in-hospital or 30-day mortality. RESULTS Eight RCTs published between 1988 and 2011, with a total of 1668 patients (828 in the SDD group and 840 in the control group), were included in the meta-analysis. The total number of patients with infection (reported in 5 trials) was 77 (19.2 per cent) of 401 in the SDD group, compared with 118 (28.2 per cent) of 418 in the control group (odds ratio 0.58, 95 per cent confidence interval 0.42 to 0.82; P = 0.002). The incidence of anastomotic leakage was significantly lower in the SDD group: 19 (3.3 per cent) of 582 patients versus 44 (7.4 per cent) of 595 patients in the control group (odds ratio 0.42, 0.24 to 0.73; P = 0.002). CONCLUSION This systematic review and meta-analysis suggests that a combination of perioperative SDD and perioperative intravenous antibiotics in elective gastrointestinal surgery reduces the rate of postoperative infection including anastomotic leakage compared with use of intravenous antibiotics alone.
Collapse
Affiliation(s)
- D Roos
- Department of Surgery, St Antonius Hospital, Nieuwegein, and
| | | | | | | | | | | |
Collapse
|
40
|
Cong ZJ, Hu LH, Bian ZQ, Ye GY, Yu MH, Gao YH, Li ZS, Yu ED, Zhong M. Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One 2013; 8:e75519. [PMID: 24086552 PMCID: PMC3783382 DOI: 10.1371/journal.pone.0075519] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 08/13/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A generally acceptable definition and a severity grading system for anastomotic leakages (ALs) following rectal resection were not available until 2010, when the International Study Group of Rectal Cancer (ISGRC) proposed a definition and a grading system for AL. METHODS A search for published data was performed using the MEDLINE database (2000 to December 5, 2012) to perform a systematic review of the studies that described AL, grade AL according to the grading system, pool data, and determine the average rate of AL for each grade after anterior resection (AR) for rectal cancer. RESULTS A total of 930 abstracts were retrieved; 40 articles on AR, 25 articles on low AR (LAR), and 5 articles on ultralow AR (ULAR) were included in the review and analysis. The pooled overall AL rate of AR was 8.58% (2,085/24,288); the rate of the asymptomatic leakage (Grade A) was 2.57%, that of AL that required active intervention without relaparotomy (Grade B) was 2.37%, and that of AL that required relaparotomy (Grade C) was 5.40%. The pooled rate of AL that required relaparotomy was higher in AR (5.40%) than in LAR (4.70%) and in ULAR (1.81%), which could be attributed to the higher rate of protective defunctioning stoma in LAR (40.72%) and ULAR (63.44%) compared with that in AR (30.11%). CONCLUSIONS The new grading system is simple that the ALs of each grade can be easily extracted from past publications, therefore likely to be accepted and applied in future studies.
Collapse
Affiliation(s)
- Zhi-Jie Cong
- Department of Colorectal Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China ; Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, China
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Snijders HS, Henneman D, van Leersum NL, ten Berge M, Fiocco M, Karsten TM, Havenga K, Wiggers T, Dekker JW, Tollenaar RAEM, Wouters MWJM. Anastomotic leakage as an outcome measure for quality of colorectal cancer surgery. BMJ Qual Saf 2013; 22:759-67. [PMID: 23687168 DOI: 10.1136/bmjqs-2012-001644] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION When comparing mortality rates between hospitals to explore hospital performance, there is an important role for adjustment for differences in case-mix. Identifying outcome measures that are less influenced by differences in case-mix may be valuable. The main goal of this study was to explore whether hospital differences in anastomotic leakage (AL) and postoperative mortality are due to differences in case-mix or to differences in treatment factors. METHODS Data of the Dutch Surgical Colorectal Audit were used. Case-mix factors and treatment-related factors were identified from the literature and their association with AL and mortality were analysed with logistic regression. Hospital differences in observed AL and mortality rates, and adjusted rates based on the logistic regression models were shown. The reduction in hospital variance after adjustment was analysed with Levene's test for equality of variances. RESULTS 17 of 22 case-mix factors and 4 of 11 treatment factors related to AL derived from the literature were available in the database. Variation in observed AL rates between hospitals was large with a maximum rate of 17%. This variation could not be attributed to differences in case-mix but more to differences in treatment factors. Hospital variation in observed mortality rates was significantly reduced after adjustment for differences in case-mix. CONCLUSIONS Hospital variation in AL is relatively independent of differences in case-mix. In contrast to 'postoperative mortality' the observed AL rates of hospitals evaluated in our study were only slightly affected after adjustment for case-mix factors. Therefore, AL rates may be suitable as an outcome indicator for measurement of surgical quality of care.
Collapse
Affiliation(s)
- H S Snijders
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Spontaneous healing of a rectovaginal fistula developing after laparoscopic segmental bowel resection for intestinal deep infiltrating endometriosis. Case Rep Obstet Gynecol 2013; 2013:837903. [PMID: 23710392 PMCID: PMC3655502 DOI: 10.1155/2013/837903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/09/2013] [Indexed: 02/07/2023] Open
Abstract
The surgical treatment of intestinal deep infiltrating endometriosis has an associated risk of major complications such as dehiscence of the intestinal anastomosis, pelvic abscess, and rectovaginal fistula. The management of postoperative rectovaginal fistula frequently requires a reoperation and the construction of a stoma for temporary fecal diversion. In this paper we describe a 27-year-old woman undergoing laparoscopic treatment of deep infiltrating endometriosis (extramucosal cystectomy, resection of the uterosacral ligaments, resection of the posterior vaginal fornix, and segmental bowel resection) complicated by a rectovaginal fistula, which healed spontaneously with nonsurgical conservative treatment.
Collapse
|
43
|
Compression anastomosis ring device in colorectal anastomosis: a review of 1,180 patients. Am J Surg 2013; 205:447-51. [PMID: 23290352 DOI: 10.1016/j.amjsurg.2012.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 02/19/2012] [Accepted: 03/04/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The nickel-titanium compression anastomosis ring device (ColonRing, NiTi Surgical Solutions, Netanya, Israel) has been cleared by the Food and Drug Administration in 2006 to construct gastrointestinal anastomoses. We evaluated the anastomotic leak rate after end-to-end anastomosis using the ColonRing device. METHODS Using a multinational (16 countries), multicenter (178 centers) data registry provided by NiTi Surgical Solutions, Netanya, Israel, we retrospectively examined clinical data of patients who underwent elective laparoscopic or open left-sided colectomy and anterior resection from January 2008 to June 2010. RESULTS A total of 1,180 patients underwent end-to-end anastomosis using the ColonRing device during the study period. The overall anastomotic leak rate was 3.22% (38 patients). The median length of hospital stay was 6 days (range 2 to 21 days). The median ring expulsion time was 8 days. The earliest ring expulsion time was 6 days; however, in 1 patient, the ring did not expel. In 4 patients, the anastomosis had to be immediately recreated because of 1 misfiring and 3 incomplete anastomoses. CONCLUSIONS The use of the ColonRing device is feasible and safe and could be considered an alternative technology for end-to-end colorectal anastomosis.
Collapse
|
44
|
Olivas AD, Shogan BD, Valuckaite V, Zaborin A, Belogortseva N, Musch M, Meyer F, L.Trimble W, An G, Gilbert J, Zaborina O, Alverdy JC. Intestinal tissues induce an SNP mutation in Pseudomonas aeruginosa that enhances its virulence: possible role in anastomotic leak. PLoS One 2012; 7:e44326. [PMID: 22952955 PMCID: PMC3432121 DOI: 10.1371/journal.pone.0044326] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 08/01/2012] [Indexed: 12/14/2022] Open
Abstract
The most feared complication following intestinal resection is anastomotic leakage. In high risk areas (esophagus/rectum) where neoadjuvant chemoradiation is used, the incidence of anastomotic leaks remains unacceptably high (∼10%) even when performed by specialist surgeons in high volume centers. The aims of this study were to test the hypothesis that anastomotic leakage develops when pathogens colonizing anastomotic sites become in vivo transformed to express a tissue destroying phenotype. We developed a novel model of anastomotic leak in which rats were exposed to pre-operative radiation as in cancer surgery, underwent distal colon resection and then were intestinally inoculated with Pseudomonas aeruginosa, a common colonizer of the radiated intestine. Results demonstrated that intestinal tissues exposed to preoperative radiation developed a significant incidence of anastomotic leak (>60%; p<0.01) when colonized by P. aeruginosa compared to radiated tissues alone (0%). Phenotype analysis comparing the original inoculating strain (MPAO1- termed P1) and the strain retrieved from leaking anastomotic tissues (termed P2) demonstrated that P2 was altered in pyocyanin production and displayed enhanced collagenase activity, high swarming motility, and a destructive phenotype against cultured intestinal epithelial cells (i.e. apoptosis, barrier function, cytolysis). Comparative genotype analysis between P1 and P2 revealed a single nucleotide polymorphism (SNP) mutation in the mexT gene that led to a stop codon resulting in a non-functional truncated protein. Replacement of the mutated mexT gene in P2 with mexT from the original parental strain P1 led to reversion of P2 to the P1 phenotype. No spontaneous transformation was detected during 20 passages in TSB media. Use of a novel virulence suppressing compound PEG/Pi prevented P. aeruginosa transformation to the tissue destructive phenotype and prevented anastomotic leak in rats. This work demonstrates that in vivo transformation of microbial pathogens to a tissue destroying phenotype may have important implications in the pathogenesis of anastomotic leak.
Collapse
Affiliation(s)
- Andrea D. Olivas
- Department of Surgery, University of Chicago, Illinois, United States of America
| | - Benjamin D. Shogan
- Department of Surgery, University of Chicago, Illinois, United States of America
| | - Vesta Valuckaite
- Department of Surgery, University of Chicago, Illinois, United States of America
- Bioengineering Institute for Advanced Surgery and Endoscopy, Chicago, Illinois, United States of America
| | - Alexander Zaborin
- Department of Surgery, University of Chicago, Illinois, United States of America
| | - Natalya Belogortseva
- Department of Surgery, University of Chicago, Illinois, United States of America
| | - Mark Musch
- Department of Medicine, University of Chicago, Chicago, Illinois, United States of America
| | - Folker Meyer
- Institute for Genomic and Systems Biology, Argonne National Laboratory, Argonne, Illinois, United States of America
| | - William L.Trimble
- Institute for Genomic and Systems Biology, Argonne National Laboratory, Argonne, Illinois, United States of America
| | - Gary An
- Department of Surgery, University of Chicago, Illinois, United States of America
| | - Jack Gilbert
- Institute for Genomic and Systems Biology, Argonne National Laboratory, Argonne, Illinois, United States of America
| | - Olga Zaborina
- Department of Surgery, University of Chicago, Illinois, United States of America
| | - John C. Alverdy
- Department of Surgery, University of Chicago, Illinois, United States of America
- Bioengineering Institute for Advanced Surgery and Endoscopy, Chicago, Illinois, United States of America
- * E-mail:
| |
Collapse
|
45
|
Cerroni M, Cirocchi R, Morelli U, Trastulli S, Desiderio J, Mezzacapo M, Listorti C, Esperti L, Milani D, Avenia N, Gullà N, Noya G, Boselli C. Ghost Ileostomy with or without abdominal parietal split. World J Surg Oncol 2011; 9:92. [PMID: 21849090 PMCID: PMC3170210 DOI: 10.1186/1477-7819-9-92] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 08/18/2011] [Indexed: 01/04/2023] Open
Abstract
Background In patients who undergo low anterior rectal resection, the fashioning of a covering stoma (CS) is still controversial. In fact, a covering stoma (ileostomy or colostomy) is worsened by major complications related to the procedure, longer recovery time, necessity of a re-intervention under general anesthesia for stoma closure and poorer quality of life. The advantage of Ghost Ileostomy (GI) is that an ileostomy can be performed only when there is clinical evidence of anastomotic leakage, without performing further interventions with related complications when anastomotic leak is absent and therefore the procedure is not necessary. Moreover, in case of anastomotic dehiscence and necessity of delayed stoma opening, mortality and morbidity in patients with GI are comparable with the ones that occur in patients which had a classic covering stoma. On the other hand, is simple to think about the possible economic saving: avoiding an admission for performing the closure of the ileostomy, with all the costs connected (OR, hospitalization, post-operative period, treatment of possible complications) represents a huge saving for the hospital management and also raise the quality of life of the patients. Methods In this study we prospectively analyzed 20 patients who underwent anterior extra-peritoneal rectum resection for rectal carcinoma with TME and fashioning of GI realized with or without abdominal parietal split. Results In the group of patients that received a GI without split laparotomy mortality was absent and in one case an anastomotic leak occurred. In the group of patients in which GI with split laparotomy was fashioned, one death occurred and there were one case of infection and one respiratory complication. Clinical follow-up was 12 months. Conclusions The use of different techniques for fashioning a GI do not present significant differences when they are performed by expert surgeons, but further evidence is needed with more randomized trials, in order to have more data supporting the clinical observation.
Collapse
Affiliation(s)
- Michele Cerroni
- Department of General Surgery, University of Perugia, St, Maria Hospital, Terni, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Roos D, Dijksman LM, Oudemans-van Straaten HM, de Wit LT, Gouma DJ, Gerhards MF. Randomized clinical trial of perioperative selective decontamination of the digestive tract versus placebo in elective gastrointestinal surgery. Br J Surg 2011; 98:1365-72. [PMID: 21751181 DOI: 10.1002/bjs.7631] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2011] [Indexed: 01/02/2023]
Abstract
BACKGROUND This randomized clinical trial analysed the effect of perioperative selective decontamination of the digestive tract (SDD) in elective gastrointestinal surgery on postoperative infectious complications and leakage. METHODS All patients undergoing elective gastrointestinal surgery during a 5-year period were evaluated for inclusion. Randomized patients received either SDD (polymyxin B sulphate, tobramycin and amphotericin) or placebo in addition to standard antibiotic prophylaxis. The primary endpoint was postoperative infectious complications and anastomotic leakage during the hospital stay or 30 days after surgery. RESULTS A total of 289 patients were randomized to either SDD (143) or placebo (146). Most patients (190, 65·7 per cent) underwent colonic surgery. There were 28 patients (19·6 per cent) with infectious complications in the SDD group compared with 45 (30·8 per cent) in the placebo group (P = 0·028). The incidence of anastomotic leakage in the SDD group was 6·3 per cent versus 15·1 per cent in the placebo group (P = 0·016). Hospital stay and mortality did not differ between groups. CONCLUSION Perioperative SDD in elective gastrointestinal surgery combined with standard intravenous antibiotics reduced the rate of postoperative infectious complications and anastomotic leakage compared with standard intravenous antibiotics alone. Perioperative SD.D should be considered for patients undergoing gastrointestinal surgery. REGISTRATION NUMBER P02.1187L (Dutch Central Committee on Research Involving Human Subjects).
Collapse
Affiliation(s)
- D Roos
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|