Adverse Effects of Anastomotic Leakage on Local Recurrence and Survival After Curative Anterior Resection for Rectal Cancer: A Systematic Review and Meta‐analysis

Wang, Shuanhu; Liu, Jingjing; Wang, Shan; Zhao, Hongyun; Ge, Sitang; Wang, Wenbin

doi:10.1007/s00268-016-3761-1

Cited by 151 publications

(117 citation statements)

References 53 publications

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“…A number of studies have shown that anastomotic leak is associated with increased local recurrence and reduced disease‐free survival in patients with colorectal cancer. Although this could be due to a delay in adjuvant therapy, several mechanistic theories are worthy of discussion in the context of the microbiome: implantation of exfoliated tumour cells on to the anastomotic site, metachronous carcinogenesis and inflammation‐mediated carcinogenesis.…”

Section: Anastomotic Leak and Colorectal Cancer Recurrencementioning

confidence: 99%

Gut microbiome influences on anastomotic leak and recurrence rates following colorectal cancer surgery

Gaines

Shao

Hyman

et al. 2018

British Journal of Surgery

133

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Background The pathogenesis of colorectal cancer recurrence after a curative resection remains poorly understood. A yet-to-be accounted for variable is the composition and function of the microbiome adjacent to the tumour and its influence on the margins of resection following resection. Methods PubMed was searched for historical as well as current manuscripts dated between 1970 and 2017 using the following keywords: “colorectal cancer recurrence,” “microbiome,” “anastomotic leak,” “anastomotic failure” and “mechanical bowel preparation”. Results There is a substantial and growing body of literature to demonstrate the various mechanisms by which environmental factors act on the microbiome to alter its composition and function with the net result of adversely affecting oncological outcomes following surgery. Some of these environmental factors include diet, antibiotic use, the methods used to prepare the colon for surgery, and the physiological stress of the operation itself. Conclusion Interrogating the intestinal microbiome using next-generation sequencing technology has the potential to influence cancer outcomes following colonic resection.

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Section: Anastomotic Leak and Colorectal Cancer Recurrencementioning

confidence: 99%

Gut microbiome influences on anastomotic leak and recurrence rates following colorectal cancer surgery

Gaines

Shao

Hyman

et al. 2018

British Journal of Surgery

133

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“…Total mesorectal excision (TME) with sphincter preservation is increasingly offered for rectal cancer resection [1]. However, a distal rectal anastomosis is accompanied by significant risk of leakage [2] associated with increased morbidity and mortality and adverse oncological outcomes [3][4][5][6]. A diverting stoma reduces the consequences of anastomotic leakage [7][8][9][10][11][12], with loop ileostomy widely advocated as a routine part of TME procedures [13].…”

Section: Introductionmentioning

confidence: 99%

Renal impairment after ileostomy formation: a frequent event with long‐term consequences

et al. 2019

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Aim High stoma output and dehydration is common following ileostomy formation. However, the impact of this on renal function, both in the short term and after ileostomy reversal, remains poorly defined. We aimed to assess the independent impact on kidney function of an ileostomy after rectal cancer surgery and subsequent reversibility after ileostomy closure. Methods This retrospective single‐site cohort study identified patients undergoing rectal cancer resection from 2003 to 2017, with or without a diverting ileostomy. Renal function was calculated preoperatively, before ileostomy closure, and 6 months after ileostomy reversal (or matched times for patients without ileostomy). Demographics, oncological treatments and nephrotoxic drug prescriptions were assessed. Outcome measures were deterioration from baseline renal function and development of moderate/severe chronic kidney disease (CKD ≥ 3). Multivariate analysis was performed to assess independent risk factors for postoperative renal impairment. Results Five hundred and eighty‐three of 1213 patients had an ileostomy. Postoperative renal impairment occurred more frequently in ileostomates (9.5% absolute increase in rate of CKD ≥ 3; P < 0.0001) vs no change in patients without an ileostomy (P = 0.757). Multivariate analysis identified ileostomy formation, age, anastomotic leak and renin–angiotensin system inhibitors as independently associated with postoperative renal decline. Despite stoma closure, ileostomates remained at increased risk of progression to new or worse CKD [74/438 (16.9%)] compared to patients without an ileostomy [36/437 (8.2%), P = 0.0001, OR 2.264 (1.49–3.46)]. Conclusions Ileostomy formation is independently associated with kidney injury, with an increased risk persisting after stoma closure. Strategies to protect against kidney injury may be important in higher risk patients (elderly, receiving renin–angiotensin system antihypertensives, or following anastomotic leakage).

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“…In contrast to this improved oncological outcome, nCRT followed by TME has been associated with increased postoperative surgical morbidity and decreased long‐term functional outcome. Furthermore, anastomotic leak has been associated with an increased risk of local recurrence, reduced long‐term survival and decreased disease‐free survival.…”

Section: Discussionmentioning

confidence: 99%

Population-based study of morbidity risk associated with pathological complete response after chemoradiotherapy for rectal cancer

Sluis

Couwenberg

Bock

et al. 2020

Journal of British Surgery

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Background: Neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer may induce a pathological complete response (pCR) but increase surgical morbidity due to radiation-induced fibrosis. In this study the association between pCR and postoperative surgical morbidity was investigated.Methods: Patients in the Netherlands with rectal cancer who underwent nCRT followed by total mesorectal excision between 2009 and 2017 were included. Data were stratified into patients who underwent resection with creation of a primary anastomosis and those who had a permanent stoma procedure. The association between pCR and postoperative morbidity was investigated in univariable and multivariable logistic regression analyses. Results: pCR was observed in 976 (12⋅2 per cent) of 8003 patients. In 3472 patients who had a primary anastomosis, the presence of pCR was significantly associated with surgical complications (122 of 443 (27⋅5 per cent) versus 598 of 3029 (19⋅7 per cent) in those without pCR) and anastomotic leak (35 of 443 (7⋅9 per cent) versus 173 of 3029 (5⋅7 per cent) respectively). Multivariable analysis also showed associations between pCR and surgical complications (adjusted odds ratio (OR) 1⋅53, 95 per cent c.i. 1⋅22 to 1⋅92) and pCR and anastomotic leak (adjusted OR 1⋅41, 1⋅03 to 2⋅05). Of 4531 patients with a permanent stoma, surgical complications were observed in 120 (22⋅5 per cent) of 533 patients with a pCR, compared with 798 (20⋅0 per cent) of 3998 patients with no pCR (adjusted OR 1⋅17, 0⋅94 to 1⋅46). Conclusion: Patients with a pCR in whom an anastomosis was created were at increased risk of developing an anastomotic leak.

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Adverse Effects of Anastomotic Leakage on Local Recurrence and Survival After Curative Anterior Resection for Rectal Cancer: A Systematic Review and Meta‐analysis

Cited by 151 publications

References 53 publications

Gut microbiome influences on anastomotic leak and recurrence rates following colorectal cancer surgery

Gut microbiome influences on anastomotic leak and recurrence rates following colorectal cancer surgery

Renal impairment after ileostomy formation: a frequent event with long‐term consequences

Population-based study of morbidity risk associated with pathological complete response after chemoradiotherapy for rectal cancer

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