Anastomotic Leakage and Chronic Presacral Sinus Formation After Low Anterior Resection

Borstlap, Wernard A. A.; Westerduin, E.; Aukema, Tjeerd S.; Bemelman, Willem A.; Tanis, Pieter J.

doi:10.1097/sla.0000000000002429

Cited by 212 publications

(206 citation statements)

References 29 publications

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“…Factors established as risk factors for anastomotic leakage could possibly have an impact on the long‐term outcome of permanent stoma. Neoadjuvant radiotherapy and low‐situated tumours have been reported as independent predictors of anastomotic leakage in a large cohort in which almost half of the anastomotic leakages did not heal . Neoadjuvant radiotherapy (which in our work had a tendency towards significant association with permanent stoma in binary logistic regression) could be expected to impair healing properties as well as influence the outcome of permanent stoma.…”

Section: Discussionmentioning

confidence: 50%

High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer

Jutesten

Draus

Frey³

et al. 2018

Colorectal Disease

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Aim This study investigates how often bowel continuity was restored after anastomotic leakage in anterior resection for rectal cancer and assesses the clinical factors associated with permanent stoma. Method The Swedish Colorectal Cancer Registry was used to identify cases of anastomotic leakage registered in southern Sweden between January 2001 and December 2011. Patient characteristics, surgical details and clinical information about the anastomotic leakages were retrieved from medical records. Results Of the 1442 patients operated on with anterior resection in 11 hospitals, 144 (10%) were diagnosed with anastomotic leakage after anterior resection for rectal cancer. After a median follow‐up of 87 months (range 21–165), the overall rate of permanent stoma among patients with anastomotic leakage was 65%. Age ≥ 70 years (P = 0.02) and re‐laparotomy (P < 0.001) were independently related to permanent stoma. Compared with nondefunctioned patients with anastomotic leakage, defunctioned patients with anastomotic leakage at the index procedure less often required re‐laparotomy at some point during the entire clinical course (P < 0.001), but nondefunctioned and defunctioned patients with anastomotic leakage both had permanent stoma to the same extent (67% and 62%, respectively). Conclusion Anastomotic leakage is highly associated with permanent stoma after anterior resection, especially in patients aged ≥ 70 years. In this cohort of patients with anastomotic leakage, 65% had permanent stoma at long‐term follow‐up. A defunctioning stoma ameliorates the clinical course but does not affect the end result of bowel continuity in established anastomotic leakage after anterior resection.

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Section: Discussionmentioning

confidence: 50%

High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer

Jutesten

Draus

Frey³

et al. 2018

Colorectal Disease

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“…Anastomotic leakage (AL) is one of the serious surgical complication after anterior resection 2,3 . There is been reported that the incidence of anastomotic leakage after colorectal surgery is 3% to 21% 4‐11 . It led a series complications and mortality, increased cost and time inpatient, even need to operate to the stoma 12 .…”

Section: Introductionmentioning

confidence: 99%

The influence of anastomotic leakage for rectal cancer oncologic outcome: A systematic review and meta‐analysis

Yang

Chen

et al. 2020

Journal of Surgical Oncology

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Background and Objective: Anastomotic leakage is a serious complication after arterial resection of rectal cancer. It has been found that anastomotic leakage is related to the oncological outcome. The purpose of the study is to evaluate the long-term outcome of the rectal tumor after anastomotic leakage. Methods:The effect of anastomotic leakage on the oncological outcome of rectal cancer was studied by electronic literature retrieval. Using the DerSimonian Laird random effect model to calculate the odds ratio and 95% confidence interval.Research heterogeneity was evaluated by Q statistics and I 2 , and bias was evaluated by funnel plot and Begg's test.Results: A total of 35 studies and 44 698 patients were included in the study.The studies have shown that anastomotic leakage is associated with local recurrence (OR = 1.93; 95% CI, 1.57-2.38; P < .0001), overall survival (OR = 1.64; 95% CI, 1.37-1.95; P < .00001), disease-free survival (OR = 2.07; 95% CI, 1.50-2.87; P < .00001) and cancer-specific survival (OR = 1.32; 95% CI, 1.02-1.70; P = .012), while it was not related to distant recurrence (OR = 1.25; 95% CI, 0.95-1.65; P = .12). Conclusions:The results showed that anastomotic leakage after anterior resection increased the risk of local recurrence, decreased the overall survival, cancer-specific survival and disease-free survival. K E Y W O R D S anastomotic leakage, oncologic outcome, rectal cancer 1 | INTRODUCTION Colorectal cancer has become the second reason of cancer-relative death, and the morbidity of colorectal cancer is increasing every year. 1 Anastomotic leakage (AL) is one of the serious surgical complication after anterior resection. 2,3There is been reported that the incidence of anastomotic leakage after colorectal surgery is 3% to 21%. 4-11 It led a series complications and mortality, increased cost and time inpatient, even need to operate to the stoma. 12 In addition, it has been reported that anastomotic leakage is relative to poor oncologic outcomes such as local recurrence, decreased overall survival (OS), cancer-specific survival, and disease-free survival. However, Anastomotic leakage after rectal cancer is still controversial for the long-term oncological outcome. Some research show that it is no significant correlation between anastomotic leakage and long-term oncological outcome. Four previous meta-analyses reported the oncological outcome of anastomotic leakage after colorectal cancer surgery. [63][64][65][66] Two of these studies did not separate data from colorectal cancer completely. The other two studies analyzed patients who received rectal anterior resection alone. However, one meta-analysis of rectal anterior resection failed to analyze the influence of anastomotic leakage on the OS and disease-free survival (DFS). Another meta-analysis did not analyze the effect of anastomotic leakage on distant metastasis and DFS. Therefore, we conducted a current meta-analysis to provide a comprehensive and up to date long-term outcome analysis of anastomotic leakage after rectal surgery. 1...

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“…Another anastomotic leakage has been raised from colo-anal anastomosis of the case that is anal canal tumor which was given radiotherapy. Radiotherapy is the leading factor causing anastomotic leakage [10]. In the case, the anastomosis developed within 10 days despite the ileostomy, and the process was well managed.…”

Section: Discussionmentioning

confidence: 91%

Laparoscopic colorectal surgery outcomes in our first 65 case comparing with literature

Yılmaz¹

2018

Eu Clin Anal Med

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anterior resection (AR) in 19 cases (29,2%), right colectomy in 18 cases (27,6%), abdomino-perineal resection (APR) in 5 cases (7,7%), colloanal anastomosis in 2 cases, total colectomy in 1 case (1.6%) were performed. It have been showed anastomotic leakage in 3 cases (4,6%), wound infection in 10 cases (15.3%), 3 patient incisional hernia (4,6%), ureter injury in a patient (1.5%) and urethra injury in a patient (1.5%). There was no mortality. Discussion: Although our experience with laparoscopic colorectal surgery is compatible with the literature and is not yet gold standard, we think that it gives better results than open surgery due to its advantages. Keywords

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Anastomotic Leakage and Chronic Presacral Sinus Formation After Low Anterior Resection

Cited by 212 publications

References 29 publications

High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer

High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer

The influence of anastomotic leakage for rectal cancer oncologic outcome: A systematic review and meta‐analysis

Laparoscopic colorectal surgery outcomes in our first 65 case comparing with literature

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