Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients

Eriksen, Morten; Wibe, Arne; Norstein, Jarle; Haffner, J. F. W.; Wiig, Johan N.

doi:10.1111/j.1463-1318.2004.00700.x

Cited by 324 publications

(299 citation statements)

References 28 publications

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“…In general, the global, clinical judgement seems to localize a subset of patients at risk for developing complications in general, whereas many patients with no risk factors at all may develop anastomotic leakage [12]. The risk factors for anastomotic leakage identified by univariate and multivariate analysis in our study corroborate with those found in other studies [1][2][3][4][5][6][7][8]. Similar to these studies, the number of risk factors present in an individual patient appeared to be an important predictor of anastomotic leakage in all anastomoses.…”

Section: Discussionsupporting

confidence: 88%

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Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek

Harlaar

Zeebregts

et al. 2009

Int J Colorectal Dis

392

239

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Background The dramatic clinical consequences of anastomotic leakage in gastrointestinal surgery can be reduced by a diverting stoma or drainage of the peri-anastomotic area. Currently, the surgeons' clinical judgement is of major importance in decision making, but reliable data of the diagnostic accuracy are lacking. In this prospective clinical study, the surgeons' predictive accuracy for anastomotic leakage was evaluated. Materials and methods In 191 patients undergoing colorectal resection with anastomosis, the risk for anastomotic leakage was determined by the surgeon on the basis of a visual analogue scale (VAS). This risk assessment was compared to the actual occurrence of anastomotic leakage post-operatively. Results A total of 26 (13.6%) patients showed anastomotic leakage. The surgeons' median predicted leakage rate was 7.1% in anastomoses >15 cm from the anal verge and 9.5% ≤15 cm (sensitivity 38/62%, specificity 46/52%). Diagnostic accuracy was not influenced by the surgeons' training level (VAS score, surgeons 7.8% vs assistant surgeons 8.5%, p=0.96, sensitivity 41% vs 44%, specificity 59% vs 48%, p=0.20). Conclusion The surgeons' clinical risk assessment appeared to have a low predictive value for anastomotic leakage in gastrointestinal surgery. The low a priori risk of anastomotic leakage of 14% resulted in a low post-test odds (11%) of correct prediction of anastomotic leakage. This warrants the ongoing search for a better diagnostic test of anastomotic leakage to prevent morbidity and mortality.

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Section: Discussionsupporting

confidence: 88%

“…Clinically relevant anastomotic leakage rates range between 3% and 19% [1,[3][4][5][6][7][8][9]. Anastomotic leakage may remain localized, causing perianastomotic inflammation or abscess formation, or may progress to generalised peritonitis.…”

Section: Introductionmentioning

confidence: 99%

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek

Harlaar

Zeebregts

et al. 2009

Int J Colorectal Dis

392

239

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“…Not only, the instant clinical consequences, but also AL carries long-term outcome, such as intra pelvic infection, peritonitis, sepsis, longer hospital stay, considerable extra cost, increased in-hospital morbidity and mortality, impaired pelvic organ function (Eriksen et al, 2005;Lee et al, 2008;Law et al, 2007;Riss et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Risk Assessment on Anastomotic Leakage after Rectal Cancer Surgery: An Analysis of 753 Patients

Liu¹,

Huang²,

Zhou³

2013

Asian Pacific Journal of Cancer Prevention

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Purpose: To investigate the risk factors for anastomotic leakage (AL) after anterior resection for rectal cancer with a double stapling technique. Patients and Methods: Between January 2004 and December 2011, 753 consecutive patients in Jiangsu Cancer Hospital and Research Institute diagnosed with rectal cancer and undergoing anterior resection with a double stapling technique were recruited. All patients experienced a total mesorectal excision (TME) operation. Additionally, decrease of postoperative tumor supplied group of factors (TSGF), which have not been reported before, was proposed as a new indicator for AL. Univariate and multivariate analysis were performed to determine risk factors for AL. Results: AL was detected in 57 (7.6%) of 753 patients with rectal cancer. The diagnosis of anastomotic leakage was confirmed between the 6th and 12th postoperative day (POD; mean 8th POD). After univariate analysis and multivariate analysis, age (p<0.001), gender (p=0.002), level of anastomosis (p < 0.001), preoperative body mass index (BMI) (p = 0.001) and reduction of TSGF in 5th POD was less than 10 m/ml (p < 0.001) were selected as 5 independent risk factors for AL. It was also indicated that a temporary defunctioning transverse ileostomy (p = 0.04) would decrease the occurrence of AL. Conclusion: AL after anterior resection for rectal carcinoma is related to elderly status, low level site of the tumor (below the peritoneal reflection), being male, preoperative BMI and the decrease of TSGF in 5 th POD is less than 10 m/ml. Preventive ileostomy is advisable after TME for low rectal tumors to prevent AL.

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“…Identified risk factors include male gender [12,13], tumor location and the level of anastomosis [11][12][13]28], steroid use [21], smoking [13,21], intraoperative adverse events [28], the lack of stoma [11,14,15], preoperative chemoradiotherapy or radiotherapy [12,28], severe bleeding [28], higher American Society of Anesthesiologists grade [21,29], and emergency surgery [29].…”

Section: Drain As An Independent Risk Factor Of Anastomotic Leak?mentioning

confidence: 99%

“…This concept has been advocated by subsequently published, large-scale retrospective studies [9,10]. However, introduction of total mesorectal excision (TME) for rectal cancer surgery has prompted further concern with this issue because of the increased incidence of anastomotic leakage with 10 to 20% [11][12][13][14][15]. The Dutch TME trial [15] demonstrated some supportive data of using pelvic drainage in decreasing anastomotic failure rate and the need for surgical re-intervention.…”

Section: Introductionmentioning

confidence: 99%

Drain vs No Drain After Colorectal Surgery

Tsujinaka

Konishi

2011

Indian J Surg Oncol

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In colorectal surgery, drains are expected to prevent hematoma, fluid collection, or abscess formation, to act as an indicator of postoperative complication, or to minimize the severity of complication-related symptoms. Routine drainage has not been advocated by meta-analyses as they failed to demonstrate any benefit in reducing anastomotic leak rate, minimizing symptoms, or serving as a warning function. Moreover, some reports even showed that drain itself is an independent risk factor of anastomosis. The introduction of total mesorectal excision (TME) for rectal cancer surgery has given further concern to this controversial issue, that the use of drain decreased anastomotic failure rate and the need for surgical re-intervention. While controversy still remains, the choice of using drain is left to the individual surgeon's preference in daily practice. Therefore, surgeons should be well acquainted with purpose of drainage (prophylaxis, information, or treatment), characteristics (materials), clinical application of drain (type of drainage system, timing of removal), surgical outcomes after using drain (incidence of postoperative complication), and drain-related complications. If drains are used, careful observation with proper use is crucial for the management. It is important that the duration of drainage should not be inadequately extended. Any complications directly associated with the use of drain should be avoided. New concepts of drain have been proposed as diagnostic tool using biomarkers, and as preventive device against anastomotic leak. This article overviews the available, published data on the use of drain in colorectal surgery.

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Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients

Cited by 324 publications

References 28 publications

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Risk Assessment on Anastomotic Leakage after Rectal Cancer Surgery: An Analysis of 753 Patients

Drain vs No Drain After Colorectal Surgery

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