Anastomotic leakage in rectal cancer surgery: Retrospective analysis of risk factors

Brisinda, Giuseppe; Chiarello, Maria Michela; Pepe, Gilda; Cariati, Maria; Fico, Valeria; Mirco, Paolo; Bianchi, Valentina

doi:10.12998/wjcc.v10.i36.13321

Cited by 13 publications

(9 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Allaix et al [ 26 ] reported that intraoperative ALTs enable the detection of AL defects after laparoscopic left-sided colon resection, which could be effectively managed intraoperatively, leading to a significantly lower risk of postoperative AL. Previous studies have shown higher preoperative chemoradiotherapy rates (52.3%–67.4%) than those reported in our study [ 2 13 26 27 ]. The main reason was that we omitted preoperative chemoradiotherapy in higher rectal cancer [ 28 ].…”

Section: Discussioncontrasting

confidence: 77%

Efficacy of air leak test in detection of anastomotic leaks after rectal excision: a retrospective case-controlled study

et al. 2023

View full text Add to dashboard Cite

Purpose Although its efficacy is uncertain, an intraoperative air leak test (ALT) is commonly used to detect mechanical defects following bowel anastomosis. This study aimed to evaluate the efficacy of ALT to detect anastomotic leakage (AL) following rectal excision. Methods We reviewed our database for patients with rectal cancers who had undergone curative surgery between January 2012 and January 2018. Patients were grouped according to whether or not an ALT was performed. Propensity score analyses were performed to compare outcomes for groups in a 1:1 case-matched cohort. Results In total, 1,191 patients underwent rectal excision; 438 (219 in each group) formed the case-matched cohort for analysis. The protective stoma rate was 16.0% and 14.6% in the ALT and the no-ALT groups, respectively (P = 0.791). In the ALT group, 2 patients (0.9%) showed a positive result and were treated with rectal tube drainage, resulting in no leakage. There was no significant difference in postoperative AL rate between the groups (ALT group: 4.6% vs. no-ALT group: 4.1%, P > 0.999). Conclusion ALT played a minimal role in detecting AL following rectal excision. Further studies are warranted to validate our results and clarify whether AL can be prevented with ALT or alternative methods.

show abstract

Section: Discussioncontrasting

confidence: 77%

Efficacy of air leak test in detection of anastomotic leaks after rectal excision: a retrospective case-controlled study

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Complications from colorectal anastomosis leaks are serious issues following sphincter preservation surgery. Previous reports indicate that the anastomotic leak rate ranges from 3% to 20%, significantly increasing the risk of postoperative death by up to 27%, as well as the risk of permanent colostomies and cancer recurrence [ 11 , 12 , 19 , 20 ]. Treatment of these complications has a high success rate but can still leave severe and lasting sequelae [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, these patients must also undergo surgery to close the ileostomy, which carries many risks [ 22 , 25 - 27 ]. The research by Brisinda et al showed that ileostomy did not necessarily help reduce the anastomotic leak rate [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Complications Rate and Related Factors After Laparoscopic Sphincter-Preserving Total Mesorectal Excision for Low Rectal Cancer: A Single-Center Study in Vietnam

Huu Phu,

Tat Bang,

Van Viet

et al. 2024

Cureus

View full text Add to dashboard Cite

Background: Colorectal cancer is a significant health concern. Surgery remains a critical component of the multimodal treatment strategy. The laparoscopic sphincter-preserving total mesorectal excision (TME) is increasingly utilized and effective, offering enhanced quality of life for patients compared to previous traditional methods. Objectives: This study aims to determine the rate of complications and the related factors associated with complications following laparoscopic sphincter-preserving total mesorectal excision for low rectal cancer. Methods: This retrospective study was conducted at the University Medical Center of Ho Chi Minh City from March 2022 to March 2023. It included patients aged 18 years and older diagnosed with low rectal cancer who underwent laparoscopic sphincter-preserving total mesorectal excision. Data on patient demographics, surgical details, and postoperative complications were retrospectively collected and analyzed. Follow-ups were conducted up to six months after surgery. Results: Of the 83 patients included, the postoperative complications rate was 14.5%. The complications observed included surgical wound infections (five cases), anastomotic leaks (five cases, including three recto-vaginal fistulas and two pelvic abscesses), urinary retention (one case), and pneumonia (one case). A significant finding was the higher rate of distant metastases in patients with complications compared to those without (p=0.033). Conclusion: Laparoscopic sphincter-preserving total mesorectal excision for low rectal cancer is safe and effective, with a high success rate and low complication rate during or after surgery. Anastomotic leakage remains the most significant complication. Despite advancements in surgery, modern suturing tools, and preoperative patient optimization, complications are avoidable. Therefore, understanding the related factors and implementing preventive interventions is crucial.

show abstract

“…However, this objective is likely impossible because the occurrence of anastomotic leakage depends on various factors involving non-modifiable risk factors such as patient characteristics and comorbidities (age, gender, ASA score, diabetes, tobacco use, corticosteroid use, administration of neoadjuvant treatments), as well as histopathological factors related to the disease that required the intervention [ 2 – 4 ]. Potentially modifiable risk factors to reduce the rate of this complication have been associated with optimizing preoperative albumin and haemoglobin levels, normalizing blood glucose levels, using minimally invasive surgical techniques, precise surgical timing [ 3 ], high ligation of the inferior mesenteric artery [ 5 ] and the use of a refined surgical technique [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis

Martín-Arévalo,

Pla-Martí,

Huntley

et al. 2024

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose Three types of circular staplers can be used to perform a colorectal anastomosis: two-row (MCS), three-row (TRCS) and powered (PCS) devices. The objective of this meta-analysis has been to provide the existing evidence on which of these circular staplers would have a lower risk of presenting a leak (AL) and/or anastomotic bleeding (AB). Methods An in-depth search was carried out in the electronic bibliographic databases Embase, PubMed and SCOPUS. Observational studies were included, since randomized clinical trials comparing circular staplers were not found. Results In the case of AL, seven studies met the inclusion criteria in the PCS group and four in the TRCS group. In the case of AB, only four studies could be included in the analysis in the PCS group. The AL OR reported for PCS was 0.402 (95%-confidence interval (95%-CI): 0.266–0.608) and for AB: 0.2 (95% CI: 0.08–0.52). The OR obtained for AL in TRCS was 0.446 (95%-CI: 0.217 to 0.916). Risk difference for AL in PCS was − 0.06 (95% CI: − 0.07 to − 0.04) and in TRCS was − 0.04 (95%-CI: − 0.08 to − 0.01). Subgroup analysis did not report significant differences between groups. On the other hand, the AB OR obtained for PCS was 0.2 (95% CI: 0.08–0.52). In this case, no significant differences were observed in subgroup analysis. Conclusion PCS presented a significantly lower risk of leakage and anastomotic bleeding while TRCS only demonstrated a risk reduction in AL. Risk difference of AL was superior in the PCS than in TRCS.

show abstract

Anastomotic leakage in rectal cancer surgery: Retrospective analysis of risk factors

Cited by 13 publications

References 68 publications

Efficacy of air leak test in detection of anastomotic leaks after rectal excision: a retrospective case-controlled study

Efficacy of air leak test in detection of anastomotic leaks after rectal excision: a retrospective case-controlled study

Complications Rate and Related Factors After Laparoscopic Sphincter-Preserving Total Mesorectal Excision for Low Rectal Cancer: A Single-Center Study in Vietnam

Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis

Contact Info

Product

Resources

About