Clinical Relevance of a Grading System for Anastomotic Leakage After Low Anterior Resection: Analysis From a National Cohort Database

Frouws, Martine A.; Snijders, H.S.; Malm, S H; Liefers, Gerrit‐Jan; Velde, Cornelis J.H. van de; Neijenhuis, Peter A.; Kroon, Hidde M.

doi:10.1097/dcr.0000000000000800

Cited by 43 publications

(44 citation statements)

References 34 publications

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“…In the present study, the mortality rates observed following anastomotic leakage are similar to those of other recently published studies on population‐based data . The association between anastomotic leak and increased postoperative mortality is reasonable pathophysiologically, and has been shown previously for colorectal surgery .…”

Section: Discussionsupporting

confidence: 91%

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Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer

et al. 2018

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BackgroundAnastomotic leakage following anterior resection for rectal cancer may result in death. The aim of this study was to yield an updated, population‐based estimate of postoperative mortality and evaluate possible interacting factors.MethodsThis was a retrospective national cohort study of patients who underwent anterior resection between 2007 and 2016. Data were retrieved from a prospectively developed database. Anastomotic leakage constituted exposure, whereas outcome was defined as death within 90 days of surgery. Logistic regression analyses, using directed acyclic graphs to evaluate possible confounders, were performed, including interaction analyses.ResultsOf 6948 patients, 693 (10·0 per cent) experienced anastomotic leakage and 294 (4·2 per cent) underwent reintervention due to leakage. The mortality rate was 1·5 per cent in patients without leakage and 3·9 per cent in those with leakage. In multivariable analysis, leakage was associated with increased mortality only when a reintervention was performed (odds ratio (OR) 5·57, 95 per cent c.i. 3·29 to 9·44). Leaks not necessitating reintervention did not result in increased mortality (OR 0·70, 0·25 to 1·96). There was evidence of interaction between leakage and age on a multiplicative scale (P = 0·007), leading to a substantial mortality increase in elderly patients with leakage.ConclusionAnastomotic leakage, in particular severe leakage, led to a significant increase in 90‐day mortality, with a more pronounced risk of death in the elderly.

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Section: Discussionsupporting

confidence: 91%

“…The ambiguity in the term anastomotic leakage is problematic for all research aimed at quantifying the rate of leakage. The registry used allows the surgeon to define leakage arbitrarily, thereby threatening the validity of the data on which this study was based.…”

Section: Discussionmentioning

confidence: 99%

Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer

et al. 2018

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“…Estimation of the severity of the leakage with type of intervention is well established . Our finding of re‐laparotomy (ISREC C) being a risk factor for permanent stoma, although implicating that the severity of anastomotic leakage predicts the end result of permanent stoma, has to be interpreted considering the type of intervention performed during laparotomy.…”

Section: Discussionmentioning

confidence: 92%

“…A defunctioning stoma can reduce the morbidity of anastomotic leakage and reduce the need for urgent reoperation [3,[24][25][26], although widespread implementation has been questioned given reports of unchanged leak rates despite routine use [27], longer hospital stay and stoma-related complications [28,29]. A defunctioning stoma is also reported to alleviate the symptoms of anastomotic leakage, promote anastomosis-preserving therapy and facilitate nonoperative treatment [30]. This ameliorating effect is confirmed in our study, but a defunctioning stoma from the index procedure is not related to the final outcome of permanent stoma among patients with manifest anastomotic leakage.…”

Section: Discussionmentioning

confidence: 99%

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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“…The ISREC classification, founded on the need for re-intervention [8], is useful for understanding reasons for different AL outcomes. AL patients with a diverting stoma have a better clinical course and less frequently need a reoperation [11,24]. In low ARs a defunctioning stoma appears to mitigate the effect of an AL [14,15].…”

Section: Discussionmentioning

confidence: 99%

Late leakage after anterior resection: a defunctioning stoma alters the clinical course of anastomotic leakage

Jutesten

Draus

Frey³

et al. 2018

Colorectal Disease

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Clinical Relevance of a Grading System for Anastomotic Leakage After Low Anterior Resection: Analysis From a National Cohort Database

Cited by 43 publications

References 34 publications

Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer

Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer

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

Late leakage after anterior resection: a defunctioning stoma alters the clinical course of anastomotic leakage

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