Dehiscence, stenosis and local recurrence after anterior resection in relation to the level of rectal cancer

Korontzi, M.; Kontovounisios, Christos; Armoutidis, V.; Zafiriadou, P.; Karaliotas, Constantine; Lanitis, Sophocles; Sgourakis, George

doi:10.1007/s13126-011-0052-z

Cited by 5 publications

(7 citation statements)

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“…Endoscopic treatment is often difficult in such cases. Causes of anastomotic stenosis include—but are not limited to—infection, obesity, history of irradiation, impaired blood flow, postoperative leakage, and use of a stapling device [ 1 , 2 ].…”

Section: Discussionmentioning

confidence: 99%

An endoscopic dilation method using the rendezvous approach for the treatment of severe anastomotic stenosis after rectal cancer surgery: a case report

et al. 2020

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Background Postoperative anastomotic stenosis is a common complication in colorectal cancer patients (3–30%). Complete anastomotic stenosis is rare; however, when it occurs, almost all cases require surgical treatment. We herein report a case in which endoscopic dilation was effective for treating complete anastomotic stenosis after high anterior resection in a rectal cancer patient. Case presentation The patient was a 67-year-old man who underwent laparoscopic high anterior resection for rectal cancer (RS, T4a, N0, M0, Stage IIB (TNM Classification of Malignant Tumors)) in May 2018. The postoperative course was good and the patient was discharged on the 12th postoperative day. Subsequently adjuvant chemotherapy was initiated with oral uracil and tegafur plus leucovorin (UFT/LV); however, he complained of frequent defecation and melena after completion of the first course of chemotherapy. Thus, colonoscopy was performed, which revealed anastomotic stenosis. Endoscopic dilation was initially attempted, but failed. Thus, low anterior resection was performed with diverting colostomy. Four additional courses of chemotherapy were administered for 1 month after surgery. At 6 months after the second surgery, colonoscopy was performed, and complete anastomotic stenosis was pointed out again. The patient was successfully treated by endoscopic dilation using the rendezvous method. After this treatment, the lumen of the anastomotic site was observed to have narrowed again and endoscopic dilatation to treat anastomotic stenosis was repeated. In addition, he received local injection of steroids in anastomotic stenosis site. The lumen of anastomotic stenosis remained after the local injection of steroids and closure of colostomy was performed 9 months after the second operation. Conclusions Endoscopic dilation using the rendezvous method was effective for treating anastomotic stenosis after colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

An endoscopic dilation method using the rendezvous approach for the treatment of severe anastomotic stenosis after rectal cancer surgery: a case report

et al. 2020

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“…Endoscopic treatment is often di cult in such cases. Causes of anastomotic stenosis include-but are not limited to-infection, obesity, history of irradiation, impaired blood ow, postoperative leakage, and use of a stapling device [1] [2].…”

Section: Discussionmentioning

confidence: 99%

An endoscopic dilation method using the rendezvous approach for the treatment of severe anastomotic stenosis after rectal cancer surgery: A case report

Matsuhashi

Matsuhahshi

Suetsugu

et al. 2020

Preprint

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Background: Postoperative anastomotic stenosis is a common complication in colorectal cancer patients (3-30%). Complete anastomotic stenosis is rare; however, when it occurs, almost all cases require surgical treatment. We herein report a case in which endoscopic dilation was effective for treating complete anastomotic stenosis after high anterior resection in a rectal cancer patient.Case presentation: The patient was a 67-year-old man who underwent laparoscopic high anterior resection for rectal cancer (Rs, 3/4circ, type2, pT4a, pN0, cM0, fStageII) in May 2018. The postoperative course was good and the patient was discharged on the 12th postoperative day. Subsequently adjuvant chemotherapy was initiated with oral uracil and tegafur plus leucovorin (UFT/LV); however, he complained of frequent defecation and melena after completion of the first course of chemotherapy. Thus, colonoscopy was performed, which revealed anastomotic stenosis. Endoscopic dilation was initially attempted, but failed. Thus, low anterior resection was performed with diverting colostomy. Four additional courses of chemotherapy were administered for one month after surgery. At six months after the second surgery, colonoscopy was performed, and complete anastomotic stenosis was pointed out again. The patient was successfully treated by endoscopic dilation using the rendezvous method. After this treatment, the lumen of the anastomotic site was observed to have narrowed again and endoscopic dilatation to treat anastomotic stenosis was repeated. In addition, he received local injection of steroids in anastomotic stenosis site. The lumen of anastomotic stenosis remained after the local injection of steroids and closure of colostomy was performed nine months after the second operation.Conclusions: Endoscopic dilation using the rendezvous method was effective for treating anastomotic stenosis after colorectal surgery.

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“…The likelihood of anastomotic breakdown varies depending on the surgical method used, and the level of anastomosis has also been found to be an independent risk factor for leakage. The closer the anastomosis to the anal verge, the greater the chance of breakdown following surgery [13]. Some authors consider any level less than 6 cm above the anal verge as high risk for leakage [12,13].…”

Section: Discussionmentioning

confidence: 99%

“…The closer the anastomosis to the anal verge, the greater the chance of breakdown following surgery [13]. Some authors consider any level less than 6 cm above the anal verge as high risk for leakage [12,13]. Furthermore, it has been suggested that stapled anastomoses have better outcomes than hand-sewn anastomoses [13].…”

Section: Discussionmentioning

confidence: 99%

“…While surgical technique and neoadjuvant therapies play a role in anastomotic breakdown, patient-related factors such as age greater than 60 years, male gender, preoperative medical disease, obesity, bowel obstruction, smoking, and alcohol abuse can significantly influence the probability of leakage [12,13]. Postoperative management should be catered to the patient based on risk assessment, and appropriate follow-up is essential regardless of efforts to reduce complications.…”

Section: Discussionmentioning

confidence: 99%

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Anastomotic Breakdown Five Years After Neoadjuvant Radiochemotherapy and Ultralow Anterior Resection for Rectal Adenocarcinoma

Nguyen

Dennis

2020

Cureus

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For carefully selected patients with low-lying rectal cancers, ultralow anterior resection (ULAR) can be an effective alternative to abdominal perineal resection, and together with neoadjuvant radiochemotherapy can provide the opportunity for sphincter preservation. However, ULAR is not without potential postoperative complications, particularly anastomotic dehiscence which increases in likelihood after receiving radiation therapy. While surveillance imaging is not indicated three years beyond initial surgical resection, changes in chronic symptoms refractory to conservative management may warrant further investigation. In this case report, we present an interesting case of late-onset stenosis and anastomotic breakdown following neoadjuvant radiochemotherapy, ULAR, and coloanal anastomosis for a low-lying rectal adenocarcinoma. Effective patient education, reliable symptom assessment, and multidisciplinary collaboration are essential to assessing for long-term treatment-related complications and providing appropriate treatment in a timely manner.

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Dehiscence, stenosis and local recurrence after anterior resection in relation to the level of rectal cancer

Cited by 5 publications

References 50 publications

An endoscopic dilation method using the rendezvous approach for the treatment of severe anastomotic stenosis after rectal cancer surgery: a case report

An endoscopic dilation method using the rendezvous approach for the treatment of severe anastomotic stenosis after rectal cancer surgery: a case report

An endoscopic dilation method using the rendezvous approach for the treatment of severe anastomotic stenosis after rectal cancer surgery: A case report

Anastomotic Breakdown Five Years After Neoadjuvant Radiochemotherapy and Ultralow Anterior Resection for Rectal Adenocarcinoma

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