Incidence, risks and outcome of radiological leak following early contrast enema after anterior resection

Reilly, Frank; Burke, John P.; Appelmans, Eline; Manzoor, T; Deasy, Joseph; McNamara, Deborah A.

doi:10.1007/s00384-013-1820-8

Cited by 18 publications

(16 citation statements)

References 24 publications

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“…Although hypothetical, one could argue that the observed difference in anastomotic leakage was related to differences in immune response and thus to wound and anastomotic healing. However, other studies regularly reported higher rates of anastomotic leakage in male patients in comparison to females [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 98%

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Prospective Analysis of More than 1,000 Patients with Rectal Carcinoma: Are There Gender-Related Differences?

et al. 2014

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Background: Since the beginning of the new millennium gender medicine has become more and more relevant. The goal has been to unveil differences in presentation, treatment response, and prognosis of men and women with regard to various diseases. Methods: This study encompassed 1,061 patients who underwent surgery for rectal cancer at the Department of Surgery, University Medical Center Schleswig-Holstein Campus Lübeck, Germany, between January 1990 and December 2011. Prospectively documented demographic, clinical, pathological, and follow-up data were obtained. Analysis encompassed the comparison of clinical, histopathological, and oncological parameters with regard to the subcohorts of male and female patients. Results: No statistically significant differences could be found for clinical and histopathological parameters, location of tumor, resection with or without anastomosis, palliative or curative treatment, conversion rates, duration of surgery, and long-term survival. For the entire cohort, gender-related statistically significant differences in complications encompassed anastomotic leakage, burst abdomen, pneumonia, and urinary tract complications all of which occurred more often in men. Conclusion: Data obtained in this study suggest that there are no gender-related differences in the oncologic surgical treatment of patients with rectal carcinoma. However, male sex seems to be a risk factor for increased early postoperative morbidity.

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Section: Discussionmentioning

confidence: 98%

“…Data on clinical and oncologic outcome after surgery for rectal cancer with regard to gender are limited. On the one hand, some studies suggest that anastomotic leakage occurs more frequently in male than in female patients after anterior resection [ 13 , 14 ]. Also, male sex may imply a higher risk for in-hospital mortality [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Prospective Analysis of More than 1,000 Patients with Rectal Carcinoma: Are There Gender-Related Differences?

et al. 2014

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“…In a recent study from 2014, which included 129 patients with low anterior resection, the ISREC definition and severity-grading system was applied. Of 19 patients with contrast enema proven AL, 61% had grade A, 17% grade B, and 22% grade C [ 15 ]. These results show that this new grading system has its own shortcomings.…”

Section: Discussionmentioning

confidence: 99%

Leakage after Surgery for Rectum Cancer: Inconsistency in Reporting to the Danish Colorectal Cancer Group

Borly

Ellebæk

Qvist

2015

Surgery Research and Practice

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Purpose. Anastomotic leakage accounts for up to 1/3 of all fatalities after rectal cancer surgery. Evidence suggests that anastomotic leakage has a negative prognostic impact on local cancer recurrence and long-term cancer specific survival. The reported leakage rate in 2011 in Denmark varied from 7 to 45 percent. The objective was to clarify if the reporting of anastomotic leakage to the Danish Colorectal Cancer Group was rigorous and unequivocal. Methods. An Internet-based questionnaire was e-mailed to all Danish surgical departments, who reported to Danish Colorectal Cancer Group (DCCG) in 2011. There were 23 questions. Four core questions were whether pelvic collection, fecal appearance in a pelvic drain, rectovaginal fistula, and “watchfull” waiting patients were reported as anastomotic leakage. Results. Fourteen out of 17 departments, who in 2011 according to DDCG performed rectal cancer surgery, answered the questionnaire. This gave a response rate of 82%. In three of four core questions there was disagreement in what should be reported as anastomotic leakage. Conclusion. The reporting of anastomotic leakage to the Danish Colorectal Cancer Group was not rigorous and unequivocal. The reported anastomotic leakage rate in Danish Colorectal Cancer Group should be interpreted with caution.

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“…A full blood count, CRP measurement and a renal profile were performed daily until the day of discharge. Sixty‐seven per cent of patients underwent a routine gastrograffin enema between postoperative days 3 and 5 based on consultant preference, as previously described . Patients suspected of having AL before the gastrograffin enema, or a leak not detected by the gastrograffin enema, underwent CT of their abdomen and pelvis.…”

Section: Methodsmentioning

confidence: 99%

C‐reactive protein as a predictor of anastomotic leak in the first week after anterior resection for rectal cancer

et al. 2017

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Aim Anastomotic leak (AL) after anterior resection results in increased morbidity, mortality and local recurrence. The aim of this study was to assess the ability of C-reactive protein (CRP) to predict AL in the first week after anterior resection for rectal cancer.Method A retrospective review of a prospectively maintained database that included all patients undergoing anterior resection between January 2008 and December 2013 was performed. The ability of CRP to predict AL was assessed using area under the receiver-operating characteristics (AUC) curves. The severity of AL was defined using the International Study Group of Rectal Cancer (ISREC) grading system.Results Two-hundred and eleven patients were included in the study. Statistically significant differences in mean CRP values were found between those with and without an AL on postoperative days 5, 6 and 7. A CRP value of 132 mg/l on postoperative day 5 had an AUC of 0.75, corresponding to a sensitivity of 70%, a specificity of 76.6%, a positive predictive value of 16.3% and a negative predictive value of 97.5%. Multivariable analysis found that a CRP of > 132 mg/l on postoperative day 5 was the only statistically significant patient factor that was linked to an increased risk of AL (HR = 8.023, 95% CI: 1.936-33.238, P = 0.004).Conclusion Early detection of AL may minimize postoperative complications. CRP is a useful negative predictive test for the development of AL following anterior resection.

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Incidence, risks and outcome of radiological leak following early contrast enema after anterior resection

Abstract: In the current series, early Gastrografin enema following anterior resection identifies a 14 % radiological leak rate and has a high sensitivity and specificity for predicting clinical AL. The majority of radiological leaks may be managed conservatively.

Cited by 18 publications

References 24 publications

Prospective Analysis of More than 1,000 Patients with Rectal Carcinoma: Are There Gender-Related Differences?

Prospective Analysis of More than 1,000 Patients with Rectal Carcinoma: Are There Gender-Related Differences?

Leakage after Surgery for Rectum Cancer: Inconsistency in Reporting to the Danish Colorectal Cancer Group

C‐reactive protein as a predictor of anastomotic leak in the first week after anterior resection for rectal cancer

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