Risk factors and endoscopic treatment for anastomotic stricture after resection in patients with colorectal cancer

Picazo-Ferrera, Katia; Jaurrieta-Rico, C.; Manzano-Robleda, María del Carmen; Alonso-Lárraga, Juan Octavio; Mora-Levy, Jose-Guillermo De La; Hernández-Guerrero, Angélica; Ramírez-Solis, Mauro Eduardo

doi:10.1016/j.rgmxen.2020.03.005

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…The protective stoma has also been shown to affect the rate of the stricture following surgery for colorectal cancer. Consistent with the present study, multiple studies identi ed the presence of a stoma as an independent risk factor for anastomotic stricture [19,20] . B P Waxman et al reported that dilatation due to fecal stream may be involved in prevention of anastomotic stricture [21] .…”

Section: Discussionsupporting

confidence: 91%

Nomogram for Benign Anastomotic Stricture After Surgery for Colorectal Cancer

Guo

Zhang

et al. 2021

Preprint

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Background Benign anastomotic stricture remains among the most prevalent complications following surgery for colorectal cancer, albeit its incidence is very low. Objective This study is aimed at identifying risk factors of anastomotic stricture as well as generating an effective nomogram for the stricture. Design: This is a retrospective study. Setting: This study was conducted from January, 2015 to December, 2019 in a single tertiary center with colorectal cancer. Patients: A total of 117 colorectal patients after surgery without recurrence including 39 with anastomotic stricture (the distance between anastomotic site and anal margin < = 20 cm) and 78 without the stricture were enrolled in this study. Main outcome measures: Their clinical and pathological data were collected. Multiple logistic regression analysis was conducted for identifying risk factors for anastomotic stricture, and the nomogram prediction model was generated. Results Multivariate analysis of the primary cohort led to identification of LCA (left colon artery) preservation (OR, 0.074; P = 0.0015), protective stoma (OR, 5.353; P = 0.012), anastomotic leakage (OR, 12.027; P = 0.005), and anastomotic distance (OR, 7.578; P = 0.012) as independent risk factors for anastomotic stricture. The following predictive model was derived: Logit (anastomotic stricture) = 0.074* LCA + 5.353* Protective stoma + 12.027* Anastomotic leakage + 7.578* Anastomotic distance. Assessment of the predictive model revealed that the area under curve (AUC) was 0.871, while the cutoff value was 15.444, with a sensitivity of 64.1% and a specificity of 94.8%. Limitations: A retrospective and case-controlled design with a small sample size from one single center is the main Limitation. Conclusions LCA preservation, protective stoma, anastomotic leakage, and anastomotic distance may affect the occurrence of anastomotic stricture following surgery for colorectal cancer. The nomogram model generated in the present study can be valuable in prediction of anastomotic stricture. Registered at Chinese Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR 2100043775).

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Section: Discussionsupporting

confidence: 91%

Nomogram for Benign Anastomotic Stricture After Surgery for Colorectal Cancer

Guo

Zhang

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…According to Sciuto et al 2 , most patients have considered that the closure of the colostomy would improve their quality of life, a procedure that could not be performed because there are adhesions that have appeared when the colostomy is longer, thus generating high risk of injury to the intestine or other viscera due to a second intervention. Another factor that should be evaluated when defining HP is the colonic stenosis present in 5.8-20% in initially anastomosed patients, considered as a protective factor against stenosis, different from patients with colostomy, where it is considered a risk factor and greater difficulty for the patient to be taken to a subsequent reconstruction 3 . On the other hand, in HP, high conversion rates to open surgery have been observed, ranging from 24% to 50%, this is significantly unfavorable, since minimally invasive surgery has shown a reduction in the risks of infection, hematoma, evisceration, and eventration versus open surgery 2 .…”

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confidence: 99%