Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study

Lago, Víctor; Fotopoulou, Christina; Chiàntera, Vito; Minig, Lucas; Cascales-Campos, P.A.; Jurado, M.; Tejerizo, A.; Padilla-Iserte, Pablo; Malune, M.E.; Donna, Mariano Catello Di; Marina, Tiermes; Sánchez-Iglesias, José Luís; Olloqui, A.; García-Granero, Álvaro; Matute, Luis; Fornés-Ferrer, Victoria; Domingo, Santiago

doi:10.1016/j.ygyno.2019.03.241

Cited by 43 publications

(59 citation statements)

References 34 publications

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“…The recommended average ostomy closure interval is around 3 months. Patients who have severe surgical complications, fistula occurrence, or high risk factors for local recurrence should not have their ostomy reconstructed for intestinal transit re‐establishment …”

Section: Resultsmentioning

confidence: 99%

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Laporte¹,

Zanini²,

Zanvettor³

et al. 2019

Journal of Surgical Oncology

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Background and Objectives The primary treatment for locally advanced cases of cervical cancer is chemoradiation followed by high‐dose brachytherapy. When this treatment fails, pelvic exenteration (PE) is an option in some cases. This study aimed to develop recommendations for the best management of patients with cervical cancer undergoing salvage PE. Methods A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology. Of them, 68 surgeons participated in the study and were divided into 10 working groups. A literature review of studies retrieved from the National Library of Medicine database was carried out on topics chosen by the participants. These topics were indications for curative and palliative PE, preoperative and intraoperative evaluation of tumor resectability, access routes and surgical techniques, PE classification, urinary, vaginal, intestinal, and pelvic floor reconstructions, and postoperative follow‐up. To define the level of evidence and strength of each recommendation, an adapted version of the Infectious Diseases Society of America Health Service rating system was used. Results Most conducts and management strategies reviewed were strongly recommended by the participants. Conclusions Guidelines outlining strategies for PE in the treatment of persistent or relapsed cervical cancer were developed and are based on the best evidence available in the literature.

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Section: Resultsmentioning

confidence: 99%

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Laporte¹,

Zanini²,

Zanvettor³

et al. 2019

Journal of Surgical Oncology

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“…Multivariate analysis showed postoperative hemoglobin as an independent prognostic factor. Lago et al (30) in a multinational European centers study of 695 patients found a rate of CRA leakage of 6.6% (1.7-12.5%) despite 37% of them having undergone a diverting ileostomy. Multivariate analysis showed several risk factors for anastomotic leak including manual anastomosis and distance of the anastomosis from the anal verge.…”

Section: Discussionmentioning

confidence: 98%

“…CRA leak occurred in 3.6% (range, 0% to 9.0%), proximal fecal stream diversion was performed in 18.8% (range, 0% to 58.4%), major complications occurred in 23.3% and death in 1% (range, 0-6%) of the cases, respectively. Recently several (27,30). The series from Korea (27) compares the rate of CRA leakage according to whether a TMR or a CRD were performed and they showed a higher rate for TMR (5.3 vs 0%).…”

Section: Discussionmentioning

confidence: 99%

En-bloc rectosigmoid and mesorectum resection as part of pelvic cytoreductive surgery in advanced ovarian cancer

Marchand

Azadi²,

Sainz

et al. 2020

J Turkish German Gynecol Assoc

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Objective: "En-bloc" resection of pelvic tumor in ovarian cancer (OC) is still controversial. The aim was to analyze results in an OC series from a single center, all of whom underwent "en-bloc" resection as part of cytoreductive surgery. Material and Methods: Clinical and surgical records from sixty patients with ovarian carcinoma who underwent "en-bloc" resection surgery were retrospectively analyzed. Results: Patients' mean age was 56 years; 36 patients had primary disease and 24 had recurrent disease. Carcinomatosis was present in 46.7% of patients. Primary surgery was performed in 49 and interval debulking surgery in eleven. Complete cytoreduction was achieved in 55.0% and optimal in 38.3% of patients. Carcinomatosis significantly decreased the probability of complete cytoreduction [odds ratio (OR): 0.22; p=0.021]. Mesorectal infiltration occurred in 83% of patients. Risk of death was non-significantly higher (hazard ratio: 1.9) in women with mesorectal infiltration. Median overall survival was longer for patients without infiltration (46.1 vs 79.1 months; p=0.15). Eighty-five percent suffered from mild to moderate complications and colorectal anastomosis (CRA) leak occurred in two patients (3.6%) with CRA below 6 cm. Diaphragm resection had >5 times the risk for major complications (OR: 5.35; p=0.014). There was no three month mortality. Conclusion: When contiguous gross extension of disease to pelvic peritoneum and sigmoid colon is found, in patients with advanced OC, microscopic involvement of the mesorectum and intestinal wall is present in most cases making "en-bloc" resection necessary if complete cytoreduction is to be achieved. The associated morbidity is acceptable.

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“…Given the small number of patients with anastomotic leak, we did not assess the underlying risk factors. A recent multi-center study from Spain, including 457 patients, investigated the risk factors for anastomotic leak after colorectal resection in ovarian cancer patients (17). They concluded that the following variables were independent risk factors for AL: age at surgery, preoperative serum albumin level, one or more additional small bowel resections, manual anastomosis and distance of the anastomosis form the anal verge (17).…”

Section: Discussionmentioning

confidence: 99%

“…A recent multi-center study from Spain, including 457 patients, investigated the risk factors for anastomotic leak after colorectal resection in ovarian cancer patients (17). They concluded that the following variables were independent risk factors for AL: age at surgery, preoperative serum albumin level, one or more additional small bowel resections, manual anastomosis and distance of the anastomosis form the anal verge (17). Another study from Mayo Clinic evaluated 42 AL cases in comparison to 84 controls with matched factors (19).…”

Section: Discussionmentioning

confidence: 99%

The surgical outcomes and perioperative complications of bowel resection as part of debulking surgery of advanced ovarian cancer patients.

Ye¹,

Wang²,

Chen³

et al. 2020

Preprint

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Background: To review the utilization and perioperative outcomes of bowel resection during cytoreduction of ovarian cancer patients in our institution.Methods: All the patients who received bowel resection including anastomosis and ostomy formation between 2006/01 and 2018/12 were identified. Clinicopathological information was abstracted from the medical records. Postoperative morbidities were assessed according to Clavien-Dindo classification (CDC).Results: There were 182 patients in the anastomosis group and 100 patients in the ostomy group, leading to a total of 282 patients. The median age was 57 years and most patients had high-grade serous histology (88.7%). 49 (17.3%) patients received neoadjuvant chemotherapy. During operation, 78.7% patients had ascites and the median volume was 800 mL. Extensive bowel resection (at least two-segment) and upper abdominal operation was performed in 29 (10.2%) and 69 (24.4%) patients, respectively. Rectosigmoid colon was the most commonly resected (83.8%), followed by right hemicolectomy (5.9%) and small bowel resection (2.8%). No macroscopic residual disease was observed in 42.9% of the patients, while 87.9% of had residual disease ≤1 cm. For the entire cohort, 19.9% (56/282) experienced different complications, not including anastomotic leak (AL). Severe complications (CDC 3-5) accounted for 7.8%, mostly pleural effusion requiring drainage (3.5%), and followed by wound dehiscence requiring delayed repair in operation room (1.8%). Nine patients experienced AL: one in the ostomy group with extensive bowel resection and eight in the anastomosis group. The overall AL rate was 4.2% (9/212) per anastomosis. The AL rate per anastomosis was quite comparable in different populations: 4.4% (patients in the anastomosis group), 4.3% (patients with one-segment bowel resection and anastomosis), 4.0% (patients with extensive bowel resection and anastomosis) and 5.0% (patients with isolated rectosigmoid resection and anastomosis).Conclusions: Execution of bowel resection as part of debulking surgery of patients with newly diagnosed ovarian cancer resulted in an acceptable morbidity rate. BackgroundOvarian carcinoma is the most lethal gynecologic malignancy (1). Most patients present with classification; AL: anastomotic leak. Declarations Ethics approval and consent to participateThis study was approved by the institutional review board at Fudan University Shanghai Cancer Center. The written informed consent was waived due to retrospective design. Consent for publicationNot applicable.

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Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study

Cited by 43 publications

References 34 publications

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

En-bloc rectosigmoid and mesorectum resection as part of pelvic cytoreductive surgery in advanced ovarian cancer

The surgical outcomes and perioperative complications of bowel resection as part of debulking surgery of advanced ovarian cancer patients.

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