The impact of bowel preparation on the severity of anastomotic leak in colon cancer patients

Haskins, Ivy N.; Fleshman, James W.; Amdur, Richard L.; Agarwal, Savita

doi:10.1002/jso.24426

Cited by 22 publications

(6 citation statements)

References 20 publications

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“…Duplication of results was a particular hazard encountered when selecting which of the studies to include that extracted information from the NSQIP database[ 26 - 29 , 32 - 36 ]. The papers were scrutinised for their enrollment dates.…”

Section: Methodsmentioning

confidence: 99%

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

Rollins¹,

Javanmard‐Emamghissi²,

Lobo³

2018

WJG

141

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AIMTo analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery.METHODSMeta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery.RESULTSA total of 36 studies (23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates (OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection (OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intra-abdominal collection (OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality (OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation (OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay (overall mean difference 0.11 d, 95%CI: -0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlled trials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures.CONCLUSIONIn the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.

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Section: Methodsmentioning

confidence: 99%

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

Rollins¹,

Javanmard‐Emamghissi²,

Lobo³

2018

WJG

141

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“…These parameters were quite consistent with the physically frail health of patients developing anastomotic leakage. There have been many trials to reduce SSI or anastomotic leakage based on the concept of giving antibiotics and surgical approach (open vs laparoscopic) . These effects could also be evaluated in Japanese patients by risk‐adjusted analysis using the risk models created in this study.…”

Section: Discussionmentioning

confidence: 99%

Risk assessment of morbidities after right hemicolectomy based on the National Clinical Database in Japan

Yoshida

Matsubara

Konno

et al. 2018

Annals of Gastroent Surgery

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ObjectiveNationwide databases are expected to provide critical data to improve medical practice. The present study used such data to develop risk models for clinically important outcomes after right hemicolectomy based on preoperative risk factors.MethodsJapan's National Clinical Database (NCD) identified 38 030 cases of right hemicolectomy in the years 2011 and 2012. These were used to analyze correlations between mortality and eight selected clinical outcomes of interest by Pearson's correlation coefficient (r). To construct risk models for the eight selected clinical outcomes, 80% of all the examined cases were extracted randomly as a development cohort, and preoperative risk factors for each clinical outcome were identified using a forward stepwise selection method. Morbidities predicted from the risk models were used to find areas under the receiver operator curves among the remaining 20% of the testing cohort.ResultsThe following clinical outcomes were identified as highly associated with operative mortality: systemic sepsis (r = .360), renal failure (r = .341), unplanned intubation (r = .316) and central nervous system (CNS) occurrences (r = .301). Risk models containing up to 21 preoperative variables were constructed for these eight postoperative clinical outcomes. Predictive values of the eight models were as follows: surgical site infections (0.634), anastomotic leakage (0.656), systemic sepsis (0.816), pneumonia (0.846), unplanned intubation (0.838), renal failure (0.883), CNS occurrences (0.833) and transfusion >5 units (0.846).ConclusionsThis study indicated that the NCD‐generated risk models for six of the eight selected critical postoperative outcomes had high discrimination among right hemicolectomy patients. These risk models can accurately identify high‐risk patients prior to surgery.

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“…Anastomotic leakage (AL) is one of the most dreadful complications after sphincter‐sparing procedures for rectal cancer. The leak rates are found to be much higher (9–24%)3 with colorectal/coloanal anastomosis in rectal cancer surgery comparing to those (10–13%)5 with ileocolonic/colonic anastomosis in colon cancer surgery. Although minor AL could be managed by antibiotics and conservative methods, symptomatic AL usually requires emergency surgery, increases morbidity, prolongs post‐operative hospital stay and becomes life threatening when general peritonitis or sepsis occurs 6.…”

Section: Introductionmentioning

confidence: 89%

Intraoperative indocyanine green fluorescence angiography to prevent anastomotic leak after low anterior resection for rectal cancer: a meta‐analysis

Shen

Yang

et al. 2020

ANZ Journal of Surgery

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Background: Anastomotic leakage (AL) is one of the most dreadful complications after rectal cancer surgery. Indocyanine green fluorescence angiography (ICG FA) is now being used to evaluate blood supply at the anastomotic site. The aim of this study is to conduct a meta-analysis of the available literature to evaluate whether ICG FA could prevent AL after low anterior resection (LAR) for rectal cancer. Methods: Databases including PubMed, Web of Science, Google Scholar databases, Cochrane Library and China National Knowledge Infrastructure were searched to find out potential comparative studies comparing AL rates after LAR between intraoperative use and non-use of ICG FA. Results: A total of 1499 patients undergoing LAR in six studies were included. Intraoperative use of ICG FA was associated with lower AL rate (odds ratio (OR) 0.30; 95% confidence interval (CI) 0.19-0.49; P < 0.001; I 2 = 0%), overall post-operative complication rate (OR 0.46; 95% CI 0.30-0.70; P < 0.001; I 2 = 0%) and reoperation rate (OR 0.21; 95% CI 0.06-0.75; P = 0.020; I 2 = 0%). The initial transection line was changed in 7.62% (31/407) of patients in the ICG group and 19.35% (6/31) of patients suffered AL. In transection line unchanged patients (376/407), 5.05% (19/376) of patients suffered AL. Conclusion: Intraoperative use of ICG FA is associated with lower incidence of AL after LAR. The benefit of ICG FA may be that it could identify patients with high risk for AL.

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The impact of bowel preparation on the severity of anastomotic leak in colon cancer patients

Abstract: BP is not associated with worse patients outcomes in those patients with an established anastomotic leak following elective colon research with primary anastomosis. J. Surg. Oncol. 2016;114:810-813. © 2016 2016 Wiley Periodicals, Inc.

Cited by 22 publications

References 20 publications

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis

Risk assessment of morbidities after right hemicolectomy based on the National Clinical Database in Japan

Intraoperative indocyanine green fluorescence angiography to prevent anastomotic leak after low anterior resection for rectal cancer: a meta‐analysis

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