Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients (original) (raw)
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BMC Cancer
Background The influence of anastomotic leakage (AL) on local recurrence rates and survival in rectal cancer remains controversial. The aim of this study was to analyze the effect of asymptomatic anastomotic leakage (AAL) and symptomatic anastomotic leakage (SAL) on short- and long-term outcome after curative rectal cancer resection. Methods All patients who underwent surgical resection of non-metastatic rectal cancer with curative intent from January 2005 to December 2017 were retrospectively analyzed. Short-term morbidity, long-term functional and oncological outcomes were compared between patients with SAL, AAL and without AL (WAL). Results Overall, 200 patients were included and AL was observed in 39 (19.5%) patients (10 AAL and 29 SAL) with a median follow-up of 38.5 months. Rectal cancer location and preoperative neoadjuvant treatment was similar between the three groups. Postoperative 30-day mortality rate was nil. The permanent stoma rate was higher in patients with SAL or A...
Turkish Journal of Colorectal Disease, 2018
Bu çalışmanın amacı, rektum kanseri nedeniyle opere edilen hastaları anastomoz kaçağına (AK) yatkın hale getirebilecek risk faktörlerini tespit etmek ve diversiyon stomanın (DS), gelişen AK şiddetini azaltıp azaltmadığını incelemektir. Yöntem: Kliniğimizde Ocak 2010-Aralık 2016 tarihleri arasında rektum kanseri nedeniyle elektif küratif cerrahi uygulanmış hastalar çalışmaya dahil edildi. AK tanımı ve şiddeti, International Study Group of Rectal Cancer tarafından belirlenen kriterler kullanılarak belirlendi. Klinik AK saptanan hastalarda klinik, cerrahi ve patolojik sonuçlarla ile ilişkili değişkenler arasındaki ilişkiler tek değişkenli ve çok değişkenli analizle incelendi. Subgrup analizde AK tespit edilen hastalar ise DS açılan ve açılmayan şeklinde iki gruba ayrılarak incelendi.
Purpose Anterior resection (AR) is considered the gold standard for curative cancer treatment in the middle and upper rectum. The goal of the sphincter-preserving procedure is vulnerable to anastomotic leak (AL) complications. Defunctioning stoma (DS) became the protective measure against AL. Often a defunctioning loop-ileostomy is used, which is associated with substantial morbidity. However, not much is known if the routine use of DS reduces the overall incidence of AL. Methods Elective patients subjected to AR in 2007–2009 and 2016-18 were recruited from the Swedish colorectal cancer registry (SCRCR). Patient characteristics, including DS status and occurrence of AL, were analyzed. In addition, independent risk factors for AL were investigated by multivariate regression. Results The statistical increase of DS from 71.6% in 2007–2009 to 76.7% in 2016–2018 did not impact the incidence of AL (9.2% and 8.2%), respectively. DLI was constructed in more than 35% of high-located tumors ≥...
International Journal of Colorectal Disease
Purpose A diverting stoma is commonly formed to reduce the rate of anastomotic leak following anterior resection with anastomosis, although some studies question this strategy. The aim of this study was to assess the leak rates and overall complication burden after anterior resection with and without a diverting stoma. Methods A 5-year national cohort with prospectively registered data of patients who underwent elective anterior resection for rectal cancer located < 15 cm from the anal verge. Data were retrieved from the Norwegian Registry for Gastrointestinal Surgery and the Norwegian Colorectal Cancer Registry. Primary end point was relaparotomy or relaparoscopy for anastomotic leak within 30 days from index surgery. Secondary endpoints were postoperative complications including reoperation for any cause. Results Some 1018 patients were included of whom 567 had a diverting stoma and 451 had not. Rate of reoperation for anastomotic leak was 13 out of 567 (2.3%) for patients with...
Impact of anastomotic leakage on oncological outcome after rectal cancer resection
British Journal of Surgery, 2007
Background: Anastomotic leakage has a major impact on morbidity and mortality in rectal cancer surgery. Its relevance to oncological outcome is controversial. This observational study investigated the influence of anastomotic leakage on oncological outcome. Methods: Data for 1741 patients undergoing curative resection of rectal cancer (located less than 12 cm from the anal verge) with normal healing were compared with those for 303 patients who experienced anastomotic leakage. Morbidity, mortality and long-term oncological outcomes were analysed. Results: Median follow-up was 40 months. Patients with anastomotic leakage had a higher postoperative mortality rate than those with no leakage (4•3 versus 1•2 per cent; P < 0•001). Patients with leakage necessitating surgical treatment had a higher 5-year local recurrence rate (17•5 versus 10•1 per cent; P = 0•006) and a lower 5-year disease-free survival rate (70•9 versus 75•4 per cent; P = 0•020) than those without leakage. Patients with anastomotic leakage not requiring surgical intervention did not have a worse oncological outcome. Conclusion: A negative prognostic impact of anastomotic leakage on local recurrence and disease-free survival was found only for patients with leakage needing surgical revision.
Risk factors for anastomotic leakage after resection for rectal cancer
The American Journal of Surgery, 2008
BACKGROUND: Controversy still exists concerning the impact of patient and tumor characteristics on anastomotic dehiscence after resection for rectal cancer. METHODS: Between January 1986 and July 2006, 472 patients underwent curative rectal resection. Patient and tumor characteristics, details of treatment, and postoperative results were recorded prospectively. Univariate and multivariate analysis were applied to identify risk factors for anastomotic leakage. RESULTS: In our patients, the anastomotic leak rate was 10.4% (49 of 472 patients), and mortality was 2.2% (1 of 49 patients). In univariate analysis, tumor diameter and absence of a protective stoma were associated with increased anastomotic leak rate, whereas American Society of Anesthesiologists (ASA) score and tumor localization showed borderline significance. In multivariate analysis, tumor diameter, tumor localization, and absence of a protective stoma were significantly associated with anastomotic leakage. CONCLUSIONS: Patients with large and low lying rectal tumors are at high risk for anastomotic leakage. A protective stoma significantly decreases the rate of clinical leaks and subsequent reoperation after low anterior resection.
Risk factors for anastomotic leakage in rectal cancer surgery. A retrospective cohort study
Research Square (Research Square), 2022
PURPOSE Anastomotic leakage after restorative surgery for rectal cancer is associated with signi cant morbidity and mortality. Several factors have been identi ed as risk factors for anastomotic leakage. In this retrospective cohort study, we examined cases of anastomotic leakage in rectal surgery and tried to ascertain the risk factors. METHODS A review of 583 patients who underwent rectal resection with a double-stapling colorectal anastomosis between January 2007 and January 2022 was performed. Clinical, demographic and operative features, intraoperative outcomes and oncological characteristics were evaluated to identify risk factors for anastomotic leakage. RESULTS The overall incidence of anastomotic leakage was 10.4%, with a mean time interval of 6.2 +/-2.1 days. Overall mortality was 0.8%. Mortality was higher in patients with anastomotic leakage (4.9%) than in patients without leak (0.4%, P =0.009). Poor bowel preparation, blood transfusion, median age, prognostic nutritional index <40 points, tumour diameter and intraoperative blood loss were identi ed as risk factors for anastomotic leakage. Location of anastomosis, number of stapler cartridges used to divide the rectum, diameter of circular stapler, level of vascular section, T and N status and stage of disease were also correlated to anastomotic leakage in our patients. The diverting ileostomy did not reduce the leak rate, while the use of the transanastomic tube signi cantly did. CONCLUSION Clinical, surgical and pathological factors are associated with an increased risk of anastomotic leakage. It adversely affects the morbidity and mortality of rectal cancer patients.
Journal of Gastrointestinal Oncology, 2019
Background: There is a relatively high risk of anastomotic leak in low anterior resection (LAR), associated with significant morbidity and mortality. This systematic review and meta-analysis aims to compare diverting stoma vs. no stoma for LAR in terms of leak rates, reoperations, mortality rates and complication rates. Methods: We systematically performed electronic searches of databases Ovid Medline, PubMed, CCTR, CDSR, ACP Journal Club and DARE from inception to present. Only randomized controlled trials comparing LAR for rectal cancer with versus without stoma diversion were included for analysis. Main outcomes were anastomotic leak, reoperation rate and mortality. Secondary outcomes included other operative and stoma-related complications. Results: Eight randomized controlled trials were included in the study for qualitative and quantitative analyses. A significantly longer operative duration for patients with stoma diversion was seen (WMD 19.50 min; 95% CI: 7.38, 31.63; I 2 =0%, P=0.002). The pooled rate for anastomotic leak was significantly lower for those with stoma diversion (6.3% vs. 18.3%; RR 0.36; 95% CI: 0.24, 0.54; I 2 =0%; P<0.00001). There was lower reoperation rate for patients with stoma diversion compared to no stoma (5.9% vs. 16.7%; RR 0.40; 95% CI: 0.26, 0.60; I 2 =0%; P<0.00001). No significant difference was found in terms of leakrelated mortality between stoma vs. no-stoma cohorts (0.47% vs. 1.0%; P=0.51). Conclusions: The present meta-analysis suggests a diverting or defunctioning stoma following LAR for rectal cancers can reduce anastomotic leak and reoperation rates, without increased risk of mortality or other complications.