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Wajekar A, Solanki SL, Cata J, Gottumukkala V. Postoperative Complications Result in Poor Oncological Outcomes: What Is the Evidence? Curr Oncol 2024; 31:4632-4655. [PMID: 39195329 PMCID: PMC11353844 DOI: 10.3390/curroncol31080346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/08/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024] Open
Abstract
The majority of patients with solid tumors undergo a curative resection of their tumor burden. However, the reported rate of postoperative complications varies widely, ranging from 10% to 70%. This narrative review aims to determine the impact of postoperative complications on recurrence and overall survival rates following elective cancer surgeries, thereby providing valuable insights into perioperative cancer care. A systematic electronic search of published studies and meta-analyses from January 2000 to August 2023 was conducted to examine the effect of postoperative complications on long-term survival after cancer surgeries. This comprehensive search identified fifty-one eligible studies and nine meta-analyses for review. Recurrence-free survival (RFS) and overall survival (OS) rates were extracted from the selected studies. Additionally, other oncological outcomes, such as recurrence and cancer-specific survival rates, were noted when RFS and OS were not reported as primary outcomes. Pooled hazard ratios and 95% confidence intervals were recorded from the meta-analyses, ensuring the robustness of the data. The analysis revealed that long-term cancer outcomes progressively worsen, from patients with no postoperative complications to those with minor postoperative complications (Clavien-Dindo grade ≤ II) and further to those with major postoperative complications (Clavien-Dindo grade III-IV), irrespective of cancer type. This study underscores the detrimental effect of postoperative complications on long-term oncological outcomes, particularly after thoracoabdominal surgeries. Importantly, we found a significant gap in the data regarding postoperative complications in surface and soft tissue surgical procedures, highlighting the need for further research in this area.
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Affiliation(s)
- Anjana Wajekar
- Department of Anesthesiology, Critical Care and Pain, Advanced Centre for Treatment Education and Research in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 410210, India;
| | - Sohan Lal Solanki
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| | - Juan Cata
- Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA; (J.C.); (V.G.)
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA; (J.C.); (V.G.)
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Brito da Silva F, Lopes P, Cavadas D, Pereira Gonçalves B, Bernardo M, Abecasis N, Limbert M, Maciel J. The impact of anastomotic leakage after curative colon cancer resection on long-term survival: A retrospective cohort study. Cir Esp 2024; 102:3-10. [PMID: 37423310 DOI: 10.1016/j.cireng.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/21/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Anastomotic leakage (AL) is one of the most feared postoperative complications in colon cancer surgery due to an association with increased morbidity and mortality, although its impact on long-term survival is not consensual. The aim of this study was to investigate the influence of AL on long-term survival of patients undergoing curative colon cancer resection. METHODS A single-centre retrospective cohort study was designed. Clinical records of all consecutive patients undergoing surgery at our institution between 01/01/2010 and 12/31/2019 were reviewed. Survival analysis was performed by Kaplan-Meier method to estimate overall and conditional survival and Cox regression to search for risk factors impacting survival. RESULTS A total of 2351 patients submitted to colorectal surgery were screened for eligibility, of which 686 with colon cancer were included. AL occurred in 57 patients (8,3%) and was associated with higher postoperative morbidity and mortality, length of stay and early readmissions (P < 0,05). Overall survival was inferior in the leakage group (Hazard Ratio 2,08 [1,02-4,24]). Conditional overall survival at 30, 90 days and 6 months was also inferior in the leakage group (P < 0,05), but not at 1 year. Risk factors independently associated with reduced overall survival included AL occurrence, higher ASA classification and delayed/missed adjuvant chemotherapy. AL did not impact local and distant recurrence (P > 0,05). CONCLUSION AL has a negative impact on survival. Its effect is more pronounced on short-term mortality. AL does not appear to be associated with disease progression.
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Affiliation(s)
- Francisca Brito da Silva
- Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal.
| | - Pedro Lopes
- Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Daniela Cavadas
- Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - Beatriz Pereira Gonçalves
- Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - Margarida Bernardo
- Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - Nuno Abecasis
- Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - Manuel Limbert
- Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - João Maciel
- Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal; Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal
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Wang J, Li MH. Risk factors for anastomotic fistula development after radical colon cancer surgery and their impact on prognosis. World J Gastrointest Surg 2023; 15:2470-2481. [PMID: 38111776 PMCID: PMC10725546 DOI: 10.4240/wjgs.v15.i11.2470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/05/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Colon cancer is a common malignant tumor in the gastrointestinal tract that is typically treated surgically. However, postradical surgery is prone to complications such as anastomotic fistulas. AIM To investigate the risk factors for postoperative anastomotic fistulas and their impact on the prognosis of patients with colon cancer. METHODS We conducted a retrospective analysis of 488 patients with colon cancer who underwent radical surgery. This study was performed between April 2016 and April 2019 at a tertiary hospital in Wuxi, Jiangsu Province, China. A t-test was used to compare laboratory indicators between patients with and those without postoperative anastomotic fistulas. Multiple logistic regression analysis was performed to identify independent risk factors for postoperative anastomotic fistulas. The Functional Assessment of Cancer Therapy-Colorectal Cancer was also used to assess postoperative recovery. RESULTS Binary logistic regression analysis revealed that age [odds ratio (OR) = 1.043, P = 0.015], tumor, node, metastasis stage (OR = 2.337, P = 0.041), and surgical procedure were independent risk factors for postoperative anastomotic fistulas. Multiple linear regression analysis showed that the development of postoperative anastomotic fistula (P = 0.000), advanced age (P = 0.003), and the presence of diabetes mellitus (P = 0.015), among other factors, independently affected prognosis. CONCLUSION Postoperative anastomotic fistulas significantly affect prognosis and survival rates. Therefore, focusing on the clinical characteristics and risk factors and immediately implementing individualized preventive measures are important to minimize their occurrence.
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Affiliation(s)
- Jun Wang
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Min-Hua Li
- Department of Gastroenterology, The Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
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Tonini V, Zanni M. Impact of anastomotic leakage on long-term prognosis after colorectal cancer surgery. World J Gastrointest Surg 2023; 15:745-756. [PMID: 37342854 PMCID: PMC10277951 DOI: 10.4240/wjgs.v15.i5.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/21/2023] [Accepted: 04/12/2023] [Indexed: 05/26/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies in the world. Despite significant improvements in surgical technique, postoperative complications still occur in a fair percentage of patients undergoing colorectal surgery. The most feared complication is anastomotic leakage. It negatively affects short-term prognosis, with increased post-operative morbidity and mortality, higher hospitalization time and costs. Moreover, it may require further surgery with the creation of a permanent or temporary stoma. While there is no doubt about the negative impact of anastomotic dehiscence on the short-term prognosis of patients operated on for CRC, still under discussion is its impact on the long-term prognosis. Some authors have described an association between leakage and reduced overall survival, disease-free survival, and increased recurrence, while other Authors have found no real impact of dehiscence on long term prognosis. The purpose of this paper is to review all the literature about the impact of anastomotic dehiscence on long-term prognosis after CRC surgery. The main risk factors of leakage and early detection markers are also summarized.
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Affiliation(s)
- Valeria Tonini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Bologna, Italy
| | - Manuel Zanni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Bologna, Italy
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Xia S, Wu W, Ma L, Luo L, Yu L, Li Y. Transanal drainage tube for the prevention of anastomotic leakage after rectal cancer surgery: a meta-analysis of randomized controlled trials. Front Oncol 2023; 13:1198549. [PMID: 37274258 PMCID: PMC10235681 DOI: 10.3389/fonc.2023.1198549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Background Anastomotic leakage (AL) is a serious complication of anterior resection for rectal cancer. The use of transanal drainage tubes (TDT) during surgery to prevent AL remains controversial. Therefore, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy of TDT in reducing AL. Methods Relevant data and studies published from inception until November 1, 2022, were retrieved from PubMed, Embase, and Cochrane Library databases to compare the incidence of AL after anterior resection for rectal cancer with and without TDT. Results This meta-analysis included 5 RCTs comprising 1385 patients. The results showed that the intraoperative use of TDT could not reduce the incidence of AL after rectal cancer surgery (risk ratio [RR], 0.91; 95% confidence interval [CI], 0.52-1.59; p = 0.75). A subgroup analysis of different degrees of AL revealed that TDT did not reduce the incidence of postoperative grade B AL (RR, 1.18; 95% CI, 0.67-2.09; p = 0.56) but decreased the incidence of grade C AL (RR, 0.28; 95% CI: 0.12-0.64; p = 0.003). Further, TDT did not reduce the incidence of AL in patients with rectal cancer and a stoma (RR, 2.40; 95% CI, 1.01-5.71; p = 0.05). Conclusion TDT were ineffective in reducing the overall incidence of AL, but they might be beneficial in reducing the incidence of grade C AL in patients who underwent anterior resection. However, additional multicenter RCTs with larger sample sizes based on unified control standards and TDT indications are warranted to validate these findings.
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Affiliation(s)
- Shijun Xia
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Futian, Shenzhen, China
| | - Wenjiang Wu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Futian, Shenzhen, China
| | - Lijuan Ma
- Shenzhen Traditional Chinese Medicine Anorectal Hospital, Futian, Shenzhen, China
| | - Lidan Luo
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Futian, Shenzhen, China
| | - Linchong Yu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Futian, Shenzhen, China
| | - Yue Li
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Futian, Shenzhen, China
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Tominaga T, Nonaka T, Shiraishi T, Yano H, Sato S, Fukuda A, Hisanaga M, Hashimoto S, Sawai T, Nagayasu T. Impacts of trans-anal tube placement in patients with sigmoid colon cancer: Risk verification analysis using inverse probability weighting analysis. Ann Gastroenterol Surg 2023; 7:279-286. [PMID: 36998301 PMCID: PMC10043774 DOI: 10.1002/ags3.12634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/13/2022] [Indexed: 04/01/2023] Open
Abstract
Purpose Anastomotic leakage (AL) is a serious postoperative complication that affects short- and long-term outcomes. The use of a trans-anal drainage tube (TDT) is reported to prevent AL in rectal cancer patients, but its value in sigmoid colon cancer patients is unknown. Methods Admitted to the study were 379 patients who underwent surgery for sigmoid colon cancer between 2016 and 2020. Patients were divided into two groups according to the placement (n = 197) or nonplacement of a TDT (n = 182). To determine the factors affecting the association between TDT placement and AL, we estimated average treatment effects by stratifying each factor using the inverse probability of treatment weighting method. The association between prognosis and AL was evaluated in each identified factor. Results Factors associated with postsurgical insertion of a TDT were advanced age, male sex, high body mass index (BMI), poor performance status, and presence of comorbidities. TDT placement was associated with a significantly lower AL in male patients (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.07-0.73; P = .013) and for BMI ≥ 25 kg/m2 (OR, 0.13; 95% CI, 0.02-0.65; P = .013). In addition, there was a significant association of AL with poor prognosis in patients with BMI ≥ 25 kg/m2 (P = .043), age > 75 y (P = .021), and pathological node-positive disease (P = .015). Conclusion Sigmoid colon cancer patients with BMI ≥ 25 kg/m2 are the most appropriate candidates for postoperative TDT insertion, in terms of reduced incidence of AL and improved prognosis.
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Affiliation(s)
- Tetsuro Tominaga
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical ScienceNagasakiJapan
| | - Takashi Nonaka
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical ScienceNagasakiJapan
| | - Toshio Shiraishi
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical ScienceNagasakiJapan
| | - Hiroshi Yano
- Clinical Research CenterNagasaki University HospitalNagasakiJapan
| | - Shuntaro Sato
- Clinical Research CenterNagasaki University HospitalNagasakiJapan
| | - Akiko Fukuda
- Department of SurgerySasebo City General HospitalNagasakiJapan
| | | | | | - Terumitsu Sawai
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical ScienceNagasakiJapan
| | - Takeshi Nagayasu
- Department of Surgical OncologyNagasaki University Graduate School of Biomedical ScienceNagasakiJapan
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Meng X, Xiao X, Jeon S, Kim D, Park BJ, Kim YJ, Rubab N, Kim S, Kim SW. An Ultrasound-Driven Bioadhesive Triboelectric Nanogenerator for Instant Wound Sealing and Electrically Accelerated Healing in Emergencies. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2209054. [PMID: 36573592 DOI: 10.1002/adma.202209054] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/12/2022] [Indexed: 06/18/2023]
Abstract
A bioadhesive triboelectric nanogenerator (BA-TENG), as a first-aid rescue for instant and robust wound sealing and ultrasound-driven accelerated wound healing, is designed. This BA-TENG is fabricated with biocompatible materials, and integrates a flexible TENG as the top layer and bioadhesive as the bottom layer, resulting in effective electricity supply and strong sutureless sealing capability on wet tissues. When driven by ultrasound, the BA-TENG can produce a stable voltage of 1.50 V and current of 24.20 µA underwater. The ex vivo porcine colon organ models show that the BA-TENG seals defects instantly (≈5 s) with high interfacial toughness (≈150 J m-2 ), while the rat bleeding liver incision model confirms that the BA-TENG performs rapid wound closure and hemostasis, reducing the blood loss by about 82%. When applied in living rats, the BA-TENG not only seals skin injuries immediately but also produces a strong electric field (E-field) of about 0.86 kV m-1 stimulated by ultrasound to accelerate skin wound healing significantly. The in vitro studies confirm that these effects are attributed to the E-field-accelerated cell migration and proliferation. In addition, these TENG adhesives can be applied to not only wound treatment, nerve stimulation and regeneration, and charging batteries in implanted devices.
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Affiliation(s)
- Xiangchun Meng
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Xiao Xiao
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Sera Jeon
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Dabin Kim
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Byung-Joon Park
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Young-Jun Kim
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Najaf Rubab
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - SeongMin Kim
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Sang-Woo Kim
- School of Advanced Materials Science and Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
- SKKU Institute of Energy Science and Technology (SIEST), School of Advanced Institute of Nanotechnology (SAINT), Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
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Borráez-Segura B, Anduquia-Garay F, Gómez-Raigosa J, Santa-Gil V, Erazo M, Castaño-Montoya AF, Ramírez L. Proteína C reactiva y su progresión en el tiempo para la detección de las fugas anastomóticas. REVISTA COLOMBIANA DE CIRUGÍA 2023. [DOI: 10.30944/20117582.2290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introducción. Las fugas anastomóticas son una complicación común y crítica en cirugía gastrointestinal, por lo que su identificación y tratamiento temprano son necesarios para evitar resultados adversos. El uso convencional con un valor límite de la proteína C reactiva ha demostrado una utilidad limitada. El objetivo de este estudio fue determinar la utilidad de la medición seriada de la proteína C reactiva en la detección de fugas anastomóticas.
Métodos. Revisión prospectiva de base de datos retrospectiva de pacientes sometidos a cirugía abdominal mayor con al menos una anastomosis intestinal. Se midió la proteína C reactiva al tercer y quinto día posoperatorio. Las complicaciones se categorizaron según la clasificación de Clavien-Dindo. La precisión diagnóstica fue evaluada por el área bajo la curva.
Resultados. Se incluyeron 157 pacientes, el 52 % mujeres. La edad promedio fue de 63,7 años. El mayor número de cirugías correspondió a gastrectomía (36,3 %), resección anterior de recto (15,3 %) y hemicolectomía derecha (13,4 %). El 25,5 % tuvieron alguna complicación postoperatoria y el 32,5 % (n=13) presentaron fuga en la anastomosis. El aumento de la proteína C reactiva tuvo un área bajo la curva de 0,918 con un punto de corte de aumento en 1,3 mg/L, sensibilidad de 92,3 % (IC95% 78 – 100) y una especificidad de 92,4 % (IC95% 88 – 96).
Conclusiones. El aumento de 1,3 mg/L en la proteína C reactiva entre el día de la cirugía y el quinto día fue un predictor preciso de fugas anastomóticas en pacientes con cirugía abdominal mayor.
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Wu J, Yuk H, Sarrafian TL, Guo CF, Griffiths LG, Nabzdyk CS, Zhao X. An off-the-shelf bioadhesive patch for sutureless repair of gastrointestinal defects. Sci Transl Med 2022; 14:eabh2857. [PMID: 35108064 DOI: 10.1126/scitranslmed.abh2857] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Surgical sealing and repair of injured and resected gastrointestinal (GI) organs are critical requirements for successful treatment and tissue healing. Despite being the standard of care, hand-sewn closure of GI defects using sutures faces limitations and challenges. In this work, we introduce an off-the-shelf bioadhesive GI patch capable of atraumatic, rapid, robust, and sutureless repair of GI defects. The GI patch integrates a nonadhesive top layer and a dry, bioadhesive bottom layer, resulting in a thin, flexible, transparent, and ready-to-use patch with tissue-matching mechanical properties. The rapid, robust, and sutureless sealing capability of the GI patch is systematically characterized using ex vivo porcine GI organ models. In vitro and in vivo rat models are used to evaluate the biocompatibility and degradability of the GI patch in comparison to commercially available tissue adhesives (Coseal and Histoacryl). To validate the GI patch's efficacy, we demonstrate successful sutureless in vivo sealing and healing of GI defects in rat colon, stomach, and small intestine as well as in porcine colon injury models. The proposed GI patch provides a promising alternative to suture for repair of GI defects and offers potential clinical opportunities for the repair of other organs.
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Affiliation(s)
- Jingjing Wu
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hyunwoo Yuk
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | | | - Chuan Fei Guo
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen 518055, China
| | - Leigh G Griffiths
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Christoph S Nabzdyk
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Xuanhe Zhao
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Koedam TWA, Bootsma BT, Deijen CL, van de Brug T, Kazemier G, Cuesta MA, Fürst A, Lacy AM, Haglind E, Tuynman JB, Daams F, Bonjer HJ. Oncological Outcomes After Anastomotic Leakage After Surgery for Colon or Rectal Cancer: Increased Risk of Local Recurrence. Ann Surg 2022; 275:e420-e427. [PMID: 32224742 DOI: 10.1097/sla.0000000000003889] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate oncological outcome for patients with and without anastomotic leakage after colon or rectal cancer surgery. SUMMARY OF BACKGROUND DATA The role of anastomotic leakage in oncological outcome after colorectal cancer surgery is still topic of debate and impact on follow-up and consideration for further treatment remains unclear. METHODS Patients included in the international, multicenter, non-inferior, open label, randomized, controlled trials COLOR and COLOR II, comparing laparoscopic surgery for curable colon (COLOR) and rectal (COLOR II) cancer with open surgery, were analyzed. Patients operated by abdominoperineal excision were excluded. Both univariate and multivariate analyses were performed to investigate the impact of leakage on overall survival, disease-free survival, local and distant recurrences, adjusted for possible confounders. Primary endpoints in the COLOR and COLOR II trial were disease-free survival and local recurrence at 3-year follow-up, respectively, and secondary endpoints included anastomotic leakage rate. RESULTS For colon cancer, anastomotic leakage was not associated with increased percentage of local recurrence or decreased disease-free-survival. For rectal cancer, an increase of local recurrences (13.3% vs 4.6%; hazard ratio 2.96; 95% confidence interval 1.38-6.34; P = 0.005) and a decrease of disease-free survival (53.6% vs 70.9%; hazard ratio 1.67; 95% confidence interval 1.16-2.41; P = 0.006) at 5-year follow-up were found in patients with anastomotic leakage. CONCLUSION Short-term morbidity, mortality, and long-term oncological outcomes are negatively influenced by the occurrence of anastomotic leakage after rectal cancer surgery. For colon cancer, no significant effect was observed; however, due to low power, no conclusions on the influence of anastomotic leakage on outcomes after colon surgery could be reached. Clinical awareness of increased risk of local recurrence after anastomotic leakage throughout the follow-up is mandatory.Trial Registration: Registered with ClinicalTrials.gov, number NCT00387842 and NCT00297791.
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Affiliation(s)
- Thomas W A Koedam
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Boukje T Bootsma
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Charlotte L Deijen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Tim van de Brug
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Miguel A Cuesta
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Alois Fürst
- Department of Surgery, Caritas Krankenhaus St Josef Regensburg, Regensburg, Germany
| | - Antonio M Lacy
- Department of Surgery, Hospital Clínic Universitari, Barcelona, Spain
| | - Eva Haglind
- Department of Surgery, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden
| | - Jurriaan B Tuynman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Hendrik J Bonjer
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
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Han P, Yang Y, He Y, Wu H, Wang D, Liu K, Guan C, Zhang X, Guo W, Zhang Z. The effect of atrial fibrillation on perioperative outcomes in patients with pancreatic cancer undergoing open pancreaticoduodenectomy: analysis of the National Inpatient Sample. Gland Surg 2021; 10:1951-1961. [PMID: 34268079 DOI: 10.21037/gs-21-116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/27/2021] [Indexed: 11/06/2022]
Abstract
Background To assess the role of atrial fibrillation on perioperative outcomes in patients with pancreatic cancer undergoing open pancreaticoduodenectomy (OPD). Methods We investigated patients with pancreatic cancer undergoing OPD during 2012-2014 within National Inpatient Sample database. The study population was divided into two groups based on the presence of atrial fibrillation. In-hospital mortality, length of stay, cost of hospitalization, and in-hospital complications were compared between the two groups. Logistic regression models and linear regression were used to adjust for potential confounders. Propensity score matching was also utilized. Results Of the 12,785 patients aged ≥18 years undergoing OPD during years 2012-2014, 11,469 (90%) had no atrial fibrillation and 1,316 (10%) had atrial fibrillation. Patients with atrial fibrillation were found to have significantly higher cost, but similar mortality and LOS compared to those without atrial fibrillation. The risk of gastrointestinal anastomotic leakage, cardiac complications, respiratory complications, pulmonary embolism, and perioperative shock were found to be significantly higher in atrial fibrillation group than non-atrial fibrillation group in both multivariate regression model and propensity score matching model. In older patients (>65 years), atrial fibrillation was found to be associated with a significantly higher cost, longer hospital stays, higher incidence of cardiac complications, respiratory complications, and postoperative shock, yet similar mortality. Conclusions Atrial fibrillation was found to be associated with higher cost in pancreatic cancer patients undergoing OPD, as well as increased occurrence of cardiac complications, respiratory complications, pulmonary embolism, and perioperative shock. Surgeons should pay special attention to patients with atrial fibrillation, and consider working together with cardiologists and anesthesiologists to jointly develop a management plan.
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Affiliation(s)
- Pu Han
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Yifeng Yang
- Department of Internal Medicine, University of Iowa Hospitals and Clinic, Iowa, USA
| | - Yanjie He
- Department of Surgery, NYU Langone Medical Center, New York, USA
| | - Hongwei Wu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Dong Wang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Kun Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Chengjian Guan
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Xiaodong Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Wei Guo
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; Beijing Key Laboratory of Cancer Invasion and Metastasis Research & National Clinical Research Center for Digestive Diseases, Beijing, China
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12
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Gray M, Marland JRK, Murray AF, Argyle DJ, Potter MA. Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients. J Pers Med 2021; 11:471. [PMID: 34070593 PMCID: PMC8229046 DOI: 10.3390/jpm11060471] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Development of an anastomotic leak (AL) following intestinal surgery for the treatment of colorectal cancers is a life-threatening complication. Failure of the anastomosis to heal correctly can lead to contamination of the abdomen with intestinal contents and the development of peritonitis. The additional care that these patients require is associated with longer hospitalisation stays and increased economic costs. Patients also have higher morbidity and mortality rates and poorer oncological prognosis. Unfortunately, current practices for AL diagnosis are non-specific, which may delay diagnosis and have a negative impact on patient outcome. To overcome these issues, research is continuing to identify AL diagnostic or predictive biomarkers. In this review, we highlight promising candidate biomarkers including ischaemic metabolites, inflammatory markers and bacteria. Although research has focused on the use of blood or peritoneal fluid samples, we describe the use of implantable medical devices that have been designed to measure biomarkers in peri-anastomotic tissue. Biomarkers that can be used in conjunction with clinical status, routine haematological and biochemical analysis and imaging have the potential to help to deliver a precision medicine package that could significantly enhance a patient's post-operative care and improve outcomes. Although no AL biomarker has yet been validated in large-scale clinical trials, there is confidence that personalised medicine, through biomarker analysis, could be realised for colorectal cancer intestinal resection and anastomosis patients in the years to come.
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Affiliation(s)
- Mark Gray
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Roslin, Midlothian, Edinburgh EH25 9RG, UK;
| | - Jamie R. K. Marland
- School of Engineering, Institute for Integrated Micro and Nano Systems, University of Edinburgh, Scottish Microelectronics Centre, King’s Buildings, Edinburgh EH9 3FF, UK;
| | - Alan F. Murray
- School of Engineering, Institute for Bioengineering, University of Edinburgh, Faraday Building, The King’s Buildings, Edinburgh EH9 3DW, UK;
| | - David J. Argyle
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Roslin, Midlothian, Edinburgh EH25 9RG, UK;
| | - Mark A. Potter
- Department of Surgery, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK;
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13
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Postoperative morbidity following pancreatic cancer surgery is significantly associated with worse overall patient survival; systematic review and meta-analysis. Surg Oncol 2021; 38:101573. [PMID: 33857838 DOI: 10.1016/j.suronc.2021.101573] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/10/2021] [Accepted: 03/29/2021] [Indexed: 01/13/2023]
Abstract
BACKROUND The influence of postoperative morbidity on survival after potentially curative resection for pancreatic ductal adenocarcinoma (PDAC) remains unclear. METHODS Medline, Web of Science and Cochrane Library were searched for studies reporting survival in patients with and without complications, defined according to the Clavien-Dindo classification, after primary, potentially curative resection for pancreatic cancer followed by adjuvant treatment. Meta-analysis was performed using a random-effects model. RESULTS Fourteen retrospective cohort studies comprising a total of 7.604 patients with an overall complication rate of 40.8% (n = 3.103 patients) were included. Median overall survival for the entire patient cohort ranged from 15.5 to 24 months. Overall survival in patients with severe postoperative complications ranged from 7.1 to 37.1 months and was significantly worse compared to the overall survival in patients without severe complications ranging from 16.5 to 38.2 months. Postoperative complication rates ranged from 24.3% to 64%, severe (Clavien-Dindo ≥ III) complication rates from 4.2% to 31%. Results sufficient for meta-analysis were reported by ten studies, representing 6.028 patients. Meta-analysis showed reduced overall survival following any complication (summary adjusted HR 1.47; 95% CI 1.23-1.76, p < 0.0001). Hazard of death was 1.5 times higher in patients experiencing severe postoperative complications than in patients without severe complications (summary adjusted HR 1.45; 95% CI 1.13-1.85, p = 0.003). CONCLUSIONS Postoperative complications after potentially curative resection of PDAC are significantly associated with worse overall patient survival.
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14
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Tian W, Xu X, Yao Z, Yang F, Huang M, Zhao R, Zhao Y. Early Enteral Nutrition Could Reduce Risk of Recurrent Leakage After Definitive Resection of Anastomotic Leakage After Colorectal Cancer Surgery. World J Surg 2021; 45:320-330. [PMID: 32975647 DOI: 10.1007/s00268-020-05787-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The present study aimed to evaluate the effect of early enteral nutrition (EEN) after definitive resection of anastomotic leakage (DRAL) resulting from a sigmoid colon or rectal cancer radical resection. METHODS This was a prospective cohort study performed at our center. From January 2014 to May 2016, every patient received a standard postoperative nutritional protocol (SPNP) after DRAL and was included into SPNP group. From June 2016 to December 2018, all patients received an EEN after DRAL and were included into EEN group. The effect of postoperative EEN was evaluated. RESULTS There were a final total of 133 patients enrolled in our study. There were 70 patients in the SPNP group, and 63 patients in the EEN group. There were 12 cases (19.05%) with a recurrent leakage in the EEN group, and 28 cases (40%) in the SPNP group. The recurrent rate was associated with EEN (HR = 0.417, 95% CI 0.196-0.890, p = 0.024). The median defecation time in the EEN group was 5(4-7) days, while in the SPNP group was 7(6-8.25) days. The defecation was associated with EEN (HR = 1.588, 95% CI 1.080-2.336, p = 0.019), as well. CONCLUSION EEN could reduce the recurrent leakage rate and defecation time after definitive resection of anastomotic leakage resulting from sigmoid colon or rectal cancer radical resection.
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Affiliation(s)
- Weiliang Tian
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - Xin Xu
- Department of General Surgery, Nanjing Jiangning Hospital, Hushan Road No. 169, Nanjing, 211100, Jiangsu, China
| | - Zheng Yao
- Department of General Surgery, Nanjing Jiangning Hospital, Hushan Road No. 169, Nanjing, 211100, Jiangsu, China.
| | - Fan Yang
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
| | - Ming Huang
- Department of General Surgery, Nanjing Jiangning Hospital, Hushan Road No. 169, Nanjing, 211100, Jiangsu, China
| | - Risheng Zhao
- Department of General Surgery, Nanjing Jiangning Hospital, Hushan Road No. 169, Nanjing, 211100, Jiangsu, China.
| | - Yunzhao Zhao
- Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
- Department of General Surgery, Nanjing Jiangning Hospital, Hushan Road No. 169, Nanjing, 211100, Jiangsu, China
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15
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Stormark K, Krarup PM, Sjövall A, Søreide K, Kvaløy JT, Nordholm-Carstensen A, Nedrebø BS, Kørner H. Anastomotic leak after surgery for colon cancer and effect on long-term survival. Colorectal Dis 2020; 22:1108-1118. [PMID: 32012414 DOI: 10.1111/codi.14999] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/15/2019] [Indexed: 02/08/2023]
Abstract
AIM An anastomotic leak after surgery for colon cancer is a recognized complication but how it may adversely affect long-term survival is less clear because data are scarce. The aim of the study was to investigate the long-term impact of Grade C anastomotic leak in a large, population-based cohort. METHOD Data on patients undergoing resection for Stage I-III colon cancer between 2008 and 2012 were collected from the Swedish, Norwegian and Danish Colorectal Cancer Registries. Overall relative survival and conditional 5-year relative survival, under the condition of surviving 1 year, were calculated for all patients and stratified by stage of disease. RESULTS A total of 22 985 patients were analysed. Anastomotic leak occurred in 849 patients (3.7%). Five-year relative survival in patients with anastomotic leak was 64.7% compared with 87.0% for patients with no leak (P < 0.001). Five-year relative survival among the patients who survived the first year was 88.6% vs 81.3% (P = 0.003). Stratification by cancer stage showed that anastomotic leak was significantly associated with decreased relative survival in patients with Stage III disease (P = 0.001), but not in patients with Stage I or II (P = 0.950 and 0.247, respectively). CONCLUSION Anastomotic leak after surgery for Stage III colon cancer was associated with significantly decreased long-term relative survival.
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Affiliation(s)
- K Stormark
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - P-M Krarup
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Surgery, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - A Sjövall
- Division of Coloproctology, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Clinical Surgery, University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J T Kvaløy
- Department of Research, Stavanger University Hospital, Stavanger, Norway.,Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway
| | - A Nordholm-Carstensen
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - B S Nedrebø
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - H Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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16
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Lawler J, Choynowski M, Bailey K, Bucholc M, Johnston A, Sugrue M. Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery. BJS Open 2020; 4:737-747. [PMID: 32525280 PMCID: PMC7528523 DOI: 10.1002/bjs5.50302] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/26/2020] [Accepted: 05/02/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cancer outcomes are complex, involving prevention, early detection and optimal multidisciplinary care. Postoperative infection and surgical site-infection (SSI) are not only uncomfortable for patients and costly, but may also be associated with poor oncological outcomes. A meta-analysis was undertaken to assess the oncological effects of SSI in patients with colorectal cancer. METHODS An ethically approved PROSPERO-registered meta-analysis was conducted following PRISMA guidelines. PubMed and Scopus databases were searched for studies published between 2007 and 2017 reporting the effects of postoperative infective complications on oncological survival in colorectal cancer. Results were separated into those for SSI and those concerning anastomotic leakage. Articles with a Methodological Index for Non-Randomized Studies score of at least 18 were included. Hazard ratios (HRs) with 95 per cent confidence intervals were computed for risk factors using an observed to expected and variance fixed-effect model. RESULTS Of 5027 articles were reviewed, 43 met the inclusion criteria, with a total of 154 981 patients. Infective complications had significant negative effects on overall survival (HR 1·37, 95 per cent c.i. 1·28 to 1·46) and cancer-specific survival (HR 2·58, 2·15 to 3·10). Anastomotic leakage occurred in 7·4 per cent and had a significant negative impact on disease-free survival (HR 1·14, 1·09 to 1·20), overall survival (HR 1·34, 1·28 to 1·39), cancer-specific survival (HR 1·43, 1·31 to 1·55), local recurrence (HR 1·18, 1·06 to 1·32) and overall recurrence (HR 1·46, 1·27 to 1·68). CONCLUSION This meta-analysis identified a significant negative impact of postoperative infective complications on overall and cancer-specific survival in patients undergoing colorectal surgery.
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Affiliation(s)
- J Lawler
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - M Choynowski
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - K Bailey
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - M Bucholc
- EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry, /Londonderry, UK
| | - A Johnston
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - M Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland.,EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry, /Londonderry, UK
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17
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Malnutrition-Related Factors Increased the Risk of Anastomotic Leak for Rectal Cancer Patients Undergoing Surgery. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5059670. [PMID: 32461995 PMCID: PMC7212272 DOI: 10.1155/2020/5059670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 02/18/2020] [Accepted: 04/21/2020] [Indexed: 12/24/2022]
Abstract
Objective To study the possible risk factors and related prediction indexes of anastomotic leakage (AL) in patients with rectal cancer during the perioperative period and to provide effective indexes for predicting whether AL will occur in postoperative patients with rectal cancer and whether early nutritional support is needed. Background AL after rectal cancer surgery is a common and serious complication. Many of the risk factors for AL have been confirmed. Nevertheless, the evidence of the effect of perioperative malnutrition on AL is still insufficient. This article will make a further study on this point. Methods We collected perioperative clinical data from 382 patients with rectal cancer who underwent surgery from September 2015 to May 2017. After 1 month of follow-up, relevant risk factor data were collected and analyzed. Results Data analysis showed that the incidence of AL was 14.65%. In single factor analysis, patients with high score of NRS-2002, high score of PG-SGA, diabetes, perioperative blood transfusion, postoperative diarrhea, later tumor stage, high score of ASA, low postoperative albumin, and rectal cancer patients with tumor close to the anus may led to AL. Multivariate analysis revealed that low postoperative albumin (p = 0.044), tumor close to the anus (p = 0.004), diabetes (p = 0.003), perioperative blood transfusion (p < 0.001), diarrhea (p = 0.005), later tumor stage, and high score of PG-SGA (p < 0.001) were the independent risk factors for postoperative AL. Conclusions AL in rectal cancer operation is a common postoperative complication. Patients with diabetes or high PG-SGA score or low perioperative albumin will have increased risk factors of AL, which should be paid enough attention in the perioperative period and nutritional support should be provided as soon as possible. Patients who have incomplete intestinal obstruction but can make effective intestinal preparation or who receive neoadjuvant chemotherapy have no increased risk of AL.
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18
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Sun X, Han H, Qiu H, Wu B, Lin G, Niu B, Zhou J, Lu J, Xu L, Zhang G, Xiao Y. Comparison of safety of loop ileostomy and loop transverse colostomy for low-lying rectal cancer patients undergoing anterior resection: A retrospective, single institution, propensity score-matched study. Asia Pac J Clin Oncol 2020; 19:e5-e11. [PMID: 32199033 DOI: 10.1111/ajco.13322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/29/2019] [Accepted: 01/23/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This study was to compare the prevalence of stoma-related complications and stoma reversal perioperative complications of patients with low-lying rectal cancer who received preventative loop ileostomy and those who underwent loop transverse colostomy. METHODS This retrospective single-center study analyzed the clinicopathologic and surgical data of 288 patients with pathologically proven primary rectal cancer who underwent anterior resection with either preventative loop ileostomy (n = 82) or loop transverse colostomy. To achieve comparability of a propensity score matching method was used to match patients from each group in a 1:2 ratio. Determinants of stoma-related complications were analyzed by multivariate logistic regression analysis. RESULTS Forty-nine (74.3%) patients in the loop ileostomy group experienced stoma-related complications versus 48.7% in the loop transverse colostomy group (P < 0.01). Irritant dermatitis was the most frequent complication in both groups. The loop ileostomy group had a significantly higher rate (24.24%) of stoma reversal perioperative complications than the loop transverse colostomy group. Multivariate logistic regression analysis showed that ileostomy versus loop transverse colostomy was a significant independent risk for stoma-related complications and stoma reversal perioperative complications. Furthermore, by Clavien-Dindo classification, patients receiving loop ileostomy had an overall higher rate of complications and stoma reversal perioperative complications versus those undergoing loop transverse colostomy (P < 0.01). The rate of grade II complications was significantly higher in the loop ileostomy group (43.9%) than that of loop transverse colostomy group (13.5%, P < 0.01), whereas the rate of grade I, and grade IIIa and IIIb complications and stoma reversal perioperative complications was comparable between the two groups. CONCLUSION The study has demonstrated that loop transverse colostomy is associated with significantly lower rates of stoma-related complications and stoma reversal perioperative complications compared to loop transverse colostomy.
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Affiliation(s)
- Xiyu Sun
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huiqiao Han
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Huizhong Qiu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guole Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Beizhan Niu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaolin Zhou
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junyang Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lai Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guannan Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Baguena G, Pellino G, Frasson M, Escrig J, Marinello F, Espí A, García-Granero A, Roselló S, Cervantes A, García-Granero E. Impact of perioperative transfusions and sepsis on long-term oncologic outcomes after curative colon cancer resection. A retrospective analysis of a prospective database. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 43:63-72. [PMID: 31918857 DOI: 10.1016/j.gastrohep.2019.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/18/2019] [Accepted: 07/04/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Intra-abdominal septic complications (IASC) affect short-term outcomes after surgery for colon cancer. Blood transfusions have been associated with worse short-term results. The role of IASC and blood transfusions on long-term oncologic results is still debated. This study aims to assess the impact of these two variables on survival after curative colon cancer resection. PATIENTS AND METHODS Retrospective analysis of a prospectively maintained database of patients who underwent curative surgery for colon cancer at a university hospital, between 1993 and 2010. Cox regression was used to identify the role of IASC and transfusions (alone and combined) on local recurrence (LR), disease-free survival (DFS), and cancer-specific survival (CSS). RESULTS Out of the 1686 patients analyzed, 1277 fit in the inclusion criteria. Colorectal surgeons performed the procedure in 82.2% of the patients. Blood transfusions were administered to 25.8% of the patients. Thirty-day complication and mortality rates were 34.5% and 6.1%. IASC occurred in 9.9%. The mean follow-up was 66 months. The 5-year rates of LR, DFS, and CSS were 7%, 79.8%, and 85.1%. The year of surgery and pT (Hazard ratio 9.35, 95% CI 1.23-70.9, for T4) and pN (Hazard ratio 2.57, 95% CI 1.39-4.72, for N2) stages were independent risk factors for LR. The same variables, bowel obstruction and surgeries performed by surgeons not specialized in colorectal surgery, were also associated with worse DFS and CSS. IASC and blood transfusions were not associated with LR, DFS, and CSS, whether alone or combined. CONCLUSIONS IASC and transfusions were not associated with worse oncological outcomes after curative colon cancer surgery per se. Other factors were more important predictors of survival.
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Affiliation(s)
- Gloria Baguena
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain
| | - Gianluca Pellino
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain; Colorectal Surgery, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Matteo Frasson
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain.
| | | | - Franco Marinello
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain
| | - Alejandro Espí
- Department of General Surgery, Coloproctology Unit, Hospital Clínico Universitario, University of Valencia, Spain
| | - Alvaro García-Granero
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain; Department of Human Anatomy and Embryology, University of Valencia, Spain
| | - Susana Roselló
- Department of Haematology and Medical Oncology, Hospital Clínico Universitario, University of Valencia, Spain
| | - Andres Cervantes
- Department of Haematology and Medical Oncology, Hospital Clínico Universitario, University of Valencia, Spain
| | - Eduardo García-Granero
- Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain
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20
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Luo W, Qian C, Lu T, Zhang L, Sun M, Li F, Xu Z, Jia Y. A Modified Side-to-Side Anastomosis Using a Circular Stapler Reduces Anastomotic Leakage in Colonic Surgery. Surg Innov 2020; 27:143-149. [PMID: 31893973 DOI: 10.1177/1553350619895629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background. Anastomotic leakage (AL) remains one of the serious complications after colonic surgery. Method. A prospective interventional study to assess a modified technique of creating the ileocolic, colic-colic, and colorectal side-to-side anastomoses using a circular stapler. The primary endpoint was to evaluate the safety and efficacy of this technique in the reduction of AL. Computed tomography scan was performed when AL was clinically suspected. Result. One hundred and forty-five patients who underwent colonic resection between January 2015 and August 2018 were included. One patient underwent surgery for severe inflammatory bowel disease, and the others underwent surgery for colonic cancer. The procedures were open surgeries, including right hemicolectomy (n = 79 [54.5%]), left hemicolectomy (n = 29 [20%]), sigmoidectomy (n = 30 [20.7%]), and transverse colectomy (n = 7 [4.8%]). In 23 patients with ascending colonic obstruction, emergency right colectomy with primary anastomosis was performed. Two surgeons performed the operations (52.4% and 47.6%, respectively), and intraoperative blood loss was 50 to 100 mL. The operative time was 160 to 240 minutes. There was no mortality postoperatively, and 26 (17.9%) patients developed complications. One patient who underwent transverse colonic cancer resection developed a clinical AL (0.7%). After ileostomy, the patient was discharged with no other serious complication. The median of postoperative hospital stay was 8 days (range = 5-18 days). Conclusion. This modified technique is a safe and efficient method for anastomotic configuration in colonic surgery.
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Affiliation(s)
- Wenjun Luo
- Suining Central Hospital, Suining, Sichuan, China
| | - Chuan Qian
- Suining Central Hospital, Suining, Sichuan, China
| | - Tingting Lu
- Suining Central Hospital, Suining, Sichuan, China
| | | | - Meng Sun
- Suining Central Hospital, Suining, Sichuan, China
| | - Fugen Li
- Suining Central Hospital, Suining, Sichuan, China
| | - Zhengwen Xu
- Suining Central Hospital, Suining, Sichuan, China
| | - Yingdong Jia
- Suining Central Hospital, Suining, Sichuan, China
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21
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Risk factors for ileocolic anastomosis dehiscence; a cohort study. Am J Surg 2019; 220:170-177. [PMID: 31759455 DOI: 10.1016/j.amjsurg.2019.11.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/25/2019] [Accepted: 11/10/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anastomotic leak (AL) after ileocolic anastomosis influences morbidity, mortality, length of hospitalization and costs. This study analyzes risk and protective factors for AL on ileocolic anastomoses. METHODS We retrospectively analyzed our single institution patients' series undergoing elective ileocolic anastomosis for AL between 1/2008-12/2017. AL grade A/B (antibiotic treatment and/or radiological drainage) were summarized as mild, grade C (surgical re-intervention) corresponds to severe AL. RESULTS We included 470 patients (mean age 70.8 years, 43.2% females). Overall AL rate was 9.4% (44 patients) with 6.0% severe and 3.4% mild AL. There was no difference in AL between hand sewn and stapled anastomoses. Multivariate analysis revealed preoperative serum albumin (p = 0.004), smoking habits (p = 0.005) and perioperative blood transfusion (p = 0.038) as risk factors for AL. Suture oversewing as anastomotic reinforcement resulted as independent protective factor (p < 0.001). CONCLUSION Poor nutritional status, smoking habits and perioperative blood transfusion are negative factors influencing on AL. Suture oversewing as anastomotic reinforcement associates with significantly less AL.
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22
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Bashir Mohamed K, Hansen CH, Krarup PM, Fransgård T, Madsen MT, Gögenur I. The impact of anastomotic leakage on recurrence and long-term survival in patients with colonic cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2019; 46:439-447. [PMID: 31727475 DOI: 10.1016/j.ejso.2019.10.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/OBJECTIVE Anastomotic leakage (AL) is one of the most severe complications following colorectal cancer surgery and is associated with increased short and long term mortality. The literature is conflicting regarding increased risk of recurrence after AL. The aim of this study was to systematically review the impact of anastomotic leakage on the risk of local or distant recurrence and overall survival, cancer specific survival, and disease-free survival. METHODS A systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. A systematic search in PubMed, EMBASE, CINHAL, and The Cochrane Library was performed and meta-analyses were performed on all outcomes including analysis based on time-to-event data. RESULTS A total of eighteen cohort studies, including 69,047 patients whereof 2,555 patients had anastomotic leakage, were included. Meta-analysis demonstrated no significant effects of anastomotic leakage on local recurrence (RR 1.16, 95% CI 0.84-1.59) or distant recurrence (RR 1.44, 95% CI 0.52-3.96). Anastomotic leakage decreased overall survival (RR 0.85, 95% CI 0.77-0.94), disease free survival (RR 0.80, 95% CI 0.72-0.89), and cancer specific survival (RR 0.90, 95% CI 0.83-0.97). A time-to-event analysis was conducted on available data and the results were congruent with the frequency analyses. CONCLUSION Anastomotic leakage following colonic resections is significantly associated with impaired overall survival, disease free survival and cancer specific survival. The study did not show any statistically significant association between anastomotic leakage and recurrence.
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Affiliation(s)
- Khadra Bashir Mohamed
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark.
| | - Christine Haangard Hansen
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark
| | - Peter-Martin Krarup
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark
| | - Tina Fransgård
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark
| | - Michael Tvilling Madsen
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark; Institute of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
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23
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Yang SU, Park EJ, Baik SH, Lee KY, Kang J. Modified Colon Leakage Score to Predict Anastomotic Leakage in Patients Who Underwent Left-Sided Colorectal Surgery. J Clin Med 2019; 8:1450. [PMID: 31547283 PMCID: PMC6780090 DOI: 10.3390/jcm8091450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/17/2022] Open
Abstract
Colon leakage score (CLS) was introduced as a clinical tool to predict anastomotic leakage (AL) in patients who underwent left-sided colorectal surgery, but its clinical validity has not been widely studied. We evaluated the clinical utility of CLS and developed a modified CLS (m-CLS). In total, 566 patients who underwent left-sided colorectal surgery were enrolled and categorized into training (n = 396) and validation (n = 170) sets via random sampling. Using CLS variables, the least absolute shrinkage and selection operator (LASSO) regression model was applied for variable selection and predictive signature building in the training set. The model's performance was validated in the validation set. The predictive powers of m-CLS and CLS were compared by the area under the receiver operating characteristic (AUROC) curve in the overall group. Twenty-three AL events (4.1%) were noted. The AL group had a significantly higher mean CLS than the No Leakage group (12.5 vs. 9.6, p = 0.001). Five clinical variables were selected and used to generate m-CLS. The predictive performance of m-CLS was similar in training and validation sets (AUROC 0.838 vs. 0.803, p = 0.724). In the overall set, m-CLS was significantly predictive of AL and performed better than CLS (AUROC 0.831 vs. 0.701, p = 0.008). In conclusion, LASSO-model-generated m-CLS could predict AL more accurately than CLS.
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Affiliation(s)
- Seung Up Yang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
| | - Eun Jung Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
| | - Seung Hyuk Baik
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
| | - Kang Young Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Jeonghyun Kang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea.
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24
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Prognostic significance of pancreatic fistula and postoperative complications after pancreaticoduodenectomy in patients with pancreatic ductal adenocarcinoma. Surgeon 2019; 18:24-30. [PMID: 31466841 DOI: 10.1016/j.surge.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/17/2019] [Accepted: 07/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The influence of postoperative complications, specifically, pancreatic fistula (PF), on long-term oncologic outcome in patients with pancreatic ductal adenocarcinoma (PDAC) is unclear. METHODS Prospectively collected data of patients who underwent pancreaticoduodenectomy (PD) for PDAC between 2008 and 2016 were retrospectively reviewed and analyzed. Deaths within 90 days were excluded. Median follow-up time was 22 months for the entire cohort (range 2-102 months). PF was graded as biochemical leak, grade B, or grade C according to the criteria of the International Study Group on Pancreatic Fistula. Postoperative complications were graded according to the Clavien-Dindo classification (CDC). Data on clinical and pathological characteristics as well as on recurrence and survival were collected. RESULTS Twenty-nine of the 148 identified patients (19%) developed PF, of whom 17 (11.4%) had a PF grade B or C. 29 patients developed a postoperative complication CDC grade 3 or 4. The respective 3-year disease-free survival was 15.5% and 19.2% (P = 0.725), and the 5-year overall survival was 20% and 16% (P = 0.914) in patients with and without PF. On multivariate analysis, the use of adjuvant chemotherapy, lymph node involvement, surgical margin involvement, and tumor grade were associated with patient survival. PF and postoperative complications CDC grade 3 or 4 were not associated with decreased long-term survival, disease-free survival or local recurrence rate. CONCLUSIONS While acknowledging the limited sample size, no association was seen between PF or postoperative complications and overall or disease-free survival in patients undergoing PD for PDAC.
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25
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Gray ME, Marland JRK, Dunare C, Blair EO, Meehan J, Tsiamis A, Kunkler IH, Murray AF, Argyle D, Dyson A, Singer M, Potter MA. In vivo validation of a miniaturized electrochemical oxygen sensor for measuring intestinal oxygen tension. Am J Physiol Gastrointest Liver Physiol 2019; 317:G242-G252. [PMID: 31188641 PMCID: PMC6734375 DOI: 10.1152/ajpgi.00050.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recent advances in the fields of electronics and microfabrication techniques have led to the development of implantable medical devices for use within the field of precision medicine. Monitoring visceral surface tissue O2 tension (PTo2) by means of an implantable sensor is potentially useful in many clinical situations, including the perioperative management of patients undergoing intestinal resection and anastomosis. This concept could provide a means by which treatment could be tailored to individual patients. This study describes the in vivo validation of a novel, miniaturized electrochemical O2 sensor to provide real-time data on intestinal PTo2. A single O2 sensor was placed onto the serosal surface of the small intestine of anesthetized rats that were exposed to ischemic (superior mesenteric artery occlusion) and hypoxemic (alterations in inspired fractional O2 concentrations) insults. Control experiments demonstrated that the sensors can function and remain stable in an in vivo environment. Intestinal PTo2 decreased following superior mesenteric artery occlusion and with reductions in inspired O2 concentrations. These results were reversible after reinstating blood flow or by increasing inspired O2 concentrations. We have successfully developed an anesthetized rat intestinal ischemic and hypoxic model for validation of a miniaturized O2 sensor to provide real-time measurement of intestinal PTo2. Our results support further validation of the sensors in physiological conditions using a large animal model to provide evidence of their use in clinical applications where monitoring visceral surface tissue O2 tension is important.NEW & NOTEWORTHY This is the first report of real-time continuous measurements of intestinal oxygen tension made using a microfabricated O2 sensor. Using a developed rodent model, we have validated this sensor's ability to accurately measure dynamic and reversible changes in intestinal oxygenation that occur through ischemic and hypoxemic insults. Continuous monitoring of local intestinal oxygenation could have value in the postoperative monitoring of patients having undergone intestinal surgery.
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Affiliation(s)
- Mark E. Gray
- 1The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom,2Cancer Research United Kingdom Edinburgh Centre and Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jamie R. K. Marland
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - Camelia Dunare
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - Ewen O. Blair
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - James Meehan
- 2Cancer Research United Kingdom Edinburgh Centre and Division of Pathology Laboratories, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Andreas Tsiamis
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - Ian H. Kunkler
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - Alan F. Murray
- 3School of Engineering, Institute for Integrated Micro and Nano Systems, Edinburgh, United Kingdom
| | - David Argyle
- 1The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Alex Dyson
- 4Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Mervyn Singer
- 4Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Mark A. Potter
- 5Department of Surgery, Western General Hospital, Edinburgh, United Kingdom
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26
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Voron T, Bruzzi M, Ragot E, Zinzindohoue F, Chevallier JM, Douard R, Berger A. Anastomotic Location Predicts Anastomotic Leakage After Elective Colonic Resection for Cancer. J Gastrointest Surg 2019; 23:339-347. [PMID: 30076589 DOI: 10.1007/s11605-018-3891-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/16/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) is a potential feared complication after colorectal resection, which is associated with an increased risk of postoperative mortality and frequently requires additional surgery. The aim of this study was to assess major independent risk factors for AL after elective colonic resection for cancer, including anastomotic location. METHODS Among 1940 consecutive patients referred to our institution for colorectal adenocarcinoma, 1025 patients had elective colonic resection with intraperitoneal anastomosis without diverting stoma. Risk factors were assessed among preoperative, operative, and histological data. RESULTS Clinical AL was observed in 36 patients (3.5%) with 24 patients requiring revisional surgery (67%). In multivariate analysis, endoscopic impassable tumor and colo-colic or ileo-colic anastomosis were independent risk factors for AL. The occurrence of AL was associated with poor overall (43.1 months vs. 146.4 months; p < 0.001) and disease-free survival (40.5 months vs. 137.3 months; p = 0.003). CONCLUSION Anastomotic leakage occurs more frequently after colo-colic and ileo-colic anastomosis than after intraperitoneal colorectal anastomosis. The right colectomy appears to be at higher risk of AL, with a greater risk of surgical intervention than after an elective left colectomy. Ileo-colic anastomosis should be avoided in cases of suboptimal conditions.
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Affiliation(s)
- Thibault Voron
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France. .,Faculté de Médecine Paris Descartes, Paris, France.
| | - Matthieu Bruzzi
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France.,Faculté de Médecine Paris Descartes, Paris, France
| | - Emilia Ragot
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France
| | - Franck Zinzindohoue
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France.,Faculté de Médecine Paris Descartes, Paris, France
| | - Jean-Marc Chevallier
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France.,Faculté de Médecine Paris Descartes, Paris, France
| | - Richard Douard
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France.,Faculté de Médecine Paris Descartes, Paris, France
| | - Anne Berger
- Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France.,Faculté de Médecine Paris Descartes, Paris, France
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27
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Ramphal W, Boeding JRE, Gobardhan PD, Rutten HJT, de Winter LJMB, Crolla RMPH, Schreinemakers JMJ. Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol 2018; 27:730-736. [PMID: 30449500 DOI: 10.1016/j.suronc.2018.10.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/31/2018] [Accepted: 10/01/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Anastomotic leakage is one of the most severe early complications after colorectal surgery, and it is associated with a high reoperation rate-, and increased in short-term morbidity and mortality rates. It remains unclear whether anastomotic leakage is associated with poor oncologic outcomes. The aim of this study was to determine the impacts of anastomotic leakage on long-term oncologic outcomes, disease-free survival and overall mortality in patients who underwent curative surgery for colorectal cancer. METHODS This single-centre, retrospective, observational cohort study included patients who underwent curative surgery for colorectal cancer between 2005 and 2015 and who had a primary anastomosis. Survival- and multivariate cox regression analyses were performed to adjust for confounding. RESULTS A total of 1984 patients had a primary anastomosis after surgery. The overall incidence of anastomotic leakage was 7.5%; 19 patients were excluded because they were lost to follow-up. Of the remaining 1965 patients, 41 (2.1%) developed local recurrence associated with anastomotic leakage [adjusted hazard ratio (HR) = 2.25; 95% confidence interval (CI) 1.14-5.29; P = 0.03]. Distant recurrence developed in 291(14.8%) patients with no association with anastomotic leakage [adjusted HR = 1.30 (95% CI: 0.85-1.97) P = 0.23]. Anastomotic leakage was associated with increased long-term mortality [adjusted HR = 1.69 (95% CI 1.32-2.18) P < 0.01]. Five year disease-free survival was significantly decreased in patients with anastomotic leakage, (log rank test P < 0.01). CONCLUSION Anastomotic leakage was significantly associated with increased rates of local recurrence, disease free-survival and overall mortality. Associations of anastomotic leakage with distant recurrence was not found.
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Affiliation(s)
- Winesh Ramphal
- Department of Surgery, Amphia Hospital Breda, the Netherlands.
| | | | | | - Harm J T Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands
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28
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Huo E, Eisenmenger L, Weinstein S. Imaging of the Postoperative Colon. Radiol Clin North Am 2018; 56:835-845. [PMID: 30119777 DOI: 10.1016/j.rcl.2018.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recognition of postoperative complications is important for the immediate diagnosis and treatment needed for appropriate patient care. Identification of postoperative complications from colon surgery requires not only knowledge of the type of procedure, but also the expected normal postoperative appearance. The purpose of this article is to discuss and review the expected anatomic changes after colorectal surgery, and the appearance of the most common postoperative complications.
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Affiliation(s)
- Eugene Huo
- Department of Radiology, San Francisco VA Medical Center, 4150 Clement Street (114), San Francisco, CA 94121, USA.
| | - Laura Eisenmenger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 513 Parnassus Avenue, Room S-261, Box 0628, San Francisco, CA 94143, USA
| | - Stefanie Weinstein
- Department of Radiology, San Francisco VA Medical Center, 4150 Clement Street (114), San Francisco, CA 94121, USA
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29
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Grewal S, Korthouwer R, Bögels M, Braster R, Heemskerk N, Budding AE, Pouw SM, van Horssen J, Ankersmit M, Meijerink J, van den Tol P, Oosterling S, Bonjer J, Gül N, van Egmond M. Spillage of bacterial products during colon surgery increases the risk of liver metastases development in a rat colon carcinoma model. Oncoimmunology 2018; 7:e1461302. [PMID: 30228930 PMCID: PMC6140552 DOI: 10.1080/2162402x.2018.1461302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 01/03/2023] Open
Abstract
Surgical resection of the primary tumor provides the best chance of cure for patients with colorectal carcinoma (CRC). However, bacterial translocation during intestinal surgery has been correlated with poor long-term oncological outcome. Therefore, we investigated the influence of bacterial contamination during colon surgery on CRC liver metastases development. Blood and liver samples of patients undergoing resection of primary CRC or liver metastases were collected. Cell numbers, activation markers and inflammatory mediators were determined. Tumor cell adhesion and outgrowth after sham- or colectomy operations were determined in a rat model, in which tumor cells had been injected into the portal vein. White blood cells and granulocytes were increased in per- and post-operative patient blood samples. IL-6 was also increased post-operatively compared to the preoperative level. Expression of NOX-2, NOX-4 and polymorphonuclear cells (PMNs) numbers were elevated in post-operative human liver samples. In vitro stimulation of macrophages with plasma of rats after colectomy resulted in production of reactive oxygen species (ROS). Colectomy in rats increased D-lactate levels in plasma, supporting bacterial translocation. Decreased expression of tight junction molecules and increased tumor cell adhesion and outgrowth was observed. Treatment with a selective decontamination of the digestive tract (SDD) cocktail decreased tumor cell adherence after colectomy. In conclusion, postoperative bacterial translocation may activate liver macrophages and PMNs, resulting in ROS production. As we previously showed that ROS release led to liver vasculature damage, circulating tumor cells may adhere to exposed extracellular matrix and grow out into liver metastases. This knowledge is pivotal for development of therapeutic strategies to prevent surgery-induced liver metastases development.
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Affiliation(s)
- Simran Grewal
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands.,Department of Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Rianne Korthouwer
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Marijn Bögels
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands.,Department of Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Rens Braster
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Niels Heemskerk
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Andries E Budding
- Department of Medical Microbiology and Infection Control, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Stephan M Pouw
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Jack van Horssen
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Marjolein Ankersmit
- Department of Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Jeroen Meijerink
- Department of Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Petrousjka van den Tol
- Department of Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Steven Oosterling
- Department of Surgery, Spaarne Gasthuis, PO Box 417, 2000 AK Haarlem, the Netherlands
| | - Jaap Bonjer
- Department of Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
| | - Nuray Gül
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Marjolein van Egmond
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands.,Department of Surgery, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, the Netherlands
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30
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Hüttner FJ, Warschkow R, Schmied BM, Diener MK, Tarantino I, Ulrich A. Prognostic impact of anastomotic leakage after elective colon resection for cancer - A propensity score matched analysis of 628 patients. Eur J Surg Oncol 2018; 44:456-462. [PMID: 29396327 DOI: 10.1016/j.ejso.2018.01.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/08/2017] [Accepted: 01/09/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is limited information regarding the impact of anastomotic leakage on oncologic outcome in exclusively colon cancer patients. METHODS The colorectal database of the Department of Surgery of the University of Heidelberg was used to assess the impact of anastomotic leakage on oncologic outcome in patients undergoing curative resection for Stage I-III colon cancer. Risk-adjusted Cox regression analysis and propensity score methods were used to assess overall, disease-free, and relative survival. RESULTS 628 patients of which 26 (4.1%) experienced anastomotic leakage were analysed. Anastomotic leakage was associated with significantly worse overall, disease-free and relative survival in univariate and multivariate analysis. The analysis after exact propensity score matching confirmed the negative impact of anastomotic leakage on overall (HR 2.62, 95% CI 1.33-5.18, p = .011), disease-free (HR 2.28, 95% CI 1.16-4.47, p = .027) and relative survival (HR 3.70, 95% CI 1.82-7.52, p < .001). 5-year overall survival was 51.6% (95% CI 34.5-77.2%) for patients with anastomotic leakage compared to 77.7% (95% CI 73.0-82.8%) for patients without anastomotic leakage. CONCLUSIONS All conceivable efforts should be made to avoid anastomotic leakage after colon resection for cancer not only to evade short-term consequences but also to allow for adequate long-term outcome.
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Affiliation(s)
- Felix J Hüttner
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany; Study Centre of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Rene Warschkow
- Department of Surgery, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland; Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130, 69120, Heidelberg, Germany
| | - Bruno M Schmied
- Department of Surgery, Kantonsspital St. Gallen, Rorschacher Str. 95, 9007, St. Gallen, Switzerland
| | - Markus K Diener
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany; Study Centre of the German Surgical Society, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Ignazio Tarantino
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Does advancement in stapling technology with triple-row and enhanced staple configurations confer additional safety? A matched comparison of 340 stapled ileocolic anastomoses. Surg Endosc 2018; 32:3122-3130. [DOI: 10.1007/s00464-018-6027-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 01/03/2018] [Indexed: 12/26/2022]
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32
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Local antibiotic decontamination to prevent anastomotic leakage short-term outcome in rectal cancer surgery. Int J Colorectal Dis 2018; 33:53-60. [PMID: 29119289 DOI: 10.1007/s00384-017-2933-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Anastomotic leakage still presents an issue in rectal cancer surgery with rates of about 11%. As bacteria play a critical role, there is the concept of perioperative local decontamination to prevent anastomotic leakage. METHODS To ascertain the effectiveness of this treatment, we performed a retrospective analysis on 206 rectal resections with primary anastomosis and routine use of a selective decontamination of the digestive tract (SDD) regimen for local decontamination. SDD medication was administered every 8 h from the day before surgery to the seventh postoperative day. All patients were treated according to the fast-track protocol without mechanical bowel preparation; instead, a laxative was used. RESULTS Overall morbidity was 30%, overall mortality 0.5%. In our data, overall rate of anastomotic leakage (AL) was 5.8%, with 3.9% in anterior rectal resection and 6.5% in low anterior rectal resection group. In 75% of cases, anastomotic leakage was grade "C" and needed re-laparotomy. Surgical site infection rate was 19.9%. No serious adverse events were related to decontamination. CONCLUSION Local antibiotic decontamination appears to be safe and effective to decrease the rate of anastomotic leakage in rectal cancer surgery. Further focus should be on perioperative management including bowel preparation and choice of antimicrobial agents for local decontamination.
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Crafa F, Smolarek S, Missori G, Shalaby M, Quaresima S, Noviello A, Cassini D, Ascenzi P, Franceschilli L, Delrio P, Baldazzi G, Giampiero U, Megevand J, Maria Romano G, Sileri P. Transanal Inspection and Management of Low Colorectal Anastomosis Performed With a New Technique: the TICRANT Study. Surg Innov 2017; 24:483-491. [PMID: 28514887 DOI: 10.1177/1553350617709182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anastomotic leakage is one of the most serious complications after rectal cancer surgery. METHOD A prospective multicenter interventional study to assess a newly described technique of creating the colorectal and coloanal anastomosis. The primary outcome was to access the safety and efficacy of this technique in the reduction of anastomotic leak. RESULT Fifty-three patients with rectal cancer who underwent low or ultra-low anterior resection were included in the study. There were 35 males and 18 females, with a median age of 68 years (range = 49-89 years). The median tumor distance from the anal verge was 8 cm (range = 4-12 cm), and the median body mass index was 24 kg/m2 (range = 20-35 kg/m2). Thirty patients underwent open, 16 laparoscopic, and 7 robotic surgeries. Multiple firing (2-charges) was required in 30 patients to obtain a complete rectal division. Forty-five patients had colorectal anastomosis, and 8 patients had coloanal anastomosis. The protective ileostomy was created in 40 patients at the time of initial surgery. There was no mortality in the first 30 days postoperatively, and only 10 (19%) patients developed complications. There were 3 anastomotic leakages (6%); 2 of them were subclinical with ileostomy created at initial operation and both were treated conservatively with transanal drainage and intravenous antibiotics. One patient required reoperation and ileostomy. The median length of hospital stay was 10 days (range = 4-20 days). CONCLUSION Our technique is a safe and efficient method of creation of colorectal anastomosis. It is also a universal method that can be used in open, laparoscopic, and robotic surgeries.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Paolo Delrio
- 5 Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
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Ha GW, Kim JH, Lee MR. Oncologic Impact of Anastomotic Leakage Following Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2017; 24:3289-3299. [DOI: 10.1245/s10434-017-5881-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Indexed: 12/15/2022]
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Goto S, Hasegawa S, Hida K, Uozumi R, Kanemitsu Y, Watanabe T, Sugihara K, Sakai Y. Multicenter analysis of impact of anastomotic leakage on long-term oncologic outcomes after curative resection of colon cancer. Surgery 2017; 162:317-324. [PMID: 28433249 DOI: 10.1016/j.surg.2017.03.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND In rectal cancer, anastomotic leakage was reported to have a negative impact on both short- and long-term outcomes. However, there is limited data on the impact of anastomotic leakage on oncologic outcomes in patients with colon cancer. We aimed to evaluate the impact of anastomotic leakage on disease recurrence and long-term survival after curative resection of colon cancer. METHODS This multicenter, retrospective cohort study of 4,919 consecutive patients utilized data from the Japanese Society for Cancer of the Colon and Rectum. Multivariable Cox regression analysis was used to adjust for confounding. RESULTS The incidence of anastomotic leakage was 2.5% and 30-day mortality was 0.21%. The 5-year overall survival rate was 80.8% in the anastomotic leakage group, compared with 90.3% in the no leak group (P = .001). In the multivariable analysis, anastomotic leakage was significantly associated with reduced overall survival rate (hazard ratio = 1.84; 95% confidence interval, 1.06-2.96). Overall disease recurrence rate was 14.1%: 21.2% in the anastomotic leakage group and 13.9% in the no leak group. There was a significant association between anastomotic leakage and local recurrence (hazard ratio = 4.63; 95% confidence interval, 1.60-10.6). In contrast, anastomotic leakage was not significantly associated with total distant recurrence. However, anastomotic leakage did show a tendency toward increasing peritoneal recurrence, although it did not reach statistical significance (hazard ratio = 2.59; 95% confidence interval, 0.79-6.29). CONCLUSION In our study population, anastomotic leakage was associated with reduced overall survival and with increased rate of local recurrence after curative resection for colon cancer.
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Affiliation(s)
- Saori Goto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Suguru Hasegawa
- Department of Surgery, Fukuoka University Hospital, Fukuoka, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukihide Kanemitsu
- Colorectal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Kenichi Sugihara
- Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Tanaka K, Okuda J, Yamamoto S, Ito M, Sakamoto K, Kokuba Y, Yoshimura K, Watanabe M. Risk factors for anastomotic leakage after laparoscopic surgery with the double stapling technique for stage 0/I rectal carcinoma: a subgroup analysis of a multicenter, single-arm phase II trial. Surg Today 2017; 47:1215-1222. [PMID: 28280982 DOI: 10.1007/s00595-017-1496-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/07/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to determine the risk factors for anastomotic leakage after laparoscopic rectal surgery. METHODS We conducted a prospective trial involving 395 patients with stage 0/I rectal carcinoma who underwent laparoscopic low anterior resection using a double stapling technique. Data concerning variables related to patient background, tumors and surgical factors were evaluated. The outcomes with respect to anastomotic leakage were recorded, and univariate and multivariate analyses were performed to identify relevant risk factors. RESULTS The overall anastomotic leakage rate was 8.4%. A univariate analysis showed male gender (P = 0.006) and preoperative blood sugar level (P = 0.0034) to be significantly associated with anastomotic leakage. The variables of gender, preoperative blood sugar level, American Society of Anesthesiologists (ASA) classification (P = 0.15), transanal decompression tube (P = 0.06) and number of stapler cartridges used for rectal transection (P = 0.18) were selected for the multivariate analysis because of their P values being <0.2. The multivariate analysis identified male gender (odds ratio 4.12, P = 0.006) and the absence of a transanal decompression tube (odds ratio 3.11, P = 0.0484) as independent risk factors predicting anastomotic leakage. CONCLUSIONS Male gender and the absence of a transanal decompression tube appeared to be independent risk factors for anastomotic leakage. Insertion of a transanal decompression tube may help prevent anastomotic leakage after low anterior resection, particularly in male patients.
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Affiliation(s)
- Keitaro Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Junji Okuda
- Cancer Center, Osaka Medical College Hospital, Osaka, Japan
| | - Seiichiro Yamamoto
- Division of Gastroenterological Surgery, Hiratsuka City Hospital, 19-1-1, Minamihara, Hiratsuka, Kanagawa, 254-0065, Japan.
| | - Masaaki Ito
- Colorectal Surgery Division, National Cancer Center Hospital East, Chiba, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University, Tokyo, Japan
| | - Yukihito Kokuba
- Department of Gastroenterological Surgery, St. Marianna University Yokohama West Hospital, Kanagawa, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University Hospital, Ishikawa, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University Hospital, Kanagawa, Japan
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Valle SJ, Alzahrani N, Alzahrani S, Traiki TB, Liauw W, Morris DL. Enterocutaneous fistula in patients with peritoneal malignancy following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Incidence, management and outcomes. Surg Oncol 2016; 25:315-320. [PMID: 27566038 DOI: 10.1016/j.suronc.2016.05.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/20/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for peritoneal carcinomatosis (PC) from multiple origins, however is associated with increased complications compared to conventional gastrointestinal surgery. The aetiology of enterocutaneous fistulas (ECF) in most cases is a result of various contributing factors and therefore remains a major clinical problem, occurring in 4-34% of patients post-CRS. The aim of this study was to analyze the incidence and outcome of ECF following CRS/HIPEC. METHOD From April 1999 to September 2015, 53 patients of 918 CRS/HIPEC procedures developed an ECF. Patient, operative and postoperative data were retrospectively analyzed to determine aetiology, classification outcome and possible contributing factors were reviewed on univariate and multivariate analysis. RESULTS We report a 5.8% ECF rate, diagnosed at a median of 13 days. The mortality rate was 5.7% and other morbidity was significantly increased (p = 0.0001). Twenty-five (47.2%), 8 (15.1%) and 20 patients (37.7%) had low, moderate and high output ECF respectively. Patients that had a CC2 cytoreduction, abdominal VAC or smoked had a higher risk of fistula (p = 0.004, p < 0.0001, p = 0.008). Spontaneous closure was achieved in 49.2% with conservative treatment (median 29 days) and 33.9% underwent surgical intervention. Preoperative serum albumin <35 g/L (p = 0.04), PCI>17 (p = 0.025) and operation >8.6 h s (p = 0.001) were independent risk factors on multivariate analysis. Overall and 5-year survival was significantly reduced (p < 0.0001,p = 0.016). CONCLUSION CRS/HIPEC remains an effective treatment modality for PC in selected patients with a comparable ECF incidence to reported elective gastrointestinal surgery rates. This study identifies multiple risk factors that should be considered in patients undergoing CRS/HIPEC.
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Affiliation(s)
- Sarah J Valle
- UNSW Department of Surgery, St George Hospital, Kogarah, NSW, Australia
| | - Nayef Alzahrani
- UNSW Department of Surgery, St George Hospital, Kogarah, NSW, Australia; Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
| | - Saleh Alzahrani
- UNSW Department of Surgery, St George Hospital, Kogarah, NSW, Australia
| | - Thamer Bin Traiki
- UNSW Department of Surgery, St George Hospital, Kogarah, NSW, Australia
| | - Winston Liauw
- UNSW Department of Surgery, St George Hospital, Kogarah, NSW, Australia; Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia
| | - David L Morris
- UNSW Department of Surgery, St George Hospital, Kogarah, NSW, Australia.
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Marinello FG, Baguena G, Lucas E, Frasson M, Hervás D, Flor-Lorente B, Esclapez P, Espí A, García-Granero E. Anastomotic leakage after colon cancer resection: does the individual surgeon matter? Colorectal Dis 2016; 18:562-9. [PMID: 26558741 DOI: 10.1111/codi.13212] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 08/01/2015] [Indexed: 12/13/2022]
Abstract
AIM Anastomotic leakage is one of the most feared complications after colonic resection. Many risk factors for anastomotic leakage have been reported, but the impact of an individual surgeon as a risk factor has scarcely been reported. The aim of this study was to assess if the individual surgeon is an independent risk factor for anastomotic leakage in colonic cancer surgery. METHOD This was a retrospective analysis of prospectively collected data from patients who underwent elective resection for colon cancer with anastomosis at a specialized colorectal unit from January 1993 to December 2010. Anastomotic leaks were diagnosed according to standardized criteria. Patient and tumour characteristics, surgical procedure and operating surgeons were analysed. A logistic regression model was used to discriminate statistical variation and identify risk factors for anastomotic leakage. RESULTS A total of 1045 patients underwent elective colon cancer resection with primary anastomosis. Anastomotic leakage occurred in 6.4% of patients. Ileocolic anastomosis had an anastomotic leakage rate of 7.2%, colo-colonic/colorectal anastomosis 5.2% and ileorectal anastomosis 12.7%, with intersurgeon variability. The independent risk factors associated with anastomotic leakage were the use of perioperative blood transfusion (OR 2.83, CI 1.59-5.06, P < 0.0001) and the individual surgeon performing the procedure (OR up to 8.44, P < 0.0001). CONCLUSION In addition to perioperative blood transfusion, the individual surgeon was identified as an important risk factor for anastomotic leakage. Efforts should be made to reduce performance variability amongst surgeons.
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Affiliation(s)
- F G Marinello
- Department of Surgery, University of Valencia, Valencia, Spain
| | - G Baguena
- Department of Surgery, University of Valencia, Valencia, Spain
| | - E Lucas
- Department of Surgery, University of Valencia, Valencia, Spain
| | - M Frasson
- Department of Surgery, University of Valencia, Valencia, Spain
| | - D Hervás
- Department of Biostatistics, IIS La Fe, Valencia, Spain
| | - B Flor-Lorente
- Department of Surgery, University of Valencia, Valencia, Spain
| | - P Esclapez
- Department of Surgery, University of Valencia, Valencia, Spain
| | - A Espí
- Department of Surgery, University of Valencia, Valencia, Spain
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Galissier T, Schneider C, Nasri S, Kanagaratnam L, Fichel C, Coquelet C, Diebold MD, Kianmanesh R, Bellon G, Dedieu S, Marchal Bressenot A, Boulagnon-Rombi C. Biobanking of Fresh-Frozen Human Adenocarcinomatous and Normal Colon Tissues: Which Parameters Influence RNA Quality? PLoS One 2016; 11:e0154326. [PMID: 27124490 PMCID: PMC4849710 DOI: 10.1371/journal.pone.0154326] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 04/12/2016] [Indexed: 12/01/2022] Open
Abstract
Medical research projects become increasingly dependent on biobanked tissue of high quality because the reliability of gene expression is affected by the quality of extracted RNA. Hence, the present study aimed to determine if clinical, surgical, histological, and molecular parameters influence RNA quality of normal and tumoral frozen colonic tissues. RNA Quality Index (RQI) was evaluated on 241 adenocarcinomas and 115 matched normal frozen colon tissues collected between October 2006 and December 2012. RQI results were compared to patients’ age and sex, tumor site, kind of surgery, anastomosis failure, adenocarcinoma type and grade, tumor cell percentage, necrosis extent, HIF-1α and cleaved caspase-3 immunohistochemistry, and BRAF, KRAS and microsatellites status. The RQI was significantly higher in colon cancer tissue than in matched normal tissue. RQI from left-sided colonic cancers was significantly higher than RQI from right-sided cancers. The RNA quality was not affected by ischemia and storage duration. According to histological control, 7.9% of the samples were unsatisfactory because of inadequate sampling. Biobanked tumoral tissues with RQI ≥5 had lower malignant cells to stromal cells ratio than samples with RQI <5 (p <0.05). Cellularity, necrosis extent and mucinous component did not influence RQI results. Cleaved caspase-3 and HIF-1α immunolabelling were not correlated to RQI. BRAF, KRAS and microsatellites molecular status did not influence RNA quality. Multivariate analysis revealed that the tumor location, the surgical approach (laparoscopy versus open colectomy) and the occurrence of anastomotic leakage were the only parameters influencing significantly RQI results of tumor samples. We failed to identify parameter influencing RQI of normal colon samples. These data suggest that RNA quality of colonic adenocarcinoma biospecimens is determined by clinical and surgical parameters. More attention should be paid during the biobanking procedure of right-sided colon cancer or laparoscopic colectomy specimen. Histological quality control remains essential to control sampling accuracy.
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Affiliation(s)
- Thibaut Galissier
- Laboratoire d’Anatomie Pathologique, Centre Hospitalier Universitaire, Reims, France
| | - Christophe Schneider
- CNRS UMR 7369, Matrice Extracellulaire et Dynamique Cellulaire, MEDyC, Reims, France
- Laboratoire SiRMa, Université de Reims Champagne-Ardenne, UFR Sciences Exactes et Naturelles, Reims, France
| | - Saviz Nasri
- Tumorothèque de Champagne Ardenne, Reims, France
| | - Lukshe Kanagaratnam
- Unité d’Aide Méthodologique, Centre Hospitalier Universitaire, Reims, France
| | - Caroline Fichel
- Laboratoire d’Anatomie Pathologique, Université de Reims Champagne-Ardenne, UFR Médecine, Reims, France
| | | | - Marie-Danièle Diebold
- Laboratoire d’Anatomie Pathologique, Centre Hospitalier Universitaire, Reims, France
- CNRS UMR 7369, Matrice Extracellulaire et Dynamique Cellulaire, MEDyC, Reims, France
- Tumorothèque de Champagne Ardenne, Reims, France
- Laboratoire d’Anatomie Pathologique, Université de Reims Champagne-Ardenne, UFR Médecine, Reims, France
| | - Reza Kianmanesh
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire, Reims, France
| | - Georges Bellon
- CNRS UMR 7369, Matrice Extracellulaire et Dynamique Cellulaire, MEDyC, Reims, France
- Laboratoire de Biochimie, Centre Hospitalier Universitaire, Reims, France
| | - Stéphane Dedieu
- CNRS UMR 7369, Matrice Extracellulaire et Dynamique Cellulaire, MEDyC, Reims, France
- Laboratoire SiRMa, Université de Reims Champagne-Ardenne, UFR Sciences Exactes et Naturelles, Reims, France
| | - Aude Marchal Bressenot
- Laboratoire d’Anatomie Pathologique, Centre Hospitalier Universitaire, Reims, France
- Laboratoire d’Anatomie Pathologique, Université de Reims Champagne-Ardenne, UFR Médecine, Reims, France
| | - Camille Boulagnon-Rombi
- Laboratoire d’Anatomie Pathologique, Centre Hospitalier Universitaire, Reims, France
- CNRS UMR 7369, Matrice Extracellulaire et Dynamique Cellulaire, MEDyC, Reims, France
- Laboratoire d’Anatomie Pathologique, Université de Reims Champagne-Ardenne, UFR Médecine, Reims, France
- * E-mail:
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Ukegjini K, Zadnikar M, Warschkow R, Müller S, Schmied BM, Marti L. Baseline mortality-adjusted survival in colon cancer patients. Langenbecks Arch Surg 2016; 401:633-41. [PMID: 27102323 DOI: 10.1007/s00423-016-1432-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 04/11/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND This investigation assessed the baseline mortality-adjusted survival after colon cancer resection. MATERIAL AND METHODS In total, 523 patients with adenocarcinoma of the colon who underwent primary colon resection at Kantonsspital St. Gallen, Switzerland, between 1996 and 2008 were included. RESULTS The median follow-up was 25 months for all patients and 39 months for those who survived until the end of the follow-up. The 5-year relative survival rate was 63.2 % (95 % CI 57.3-69.6 %), and the overall survival rate was 52 % (95 % CI 47.6-57.7 %). After curative resection of stage I-III colon cancer, 40 % of the observed deaths were cancer-related and 60 % reflected the baseline mortality. In stage I, the 5-year relative survival was 103.2 % (95 % CI 91.4-116.5 %) and was not different from a matched population (p = 0.820). In multivariate analysis, good general health and less advanced cancer stages were associated with better relative and overall survival rates. A more advanced age was associated with better relative survival, but worse overall survival. CONCLUSIONS The analysis of relative survival of patients exclusively with colon cancer revealed that prognosis of patients suffering from stage I colon cancer does not differ significantly from that of the general population. In more advanced stages, a relevant fraction of deaths is not cancer-related. As the stage determines a patient's survival, early diagnosis is crucial for prognosis.
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Affiliation(s)
- Kristjan Ukegjini
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Marcel Zadnikar
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Rene Warschkow
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany
| | - Sascha Müller
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Bruno M Schmied
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland
| | - Lukas Marti
- Department of General, Visceral, Endocrine and Transplantation Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany.
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Abstract
OBJECTIVE To study the association between ketorolac use and postoperative complications. BACKGROUND Nonsteroidal anti-inflammatory drugs may impair wound healing and increase the risk of anastomotic leak in colon surgery. Studies to date have been limited by sample size, inability to identify confounding, and a focus limited to colon surgery. METHODS Ketorolac use, reinterventions, emergency department (ED) visits, and readmissions in adults (≥ 18 years) undergoing gastrointestinal (GI) operations was assessed in a nationwide cohort using the MarketScan Database (2008-2012). RESULTS Among 398,752 patients (median age 52, 45% male), 55% underwent colorectal surgery, whereas 45% had noncolorectal GI surgery. Five percent of patients received ketorolac. Adjusting for demographic characteristics, comorbidities, surgery type/indication, and preoperative medications, patients receiving ketorolac had higher odds of reintervention (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.08-1.32), ED visit (OR 1.44, 95% CI 1.37-1.51), and readmission within 30 days (OR 1.11, 95% CI 1.05-1.18) compared to those who did not receive ketorolac. Ketorolac use was associated with readmissions related to anastomotic complications (OR 1.20, 95% CI 1.06-1.36). Evaluating only admissions with ≤ 3 days duration to exclude cases where ketorolac might have been used for complication-related pain relief, the odds of complications associated with ketorolac were even greater. CONCLUSIONS Use of intravenous ketorolac was associated with greater odds of reintervention, ED visit, and readmission in both colorectal and noncolorectal GI surgery. Given this confirmatory evaluation of other reports of a negative association and the large size of this cohort, clinicians should exercise caution when using ketorolac in patients undergoing GI surgery.
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Park JS, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, Lee WY. Risk Factors of Anastomotic Leakage and Long-Term Survival After Colorectal Surgery. Medicine (Baltimore) 2016; 95:e2890. [PMID: 26937928 PMCID: PMC4779025 DOI: 10.1097/md.0000000000002890] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Anastomotic leakage (AL) is one of the most serious complications of colorectal surgery. It can affect long-term oncologic outcomes, but the impact on long-term survival remains uncertain. The aim of this study is to evaluate the operative characteristics of leakage and no leakage groups and to analyze long-term oncologic outcomes.We prospectively enrolled 10,477 patients from 2000 to 2011 and retrospectively reviewed the data.Male sex (odds ratio [OR], 3.90; P < 0.001), intraoperative transfusion (OR, 2.31; P = 0.042), and operative time (OR, 1.73; P = 0.032) were independent risk factors of AL in the colon. In the rectum, male sex (OR, 2.37; P < 0.001), neoadjuvant chemoradiotherapy (OR, 2.26; P < 0.001), and regional lymph node metastasis (OR, 1.43; P = 0.012) were independent risk factors of AL, and diverting stoma (OR, 0.24; P < 0.001) was associated with a deceased risk of AL. AL in the rectum without a diverting stoma was associated with disease-free survival (DFS, OR, 1.47; P = 0.037). Colonic leakage was not associated with 5-year DFS (leakage group vs nonleakage group, 72.4% vs 80.9%, P = 0.084); however, in patients undergoing rectal resection, there was a significant difference in 5-year DFS (67.0% vs 76.6%, P = 0.005, respectively).AL in the rectum is associated with worse long-term DFS and overall survival. A diverting stoma was shown to protect against this effect and was associated with long-term survival in rectal surgery. Therefore, creating a diverting stoma should be considered in high-risk patients undergoing rectal surgery.
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Affiliation(s)
- Jong Seob Park
- From the Department of Surgery, CHA Gangnam Medical Center, CHA University School of Medicine (JSP); and Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine (JWH, YAP, YBC, SHY, HCK, WYL), Seoul, Korea
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Kim IY, Kim BR, Kim YW. The impact of anastomotic leakage on oncologic outcomes and the receipt and timing of adjuvant chemotherapy after colorectal cancer surgery. Int J Surg 2015; 22:3-9. [DOI: 10.1016/j.ijsu.2015.08.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 01/18/2023]
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Risk Factors for Anastomotic Leak After Colon Resection for Cancer: Multivariate Analysis and Nomogram From a Multicentric, Prospective, National Study With 3193 Patients. Ann Surg 2015; 262:321-30. [PMID: 25361221 DOI: 10.1097/sla.0000000000000973] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine pre-/intraoperative risk factors for anastomotic leak after colon resection for cancer and to create a practical instrument for predicting anastomotic leak risk. BACKGROUND Anastomotic leak is still the most dreaded complication in colorectal surgery. Many risk factors have been identified to date, but multicentric prospective studies on anastomotic leak after colon resection are lacking. METHODS Fifty-two hospitals participated in this prospective, observational study. Data of 3193 patients, operated for colon cancer with primary anastomosis without stoma, were included in a prospective online database (September 2011-September 2012). Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak (60-day follow-up). A nomogram was created to easily predict the risk of anastomotic leak for a given patient. RESULTS The anastomotic leak rate was 8.7%, and widely varied between hospitals (variance of 0.24 on the logit scale). Anastomotic leak significantly increased mortality (15.2% vs 1.9% in patients without anastomotic leak, P < 0.0001) and length of hospitalization (median 23 vs 7 days in uncomplicated patients, P < 0.0001). In the multivariate analysis, the following variables were independent risk factors for anastomotic leak: obesity [P = 0.003, odds ratio (OR) = 2.7], preoperative serum total proteins (P = 0.03, OR = 0.7 per g/dL), male sex (P = 0.03, OR = 1.6), ongoing anticoagulant treatment (P = 0.05, OR = 1.8), intraoperative complication (P = 0.03, OR = 2.2), and number of hospital beds (P = 0.04, OR = 0.95 per 100 beds). CONCLUSIONS Anastomotic leak after colon resection for cancer is a frequent, relevant complication. Patients, surgical technique, and hospital are all important determining factors of anastomotic leak risk.
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Transanal drainage tube placement to prevent anastomotic leakage following colorectal cancer surgery with double stapling reconstruction. Surg Today 2015; 46:613-20. [DOI: 10.1007/s00595-015-1230-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/02/2015] [Indexed: 12/28/2022]
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Wenger FA, Szucsik E, Hoinoiu BF, Cimpean AM, Ionac M, Raica M. Circular anastomotic experimental fibrin sealant protection in deep colorectal anastomosis in pigs in a randomized 9-day survival study. Int J Colorectal Dis 2015; 30:1029-39. [PMID: 26008730 DOI: 10.1007/s00384-015-2260-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE The reported rate of clinically apparent anastomotic leakage (AL) in a low anterior resection of the rectum (LAR) (≤7 cm from the anal verge) using a circular double-stapled anastomosis (CDSA) without defunctioning stoma is up to 37.5 %. Since AL may result in life-threatening peritonitis, sepsis, and multiple organ failure, LAR and CDSA are regularly combined with defunctioning stoma. Accordingly, we now evaluated whether LAR and CDSA without defunctioning stoma but with extraluminal anastomotic application of an experimental fibrin sealant reduce the AL rate. This might prevent humans from defunctioning stoma increasing quality of life and decreasing surgical costs. METHODS Forty 8-week-old pigs underwent LAR and CDSA in an end-to-end technique (descendo-rectostomy). Animals were randomized into a therapy and control group (gr.). The therapy gr. (n = 20) received an additional extraluminal circular application of an experimental fibrin sealant to the anastomosis. The objective was to assess the incidence of clinically apparent and non-clinically apparent leakage through the ninth postoperative day. Double-contrast barium CT radiographs of the colorectal region were performed on the ninth postoperative day or earlier, in case there were clinical signs of AL. All remaining animals were sacrificed on the ninth postoperative day and the anastomotic region was histopathologically analyzed. In case of earlier diagnosed AL, animals were sacrificed immediately. Blood samples were taken for complete blood count, chemistry, and coagulation profile prior to surgery and on the first, third, fifth, seventh, and ninth postoperative day. RESULTS A circular extraluminal anastomotic application of an experimental fibrin protection decreased the rate of clinically and non-clinically apparent AL from 20 % (n = 4) in the control group to 5 % (n = 1) in the treatment group. Ulcerations were also observed in both gr. (control gr.-5 animals, therapy gr. -3 animals). All animals with AL showed necrosis surrounding the hole at the anastomoses. Three additional animals had a full wall defect at the anastomotic region that was blocked by the experimental fibrin sealant. The fibrin sealant was present at necropsy in all treated animals. CONCLUSION Circular anastomotic protection with the experimental fibrin sealant blocked anastomotic full wall defects, preventing peritonitis and significantly reducing the AL rate from 25 to 5 %.
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Affiliation(s)
- F A Wenger
- Clinic of General, Visceral and Thoracic Surgery, Asklepios Südpfalzklinik Kandel, Luitpoldstraße 14, 76870, Kandel, Germany,
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Blot C, Sabbagh C, Rebibo L, Brazier F, Chivot C, Fumery M, Regimbeau JM. Use of transanastomotic double-pigtail stents in the management of grade B colorectal leakage: a pilot feasibility study. Surg Endosc 2015; 30:1869-75. [PMID: 26183957 DOI: 10.1007/s00464-015-4404-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/02/2015] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Anastomotic leakage (AL) is a major complication of colorectal surgery. The leakage is classified as grade B when the patient's clinical condition requires an active therapeutic intervention but does not require further surgery. The management of grade B AL commonly includes administration of antibiotics and/or the placement of a pelvic drainage performed under radiological guidance or transanal drain. The objective of this study was to evaluate the feasibility and the efficacy of endoscopic transanastomotic drainage using double-pigtail stents (DPSs) in the management of grade B AL in colorectal surgery. PATIENTS AND METHODS Between September 2011 and December 2014, 650 patients underwent a colorectal procedure in our university hospital; 8.7 % presented with AL, including 42.8 % with grade B. Fourteen patients required endoscopic management and constituted the study population. The study's primary objective was to assess the feasibility and efficacy of DPS placement for the treatment of grade B AL after colorectal surgery. The secondary endpoints were the requirement for radiological drainage, the DPS placement failure rate, the rate of stoma closure and, lastly, feasibility of chemotherapy (if indicated). RESULTS DPS placement was feasible in 92.8 % of the 14 patients (n = 13). The overall success rate for endoscopic management was 78.5 % (n = 11). The median length of hospitalization after DPS placement was 5 days (3-17). The average duration of drainage through a DPS was 62 days (28-181). Five patients (35.7 %) also underwent drainage with radiological guidance. Of the 10 patients with stoma, closure occurred in 80 %. All patients that required adjuvant chemotherapy were able to receive it. CONCLUSION The treatment of AL requires multidisciplinary collaboration to save the anastomosis. DPS placement under endoscopic control is associated with AL healing, good clinical tolerance and the ability to undergo chemotherapy and is an alternative to repeat laparotomy when radiological drainage is unfeasible or inefficient.
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Affiliation(s)
- Christelle Blot
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.,Jules Verne University of Picardie, Amiens Cedex 01, France
| | - Charles Sabbagh
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.,Jules Verne University of Picardie, Amiens Cedex 01, France.,INSERM Unit 1088, Amiens Cedex 01, France
| | - Lionel Rebibo
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.,Jules Verne University of Picardie, Amiens Cedex 01, France
| | - Franck Brazier
- Department of Hepatogastroenterology, Amiens University Hospital, Amiens Cedex 01, France
| | - Cyril Chivot
- Department of Radiology, Amiens University Hospital, Amiens Cedex 01, France
| | - Mathurin Fumery
- Jules Verne University of Picardie, Amiens Cedex 01, France.,Department of Hepatogastroenterology, Amiens University Hospital, Amiens Cedex 01, France
| | - Jean-Marc Regimbeau
- Department of Digestive and Oncological Surgery, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France. .,Jules Verne University of Picardie, Amiens Cedex 01, France. .,EA4294, Jules Verne University of Picardie, Amiens Cedex 01, France. .,Clinical Research Centre, Amiens University Hospital, Amiens Cedex 01, France.
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Nordentoft T, Pommergaard HC, Rosenberg J, Achiam MP. Fibrin glue does not improve healing of gastrointestinal anastomoses: a systematic review. Eur Surg Res 2014; 54:1-13. [PMID: 25247310 DOI: 10.1159/000366418] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/04/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Anastomotic leakage remains a frequent and serious complication in gastrointestinal surgery. In order to reduce its incidence, several clinical and experimental studies on anastomotic sealing have been performed. In a number of these studies, the sealing material has been fibrin glue (FG), and the results in individual studies have been varying. The positive effect of anastomotic sealing with FG might be due to the mechanical/physical properties, the increased healing of the anastomoses or both. The aim of this systematic review was to evaluate the existing evidence on the healing effects of FG on gastrointestinal anastomoses. METHODS PubMed, EMBASE and the Cochrane databases were searched for studies evaluating the healing process of gastrointestinal anastomoses after any kind of FG application. The search period was from 1953 to December 2013. RESULTS Twenty-eight studies were included in the qualitative synthesis. These studies were all experimental studies, since no human studies used histological or biochemical evaluation of healing. In 7 of the 28 studies, a positive effect of FG on healing was found, while 8 studies reported a negative effect and 11 studies found no effect. Furthermore, 2 studies reported unclear results. The difference in the study outcome was independent of the study design and the type of FG used. CONCLUSION In the available studies, FG did not consistently have a positive influence on the healing of gastrointestinal anastomoses. It is consequently plausible that the positive effect of FG sealing of gastrointestinal anastomoses, if there is any, may be due to a mechanical sealing effect rather than due to improved healing per se.
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Affiliation(s)
- Tyge Nordentoft
- Department of Gastrointestinal Surgery 360, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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Ramanathan ML, MacKay G, Platt J, Horgan PG, McMillan DC. The Impact of Open Versus Laparoscopic Resection for Colon Cancer on C-Reactive Protein Concentrations as a Predictor of Postoperative Infective Complications. Ann Surg Oncol 2014; 22:938-43. [DOI: 10.1245/s10434-014-4065-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Indexed: 01/21/2023]
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Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery. J Crit Care 2014; 29:528-32. [DOI: 10.1016/j.jcrc.2014.03.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 03/26/2014] [Accepted: 03/29/2014] [Indexed: 01/26/2023]
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