Journal ArticleDOI
Risk factors for anastomotic leakage after anterior resection of the rectum
TLDR
The aim of this study was to identify risk factors for anastomotic leakage in anterior resection and to assess the role of a temporary stoma and the need for urgent re‐operations in relation to anastOMotic leakage.Abstract:
Objective. Surgical technique and peri-operative management of rectal carcinoma have developed substantially in the last decades. Despite this, morbidity and mortality after anterior resection of the rectum are still important problems. The aim of this study was to identify risk factors for anastomotic leakage in anterior resection and to assess the role of a temporary stoma and the need for urgent re-operations in relation to anastomotic leakage.Patients and methods. In a nine-year period, from 1987 to 1995, a total of 6833 patients underwent elective anterior resection of the rectum in Sweden. A random sample of 432 of these patients was analysed (sample size 6.3%). The associations between death and 10 patient-and surgery-related variables were studied by univariate and multivariate analysis. Data were obtained by review of the hospital files from all patients.Results. The incidence of symptomatic clinically evident anastomotic leakage was 12% (53/432). The 30-day mortality was 2.1% (140/6833). The rate of mortality associated with leakage was 7.5%. A temporary stoma was initially fashioned in 17% (72/432) of the patients, and 15% (11/72) with a temporary stoma had a clinical leakage, compared with 12% (42/360) without a temporary stoma, not significant. Multivariate analysis showed that low anastomosis (≤ 6 cm), pre-operative radiation, presence of intra-opcrative adverse events and male gender were independent risk factors for leakage. The risk for permanent stoma after leakage was 25%. Females with stoma leaked in 3% compared to men with stoma who leaked in 29%. The median hospital stay for patients Arithout leakage was 10 days (range 5-61 days) and for patients with leakage 22 days (3-110 days).Conclusion. In this population based study, 12% of the patients had symptomatic anastomotic leakage after anterior resection of the rectum. Postoperative 30-day mortality was 2.1%. Low anastomosis, pre-operative radiation, presence of intra-operative adverse events and male gender were independent risk factors for symptomatic anastomotic leakage in the multivariate analysis. There was no difference in the use of temporary stoma in patients with or without anastomotic leakage.read more
Citations
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Journal ArticleDOI
Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer.
Nuh N. Rahbari,Jürgen Weitz,Werner Hohenberger,Richard J. Heald,Brendan Moran,Alexis Ulrich,Torbjörn Holm,W. Douglas Wong,Emmanuel Tiret,Y. Moriya,Søren Laurberg,Marcel den Dulk,Cornelis J.H. van de Velde,Markus W. Büchler +13 more
TL;DR: The proposed definition and clinical grading of anastomotic leakage is applicable easily in the setting of clinical studies and should be applied in future reports to facilitate valid comparison of the results of different studies.
Journal ArticleDOI
Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer : A randomized multicenter trial
TL;DR: Defunctioning loop stoma decreased the rate of symptomatic anastomotic leakage and is therefore recommended in low anterior resection for rectal cancer.
Journal ArticleDOI
Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks.
TL;DR: A systematic review of the literature focusing on the role of preoperative, intraoperative and postoperative factors in the development of colorectal ALs found that there remains a lack of consensus regarding factors that may predispose to AL.
Journal ArticleDOI
Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery.
Norbert Hüser,Christoph W. Michalski,Mert Erkan,Tibor Schuster,Robert D. Rosenberg,Jörg Kleeff,Helmut Friess +6 more
TL;DR: A defunctioning stoma reduces the rate of clinically relevant anastomotic leakages and is thus recommended in surgery for low rectal cancers.
Journal ArticleDOI
Practice parameters for the management of rectal cancer (revised)
Rectal Surgeons: Joe J. Tjandra,John Kilkenny,W. Donald Buie,Neil Hyman,Clifford Simmang,Thomas Anthony,Charles P. Orsay,James M. Church,Daniel Otchy,Jeffrey A. Cohen,Ronald J. Place,Frederick Denstman,Jan Rakinic,Richard Moore,Mark H. Whiteford +14 more
TL;DR: These guidelines are inclusive, and not prescriptive, and intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines.
References
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Preoperative Radiotherapy Combined with Total Mesorectal Excision for Resectable Rectal Cancer
Ellen Kapiteijn,Corrie A.M. Marijnen,Iris D. Nagtegaal,Hein Putter,W.H. Steup,Theo Wiggers,Harm J. T. Rutten,Lars Påhlman,Bengt Glimelius,J. Han van Krieken,J.W.H. Leer,Cornelis J.H. van de Velde +11 more
TL;DR: In this article, the authors conducted a multicenter, randomized trial to determine whether the addition of preoperative radiotherapy increases the benefit of total mesorectal excision, and the overall rate of survival at two years among the eligible patients was 82.0 percent in the group assigned to both radiotherapy and surgery.
Journal ArticleDOI
The mesorectum in rectal cancer surgery--the clue to pelvic recurrence?
TL;DR: Five cases are described where minute foci of adenocarcinoma have been demonstrated in the mesorectum several centimetres distal to the apparent lower edge of a rectal cancer, and these operations have been carried out as a part of over 100 consecutive anterior resections.
Journal ArticleDOI
Improved survival with preoperative radiotherapy in resectable rectal cancer.
TL;DR: A short-term regimen of high-dose preoperative radiotherapy reduces rates of local recurrence and improves survival among patients with resectable rectal cancer.
Journal Article
Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer
U Tiefenbacher,F Wenz +1 more
Journal ArticleDOI
Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision.
TL;DR: In this paper, transverse slicing was used to examine whole-mount sections of the entire operative specimen of rectal adnocarcinoma and showed that the spread to the lateral resection margin in 14 of 52 (27%) patients and 12 of these proceeded to local pelvic recurrence.