The impact of anastomotic leakage characteristics on the occurrence of anastomotic stenosis after colorectal resection, a retrospective cohort study.
Anastomotic leakage
Anastomotic stenosis
Colorectal surgery
ENPT
ISREC
Journal
International journal of colorectal disease
ISSN: 1432-1262
Titre abrégé: Int J Colorectal Dis
Pays: Germany
ID NLM: 8607899
Informations de publication
Date de publication:
06 Aug 2024
06 Aug 2024
Historique:
accepted:
23
07
2024
medline:
6
8
2024
pubmed:
6
8
2024
entrez:
6
8
2024
Statut:
epublish
Résumé
Anastomotic stenosis (AS) is a common complication after colorectal resection. However, the predisposing factors for stricture formation are not fully understood. Previous studies have shown anastomotic leakage (AL) to be a risk factor for the occurrence of AS. Therefore, we aim to investigate the impact of anastomotic leakage characteristics on the occurrence of anastomotic stenosis after colorectal resection. Consecutive patients with AL following elective, sphincter preserving, colorectal resection, with or without diversion ostomy, between January 2009 and March 2023 were identified from a prospectively collected database. The characteristics of the anastomotic leakage, patient baseline and operative characteristics as well as the postoperative outcomes were analyzed using univariate and multivariate logistic regression to identify factors associated with the occurrence of post-leakage AS. A total of 129 patients developed AL and met the inclusion criteria. Among these, 28 (21.7%) patients were diagnosed with post-leakage AS. There was a significantly higher frequency of patients with neoadjuvant radiotherapy (18% vs 3%; p = .026) and hand-sewn anastomoses (39% vs 17%; p = .011) within the AS group. Furthermore, the extent of the anastomotic defect was significantly higher in the AS group compared with the non-AS group (50%, IQR 27-71 vs. 20%, IQR 9-40, p = 0.011). Similar findings were observed between the study groups regarding age, sex, BMI, ASA score, medical comorbidities, diagnosis, surgical procedure, surgical approach (open vs. minimally invasive), and anastomotic fashioning (side-to-end vs. end-to-end). On multivariate analysis, the extent of the anastomotic defect (OR 1.01; 95% CI 1.00-1.03; p = 0.034) and hand-sewn anastomoses (OR 2.68; 95% CI 1.01-6.98; p = 0.043) were confirmed as independent risk factors for post-leakage AS. No correlation could be observed between the occurrence of post-leakage AS and the ISREC grading of AL, the anastomotic height or the management of AL. Time to ostomy reversal was significantly longer in the AS group (202d, IQR 169-275 vs. 318d IQR 192-416, p = 0.014). The extent of the anastomotic defect and hand-sewn anastomoses were confirmed as independent risk factors for the occurrence of post-leakage AS. No correlation could be observed between the ISREC grading of AL, the anastomotic height or AL management, and the occurrence of post-leakage AS.
Identifiants
pubmed: 39105987
doi: 10.1007/s00384-024-04699-4
pii: 10.1007/s00384-024-04699-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
126Informations de copyright
© 2024. The Author(s).
Références
Chan RH, Lin SC, Chen PC, Lin WT, Wu CH, Lee JC, Lin BW (2020) Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results. Tech Coloproctol 24(12):1271–1276
doi: 10.1007/s10151-020-02318-2
pubmed: 32757156
pmcid: 7661393
Cong J, Zhang H, Chen C (2023) Definition and grading of anastomotic stricture/stenosis following low anastomosis after total mesorectal excision: a single-center study. Asian J Surg 46(9):3722–3726. https://doi.org/10.1016/j.asjsur.2023.03.027
Popivanov GI, Mutafchiyski VM, Cirocchi R, Chipeva SD, Vasilev VV, Kjossev KT, Tabakov MS (2020) Endoluminal negative pressure therapy in colorectal anastomotic leaks. Colorectal Dis 22(3):243–253
doi: 10.1111/codi.14754
pubmed: 31274227
Schlegel RD, Dehni N, Parc R, Caplin S, Tiret E (2001) Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 44(10):1464–1468
doi: 10.1007/BF02234598
pubmed: 11598475
Polese L, Vecchiato M, Frigo AC, Sarzo G, Cadrobbi R, Rizzato R, Bressan A, Merigliano S (2012) Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn? Colorectal Dis 14(3):e124-128
doi: 10.1111/j.1463-1318.2011.02819.x
pubmed: 21910814
Luchtefeld MA, Milsom JW, Senagore A, Surrell JA, Mazier WP (1989) Colorectal anastomotic stenosis. Results of a survey of the ASCRS membership. Dis Colon Rectum 32(9):733–736
doi: 10.1007/BF02562119
pubmed: 2667922
Adamenko O, Ferrari C, Seewald S, Schmidt J (2022) Prophylactic endoluminal vacuum therapy after major gastrointestinal surgery: a systematic review. Updates Surg 74(4):1177–1186
doi: 10.1007/s13304-022-01265-x
pubmed: 35262844
Clifford RE, Fowler H, Manu N, Vimalachandran D (2021) Management of benign anastomotic strictures following rectal resection: a systematic review. Colorectal Dis 23(12):3090–3100
doi: 10.1111/codi.15865
pubmed: 34374203
Rickert A, Willeke F, Kienle P, Post S (2010) Management and outcome of anastomotic leakage after colonic surgery. Colorectal Dis 12(10 Online):e216-223
pubmed: 20002697
Nesbakken A, Nygaard K, Lunde OC, Blucher J, Gjertsen O, Dullerud R (2005) Anastomotic leak following mesorectal excision for rectal cancer: true incidence and diagnostic challenges. Colorectal Dis 7(6):576–581
doi: 10.1111/j.1463-1318.2005.00870.x
pubmed: 16232238
Sandra-Petrescu F, Tzatzarakis E, Kahler G, Reissfelder C, Herrle F (2021) Management of colorectal anastomotic leakage using endoscopic negative pressure therapy with or without protective ostomy: a retrospective study. Int J Colorectal Dis 36(10):2261–2269
doi: 10.1007/s00384-021-04011-8
pubmed: 34455472
pmcid: 8426235
Talboom K, Greijdanus NG, van Workum F, Ubels S, Rosman C, Hompes R, de Wilt JHW, Tanis PJ (2022) group TE-Rw: International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: a case-vignette study. Int J Colorectal Dis 37(9):2049–2059
doi: 10.1007/s00384-022-04240-5
pubmed: 36002748
pmcid: 9436864
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3):339–351
doi: 10.1016/j.surg.2009.10.012
pubmed: 20004450
Spinelli A, Anania G, Arezzo A, Berti S, Bianco F, Bianchi PP, De Giuli M, De Nardi P, de Paolis P, Foppa C et al (2020) Italian multi-society modified Delphi consensus on the definition and management of anastomotic leakage in colorectal surgery. Updat Surg 72(3):781–792
doi: 10.1007/s13304-020-00837-z
van Rooijen SJ, Jongen AC, Wu ZQ, Ji JF, Slooter GD, Roumen RM, Bouvy ND (2017) Definition of colorectal anastomotic leakage: a consensus survey among Dutch and Chinese colorectal surgeons. World J Gastroenterol 23(33):6172–6180
doi: 10.3748/wjg.v23.i33.6172
pubmed: 28970733
pmcid: 5597509
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4(10):e296
doi: 10.1371/journal.pmed.0040296
Sandra-Petrescu F, Herrle F, Hinke A, Rossion I, Suelberg H, Post S, Hofheinz RD, Kienle P (2015) CoCStom trial: study protocol for a randomised trial comparing completeness of adjuvant chemotherapy after early versus late diverting stoma closure in low anterior resection for rectal cancer. BMC Cancer 15(1):923
doi: 10.1186/s12885-015-1838-0
pubmed: 26589718
pmcid: 4654836
Kouladouros K, Reissfelder C, Kahler G (2023) Endoscopic stricturoplasty with linear stapler: an efficient alternative for the refractory rectal anastomotic stricture. Dig Dis Sci 68(12):4432–4438
doi: 10.1007/s10620-023-08156-0
pubmed: 37855986
pmcid: 10635923
Seyfried S, Herrle F, Schröter M, Hardt J, Betzler A, Rahbari NN, Reißfelder C (2021) Initial experiences with the implementation of the enhanced recovery after surgery (ERAS®) protocol. Chirurg 92(5):428–433
doi: 10.1007/s00104-020-01341-1
pubmed: 33471183
Galata C, Vassilev G, Haas F, Kienle P, Büttner S, Reißfelder C, Hardt J (2019) Clinical, oncological, and functional outcomes of Da Vinci (Xi)-assisted versus conventional laparoscopic resection for rectal cancer: a prospective, controlled cohort study of 51 consecutive cases. Int J Colorectal Dis 34(11):1907–1914
doi: 10.1007/s00384-019-03397-w
pubmed: 31642968
Surek A, Donmez T, Gemici E, Dural AC, Akarsu C, Kaya A, Ferahman S, Bozkurt MA, Karabulut M, Alis H (2023) Risk factors affecting benign anastomotic stricture in anterior and low anterior resections for colorectal cancer: a single-center retrospective cohort study. Surg Endosc 37(7):5246–5255
doi: 10.1007/s00464-023-10002-3
pubmed: 36964291
Kang J, Kim H, Park H, Lee B, Lee KY (2022) Risk factors and economic burden of postoperative anastomotic leakage related events in patients who underwent surgeries for colorectal cancer. PLoS One 17(5):e0267950
doi: 10.1371/journal.pone.0267950
pubmed: 35584082
pmcid: 9116683
Bertocchi E, Barugola G, Benini M, Bocus P, Rossini R, Ceccaroni M, Ruffo G (2019) Colorectal anastomotic stenosis: lessons learned after 1643 Colorectal Resections for Deep Infiltrating Endometriosis. J Minim Invasive Gynecol 26(1):100–104
doi: 10.1016/j.jmig.2018.03.033
pubmed: 29678755
Waterland P, Goonetilleke K, Naumann DN, Sutcliff M, Soliman F (2015) Defunctioning ileostomy reversal rates and reasons for delayed reversal: does delay impact on complications of ileostomy reversal? A study of 170 defunctioning ileostomies. J Clin Med Res 7(9):685–689
doi: 10.14740/jocmr2150w
pubmed: 26251682
pmcid: 4522985
Taylor D, Besson A, Faragher IG, Chan STF, Yeung JM (2021) Investigations and time trends in loop ileostomy reversals following anterior resections: a single Australian institution seven-years’ experience. ANZ J Surg 91(5):938–942
doi: 10.1111/ans.16483
pubmed: 33300280
Khoo TW, Dudi-Venkata NN, Beh YZ, Bedrikovetski S, Kroon HM, Thomas ML, Sammour T (2021) Impact of timing of reversal of loop ileostomy on patient outcomes: a retrospective cohort study. Tech Coloproctol 25(11):1217–1224
doi: 10.1007/s10151-021-02516-6
pubmed: 34499279
Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R (2014) Increased postoperative complications after protective ileostomy closure delay: an institutional study. World J Gastrointest Surg 6(9):169–174
doi: 10.4240/wjgs.v6.i9.169
pubmed: 25276286
pmcid: 4176777
Gordon IO, Bettenworth D, Bokemeyer A, Srivastava A, Rosty C, de Hertogh G, Robert ME, Valasek MA, Mao R, Li J et al (2022) International consensus to standardise histopathological scoring for small bowel strictures in Crohn’s disease. Gut 71(3):479–486
doi: 10.1136/gutjnl-2021-324374
pubmed: 33952604
Kulu Y, Ulrich A, Bruckner T, Contin P, Welsch T, Rahbari NN, Buchler MW, Weitz J (2013) International Study Group of Rectal C: validation of the International Study Group of Rectal Cancer definition and severity grading of anastomotic leakage. Surgery 153(6):753–761
doi: 10.1016/j.surg.2013.02.007
pubmed: 23623834
Sandra-Petrescu F, Rahbari NN, Birgin E, Kouladouros K, Kienle P, Reissfelder C, Tzatzarakis E, Herrle F (2023) Management of anastomotic leakage after colorectal resection: survey among the German CHIR-Net Centers. J Clin Med 12(15):4933
doi: 10.3390/jcm12154933
pubmed: 37568336
pmcid: 10419945
Lucha PA Jr, Fticsar JE, Francis MJ (2005) The strictured anastomosis: successful treatment by corticosteroid injections–report of three cases and review of the literature. Dis Colon Rectum 48(4):862–865
doi: 10.1007/s10350-004-0838-y
pubmed: 15747075
Neutzling CB, Lustosa SA, Proenca IM, da Silva EM, Matos D (2012) Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 2:CD003144
Liu H, Xiong M, Zeng Y, Shi Y, Pei Z, Liao C (2023) Comparison of complications and bowel function among different reconstruction techniques after low anterior resection for rectal cancer: a systematic review and network meta-analysis. World J Surg Oncol 21(1):87
doi: 10.1186/s12957-023-02977-z
pubmed: 36899350
pmcid: 9999608
Silva-Velazco J, Stocchi L, Costedio M, Gorgun E, Kessler H, Remzi FH (2016) Is there anything we can modify among factors associated with morbidity following elective laparoscopic sigmoidectomy for diverticulitis? Surg Endosc 30(8):3541–3551
doi: 10.1007/s00464-015-4651-6
pubmed: 26541732