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01.02.2016 | Colorectal Cancer

Risk Factors for Anastomotic Leakage After Intersphincteric Resection Without a Protective Defunctioning Stoma for Lower Rectal Cancer

verfasst von: Motoi Koyama, MD, Akihiko Murata, MD, Yoshiyuki Sakamoto, MD, Hajime Morohashi, MD, Tatsuya Hasebe, MD, Takeshi Saito, MD, Kenichi Hakamada, MD

Erschienen in: Annals of Surgical Oncology | Sonderheft 2/2016

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Abstract

Background

Intersphincteric resection (ISR) is performed as an alternative to abdominoperineal resection for super-low rectal cancer. The purpose of this study was to evaluate risk factors for anastomotic leakage (AL) after ISR without a defunctioning stoma for lower rectal cancer.

Methods

Between 1995 and 2012, 135 consecutive patients with lower rectal cancer underwent curative ISR without a protective defunctioning stoma. Univariate and multivariate analyses were performed to determine the risk factors for AL.

Results

The radiological and symptomatic AL rate was 17.0 % (23/135). Univariate analysis demonstrated that male sex (P = 0.030), preoperative chemotherapy (P = 0.016), partial ISR (P < 0.001), lateral lymph-node dissection (P = 0.042), distal tumor distance from the dentate line (P = 0.007), and straight reconstruction (P < 0.001) were significantly associated with AL. Severe AL requiring re-laparotomy developed in 13 (9.6 %) patients. Univariate analysis demonstrated that male sex (P = 0.006), partial ISR (P < 0.001), distal tumor distance from the dentate line (P = 0.002), and straight reconstruction (P < 0.001) were significantly associated with AL requiring relaparotomy. Multivariate analysis demonstrated that partial ISR [odds ratio (OR) 6.701; P = 0.001] and straight reconstruction (OR 5.552; P = 0.002) were independently predictive of AL.

Conclusions

Partial ISR and straight reconstruction increased the risk of AL after ISR without a protective defunctioning stoma. A defunctioning stoma might be mandatory in patients with the risk factors identified in this analysis.

Parks AG, Percy JP. Resection and sutured colo-anal anastomosis for rectal carcinoma. Br J Surg. 1982;69:301–4.CrossRefPubMed

Teramoto T, Watanabe M, Kitajima M. Per anum intersphincteric rectal dissection with direct coloanal anastomosis for lower rectal cancer: the ultimate sphincter-preserving operation. Dis Colon Rectum. 1997;40:S43–7.CrossRefPubMed

Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection; histopathological study of lateral tumour spread and surgical excision. Lancet. 1986;2:996–9.CrossRefPubMed

Nicholls RJ, Hall C. Treatment of non-disseminated cancer of the lower rectum. Br J Surg. 1996;83:15–8.CrossRefPubMed

Schiessel R, Karner-Hanusch J, Herbst F, Teleky B, Wunderlich M. Intersphincteric resection for low rectal tumours. Br J Surg. 1994;81:1376–8.CrossRefPubMed

Braun J, Treutner KH, Winkeltau G, Heidenreich U, Lerch MM, Schumpelick V. Results of intersphincteric resection of the rectum with direct coloanal anastomosis for rectal carcinoma. Am J Surg. 1992;163:407–12.CrossRefPubMed

Rullier E, Zerbib F, Laurent C, Bonnel C, Caudry M, Saric J, Parneix M. Intersphincteric resection with excision of internal anal sphincter for conservative treatment of very low rectal cancer. Dis Colon Rectum. 1999;42:1168–75.CrossRefPubMed

Köhler A, Athanasiadis S, Ommer A, Psarakis E. Long-term results of low anterior resection with intersphincteric anastomosis in carcinoma of the lower one-third of the rectum: analysis of 31 patients. Dis Colon Rectum. 2000;43:843–50.CrossRefPubMed

Portier G, Ghouti L, Kirzin S, Guimbaud R, Rives M, Lazorthes F. Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma. Br J Surg. 2007;94:341–5.CrossRefPubMed

10.

Weiser MR, Quah HM, Shia J, et al. Sphincter preservation in low rectal cancer is facilitated by preoperative chemoradiation and intersphincteric dissection. Ann Surg. 2009;249:236–42.CrossRefPubMed

11.

Saito N, Ono M, Sugito M, et al. Early results of intersphincteric resection for patients with very low rectal cancer: an active approach to avoid a permanent colostomy. Dis Colon Rectum. 2004;47:459–66.CrossRefPubMed

12.

Yamada K, Ogata S, Saiki Y, Fukunaga M, Tsuji Y, Takano M. Functional results of intersphincteric resection for low rectal cancer. Br J Surg. 2007;94:1272–7.CrossRefPubMed

13.

Schiessel R, Novi G, Holzer B, et al. Technique and long-term results of intersphincteric resection for low rectal cancer. Dis Colon Rectum. 2005;48:1858–67.CrossRefPubMed

14.

Chamlou R, Parc Y, Simon T, Bennis M, Dehni N, Parc R, Tiret E. Long-term results of intersphincteric resection for low rectal cancer. Ann Surg. 2007;246:916–22.CrossRefPubMed

15.

Akasu T, Takawa M, Yamamoto S, Fujita S, Moriya Y. Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma. J Am Coll Surg. 2007;205:642–7.CrossRefPubMed

16.

Saito N, Moriya Y, Shirouzu K, et al. Intersphincteric resection in patients with very low rectal cancer: a review of the Japanese experience. Dis Colon Rectum. 2006;49:S13–22.CrossRefPubMed

17.

Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg. 2005;241:465–9.CrossRefPubMedPubMedCentral

18.

Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg. 2001;88:400–4.CrossRefPubMed

19.

Ptok H, Marusch F, Meyer F, et al. Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg. 2007;94:1548–54.CrossRefPubMed

20.

den Dulk M, Marijnen CA, Collette L, et al. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg. 2009;96:1066–75.CrossRef

21.

Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890–9.CrossRefPubMed

22.

Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6:462–9.CrossRefPubMed

23.

Jestin P, Påhlman L, Gunnarsson U. Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Dis. 2008;10:715–21.CrossRefPubMed

24.

Pommergaard HC, Gessler B, Burcharth J, Angenete E, Haglind E, Rosenberg J. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis. doi: 10.1111/codi.12618.PubMed

25.

Park JS, Choi GS, Kim SH, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg. 2013;257:665–71.CrossRefPubMed

26.

Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85:355–8.CrossRefPubMed

27.

Law WI, Chu KW, Ho JW, Chan CW. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg. 2000;179:92–6.CrossRefPubMed

28.

Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN; Norwegian Rectal Cancer Group. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis. 2005;7:51–7.CrossRefPubMed

29.

Borowski DW, Kelly SB, Bradburn DM, Wilson RG, Gunn A, Ratcliffe AA; Northern Region Colorectal Cancer Audit Group. Impact of surgeon volume and specialization on short-term outcomes in colorectal cancer surgery. Br J Surg. 2007;94:880–9.CrossRefPubMed

30.

Kruschewski M, Rieger H, Pohlen U, Hotz HG, Buhr HJ. Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis. 2007;22:919–27.CrossRefPubMed

31.

Mäkelä JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum. 2003;46:653–60.CrossRefPubMed

32.

Yeh CY, Changchien CR, Wang JY, Chen JS, Chen HH, Chiang JM, Tang R. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg. 2005;241:9–13.PubMedPubMedCentral

33.

Vignali A, Fazio VW, Lavery IC, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1014 patients. J Am Coll Surg. 1997;185:105–13.CrossRefPubMed

34.

Peeters KC, Tollenaar RA, Marijnen CA, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2005;92:211–6.CrossRefPubMed

35.

Akasu T, Takawa M, Yamamoto S, Yamaguchi T, Fujita S, Moriya Y. Risk factors for anastomotic leakage following intersphincteric resection for very low rectal adenocarcinoma. J Gastrointest Surg. 2010;14:104–11.CrossRefPubMed

36.

Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H; Working Group ‘Colon/Rectum Carcinoma. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005;92:1137–42.CrossRefPubMed

37.

Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.CrossRefPubMedPubMedCentral

38.

Enker WE, Merchant N, Cohen AM, et al. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg. 1999;230:544–52.CrossRefPubMedPubMedCentral

39.

Shirouzu K, Ogata Y, Araki Y, Kishimoto Y, Sato Y. A new ultimate anus-preserving operation for extremely low rectal cancer and anal canal cancer. Tech Coloproctol. 2003;7:203–6.CrossRefPubMed

40.

Mori T, Takahashi K, Yasuno M. Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection. Langenbecks Arch Surg. 1998;383:409–15.CrossRefPubMed

41.

Morita T, Murata A, Koyama M, Totsuka E, Sasaki M. Current status of autonomic nerve-preserving surgery for mid and lower rectal cancers. Japanese experience with lateral node dissection. Dis Colon Rectum. 2003;46:S78–88.PubMed

42.

Sugihara K, Moriya Y, Akasu T, Fujita S. Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome. Cancer. 1996;78:1871–80.PubMed

43.

Pollett WG, Nicholls RJ. The relationship between the extent of distal clearance and survival and local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg. 1983;198:159–63.CrossRefPubMedPubMedCentral

44.

Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1479–82.CrossRefPubMed

45.

Hida J, Yasutomi M, Fujimoto K, et al. Functional outcome after low anterior resection with low anastomosis for rectal cancer using the colonic J-pouch. Prospective randomized study for determination of optimum pouch size. Dis Colon Rectum. 1996;39:986–91.CrossRefPubMed

46.

Fürst A, Suttner S, Agha A, Beham A, Jauch KW. Colonic J-pouch vs. coloplasty following resection of distal rectal cancer: early results of a prospective, randomized, pilot study. Dis Colon Rectum. 2003;46:1161–6.CrossRefPubMed

47.

Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147:339–51.CrossRefPubMed

48.

Krand O, Yalti T, Tellioglu G, Kara M, Berber I, Titiz MI. Use of smooth muscle plasty after intersphincteric rectal resection to replace a partially resected internal anal sphincter: long-term follow-up. Dis Colon Rectum. 2009;52:1895–901.CrossRefPubMed

49.

Petersen S, Freitag M, Hellmich G, Ludwig K. Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis. 1998;13:160–3.CrossRefPubMed

50.

Wille-Jørgensen P, Guenaga KF, Castro AA, Matos D. Clinical value of preoperative mechanical bowel cleansing in elective colorectal surgery: a systematic review. Dis Colon Rectum. 2003;46:1013–20.CrossRefPubMed

51.

Dehni N, Schlegel RD, Cunningham C, Guiguet M, Tiret E, Parc R. Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg. 1998;85:1114–7.CrossRefPubMed

52.

Hallböök O, Påhlman L, Krog M, Wexner SD, Sjödahl R. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg. 1996;224:58–65.CrossRefPubMedPubMedCentral

53.

Ho YH, Brown S, Heah SM, Tsang C, Seow-Choen F, Eu KW, Tang CL. Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg. 2002;236:49–55.CrossRefPubMedPubMedCentral

54.

el-Malt M, Ceelen W, Van den Broecke C, Cuvelier C, Van Belle S, de Hemptinne B, Pattyn P. Influence of neo-adjuvant chemotherapy with 5-fluorouracil on colonic anastomotic healing: experimental study in rats. Acta Chir Belg. 2003;103:309–14.PubMed

55.

Stoop MJ, Dirksen R, Wobbes T, Hendriks T. Effects of early postoperative 5-fluorouracil and ageing on the healing capacity of experimental intestinal anastomoses. Br J Surg. 1998;85:1535–8.CrossRefPubMed

Titel: Risk Factors for Anastomotic Leakage After Intersphincteric Resection Without a Protective Defunctioning Stoma for Lower Rectal Cancer
verfasst von: Motoi Koyama, MD
Akihiko Murata, MD
Yoshiyuki Sakamoto, MD
Hajime Morohashi, MD
Tatsuya Hasebe, MD
Takeshi Saito, MD
Kenichi Hakamada, MD
Publikationsdatum: 01.02.2016
Verlag: Springer International Publishing
Erschienen in: Annals of Surgical Oncology / Ausgabe Sonderheft 2/2016
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4461-z

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Abstract

Background

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Conclusions

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