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Colorectal anastomosis in rectal cancer surgery: methods of anastomotic leakage prevention

https://doi.org/10.17650/2686-9594-2021-11-2-36-43

Abstract

One of the most serious complications after low anterior resection is the failure of sutures of colorectal anastomosis, which is the most common surgical complication that results in patient’s death. Promptly diagnosed anastomotic leakage in postoperative period is challenging. Nevertheless, elimination of risk factors in preoperative period can significantly reduce complication rates.
The purpose of this review article is to analyze possible risk factors and methods for preventing colorectal anastomosis leakage.
An important area of prevention and optimization of treatment options for anastomotic leakage is the development of prognostic measures to eliminate risk factors. We see the prospects for this direction in the introduction of a nomogram, which allows the surgeon to assess the possible outcomes of the operation, to choose the optimal tactics with a minimum risk of complications, as well as the introduction of methods to avoid or prevent the development of complications of colorectal anastomosis.

About the Authors

S. G. Gaydarov
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation

Saidmagomed Gasanovich Gaydarov

24 Kashirskoe Shosse, Moscow 115478



Z Z Mamedli
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation

24 Kashirskoe Shosse, Moscow 115478



M. S. Lebedko
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation

24 Kashirskoe Shosse, Moscow 115478



V. Yu. Selchuk
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation

24 Kashirskoe Shosse, Moscow 115478



I. Sh. Tataev
N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
Russian Federation

24 Kashirskoe Shosse, Moscow 115478



References

1. Cherkasov M.F., Dmitriev A.V., Groshilin V.S. et al. Inconsistency of colorectal anastomosis: risk factors, prevention, diagnosis, treatment tactics. Rossiyskiy zhurnal gastroenterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Coloproctology 2019;29(2):27–34. (In Russ.).

2. Williams N.S., Nasmyth D.G., Jones D., Smith A.H. De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg 1986;73:566–70. DOI: 10.1002/bjs.1800730717.

3. Kit O.I. Hardware interintestinal anastomosis in colorectal cancer: immediate results. Koloproktologiya = Coloproctology 2016;(1):48–53. (In Russ.).

4. Petryashev A.V., Shishkina G.A., Plotnikov Yu.V. The use of preventive stomas in the surgical treatment of colorectal cancer. Onkologicheskaya koloproktologiya = Oncological Coloproctology 2016;6(3):29–33. (In Russ.).

5. Polovinkin V.V., Porkhanov V.A., Zavrazhnov A.A. Risk factors for the development of colorectal anastomosis leakage after surgery for rectal cancer. Kubanskiy nauchnyy medicinskiy vestnik = Kuban Scientific Medical Bulletin 2013;7(142):106–12. (In Russ.).

6. Rakhmatov K.K. Sphinctersparing surgery for distal rectal cancer: intersphincteral resection with coloanal anastomosis. Materials ofthe X Jubilee International Scientific and Practical Conference of Young Medical Scientists, Kursk, February 26–27, 2016. Ed. by V.A. Lazarenko, I.E. Esaulenko, R.Sh. Khasanov. Vol. 2. Kursk, 2016. Pp. 230–232. (In Russ.).

7. Tulina I.I. Functional results of intersphincter resection and extirpation of the rectum, performed for cancer of the lower ampullar region, and the quality of life of such patients. Vrach = Doctor 2017;(4):53–6. (In Russ.).

8. [Cherdantsev D.V., Pozdnyakov A.A., Shpak V.V. et al. Inconsistency of the colorectal anastomosis. Current state of the problem (literature review). Koloproktologiya = Coloproctology 2015;4(54):57–64. (In Russ.).

9. Darbishgadzhiev Sh.O., Baulin A.A., Ivacheva N.A. et al. The role of the level of colorectal anastomosis formation in the development of leakage and ways to improve the results of surgical treatment of rectal cancer. Vestnik novykh medicinskih tekhnologiy = Bulletin of New Medical Technologies 2020;27(1):21–5. (In Russ.).

10. Darbishgadzhiev Sh.O., Baulin A.A., Zimin Yu.I. et al. Results of surgical treatment of colorectal cancer. Zdorovye i obrazovanie v XXI veke = Health and Education in the 21st Century 2018;20(4):42–6. (In Russ.).

11. Nikolaeva A.O., Danilov M.A., Atroshchenko A.O. Assessment of risk factors for the development of intestinal anastomoses leakage: a literature review. Nauka molodykh = Young Science 2020;8(1):106–15. (In Russ.).

12. Center M., Siegel R., Jemal A. Global Cancer Facts & Figures. American Cancer Society, 2011. 58 p.

13. Weaver M., Burdon D.V., Youngs D.J. Oral neomycin and erythromycin compared with single-dose systemic metronidazole and ceftriaxone prophylaxis in elective colorectal surgery. Am J Surg 1986;151:437–42. DOI: 10.1016/0002-9610(86)90097-8.

14. Caulfield H., Hyman N.H. Anastomotic leak after low anterior resection. A spectrum of clinical entities. JAMA Surg 2013;148(2):177–82.

15. Melnik V.E., Poyda A.I. Diagnostics, treatment and prevention of complications associated with the formation of anastomoses in the colon. Khirurgiya = Surgery 2013;(8):69–74. (In Russ.).

16. Aliev S.A. Tactics of surgical treatment of postoperative complications in patients with obstructive obstruction of the colon of tumor etiology. Vestnik khirurgii im. I.I. Grekova = I.I. Grekov Bulletin of Surgery 1999;(3):66–70. (In Russ.).

17. Beunis A., Pauli S., Van Cleemput M. Anastomotic leakage of a colorectal anastomosis treated by transanal endoscopic microsurgery. Acta Chir Belg 2008;108(4):474–6.

18. Chopra S.S., Mrak K., Hunerbein M. The effect of endoscopic treatment on healing of anastomotic leaks after anterior resection of rectal cancer. Surgery 2009;145:182–8.

19. Khan A.A., Wheeler J., Cunningham C. The management and outcome of anastomotic leaks in colorectal surgery. Colorectal Dis 2008;10:587–92.

20. Akhmetzyanov F.Kh. Immediate results of intra-abdominal resection of the rectum. Povolzhskiy onkologicheskiy vestnik = Povolzhsky Oncological Bulletin 2016;5(27):25–30. (In Russ.).

21. Yanushkevich S.V., Yanushkevich V.Yu. Protection of anastomoses in rectal cancer surgery. Novosti khirurgii = Surgery News 2017;25(4):412–20. (In Russ.).

22. Gruba L.N. The surgeon’s view of the incompetence of the suture of the colonic anastomosis. Risk factors (literature review). Moskovskiy khirurgicheskiy zhurnal = Moscow Surgical Journal 2015;(6):11–21. (In Russ.).

23. Karavay A.V., Belyaev A.I., GuzaevskiyYu.N., Salmin R.M. Abdominal anal resection of the rectum for cancer of distal localization. Zhurnal Grodnenskogo gosudarstvennogo medicinskogo universiteta = Journal of Grodno State Medical University 2019;17(4):453–7. (In Russ.).

24. Karachun A.M. Cancer of the mid-ampullar rectum – which surgery to choose? Low anterior rectal resection. Zlokachestvennye opukholi = Malignant Tumors 2013;(2):23–32. (In Russ.).

25. Ermakov D.F. Risk factors for instrumental anastomosis failure after anterior rectal resection. Abstract of thesis ... of candidate of medical sciences. Moscow, 2012. (In Russ.).

26. Kotelnikova L.P., Shatrova N.A., Belyakova Ya.V. Long-term results of resections of the left half of the colon and rectum. Sovremennye problemy nauki i obrazovaniya = Modern Problems of Science and Education 2012;(2):78. (In Russ.).

27. Huser N., Michalski C.W., Erkan M. et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 2008;248:52–60. DOI: 10.1002/bjs.6594.

28. Alekseev M.V., Shelygin Yu.A., Rybakov E.G. The diagnostic value of the use of nomograms in predicting the occurrence of colorectal anastomosis leakage(literature review). Tazovaya khirurgiya i onkologiya = Pelvic Surgery and Oncology 2019;9(3):27–33. (In Russ.).

29. Komen N., Slieker J., Willemsen P. et al. Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage. Am J Surgery 2014;208(3):317–23.

30. Sparreboom C.L., van Groningen J.T., Lingsma H.F. et al. Different risk factors for early and late colorectal anastomotic leakage in a nationwide audit. Dis Colon Rectum 2018;61(11):1258–66.

31. Pina D.E., Simo R.M., Machado R.A. et al. PROCOLE(Prognostic Colorectal Leakage): A new prognostic index to predict the risk of anastomotic leak in colorectal cancer surgery. Clin Gastroenterol J 2016;1(2):1000109.

32. Caziuc A., Mironiuc A.. Anastomotic leaks after colorectal surgery: a prognostic score. acta marisiensis. Seria Medica 2014;60(1):3–6. DOI: 10. 2478/amma-2014-0001.

33. Gorissen K.J., Benning D., Berghmans T. et al. Risk of anastomotic leakage with non-steroidal anti-inflammatory drugs in colorectal surgery. Br J Surg 2012; 99(5):721–7. DOI: 10.1002/bjs.8691.

34. Vasiliu E.C., Zarnescu N.O., Costea R. et al. Review of risk factors for anastomotic leakage in colorectal surgery. Chirurgia(Bucur) 2015;110(4):319–26.

35. Teoh C.M., Gunasegaram T., Chan K.Y. et al. Review of risk factors associated with the anastomosis leakage in anterior resection in Hospital Universiti Kebangsaan Malaysia. Med J Malaysia 2005;60(3):275–80.

36. Park J.S., Huh J.W., Park Y.Ah. et al. Risk factors of anastomotic leakage and longterm survival after colorectal surgery. Medicine 2016;95(8):e2890. DOI: 10.1097/md.0000000000002890.

37. Iancu C., Mocan L.C., Todea-Iancu D. et al. Hostrelated predictive factors for anastomotic leakage following large bowel resections for colorectal cancer. J Gastrointest Liver Dis 2008;17(3):299–303.

38. Golub R., Golub R.W., Cantu R.Jr. et al. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am College Surg 1997;184(4):364–72. DOI: 10. 1016/s1072-7515(98)00241-5.

39. Abd El Hameed El-Badawy H.A. Anastomotic leakage after gastrointestinal surgery: risk factors, presentation and outcome. Egyptian J Hospital Med 2014;57:494–512. DOI: 10.12816/0008484.

40. Park J.S., Choi G.S., Kim S.H. 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. DOI: 10.1097/SLA.0b013e31827b8ed9.

41. Kang C.Y., Halabi W.J., Chaudhry O.O. et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 2013;148:65–71. DOI: 10.1001/2013.jamasurg.2.

42. Den Dulk M., Marijnen C.A., 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.

43. Peeters K.C., Tollenaar R.A., Marijnen C.A. et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005;92:211–6.

44. Paun B.C., Cassie S., MacLean A.R. et al. Postoperative complications following surgery for rectal cancer. Ann Surg 2010;251:807–18.

45. Snijders H.S., Wouters M.W., van Leersum N.J. et al. Metaanalysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol 2012;38:1013–9.

46. Ito M., Sugito M., Kobayashi A. et al. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 2008;23(7):703–7. DOI: 10.1007/s00384-008-0470-82008.

47. Hallböök O., Påhlman L., Krog M. et al. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg 1996;224(1):58–65.

48. Zheng H., Wu Z., Wu Y. et al. Laparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer. Int J Colorectal Dis 2019;34(2):319–28. DOI: 10.1007/s00384-018-3199-z.

49. Wang S., Zhang Z., Liu M. et al. Efficacy of transanal tube placement after anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg Oncol 2016;14:92. DOI: 10.1186/s12957-016-0854-0.

50. Yang C.S., Choi G.S., Park J.S. et al. Rectal tube drainage reduces major anastomotic leakage after minimally invasive rectal cancer surgery. Colorectal Dis 2016;18(12):O445–52. DOI: 10.1111/codi.13506.

51. Adamova Z. Transanal tube as a means of prevention of anastomotic leakage after rectal cancer surgery. Viszeral Medizin 2014;30(6):422–6. DOI: 10.1159/000369569.

52. Yeh C.Y., Changchien C.R., Wang J.Y. et al. 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(1):9–13. DOI: 10.1097/00000658200512000-00019.

53. Gingold B.S., Jagelman D.G. Value of pelvic suction-irrigation in reducing morbidity of low anterior resection of the rectum: a ten year experience. Surgery 1982;91(4):394–8.

54. Tsujinaka S., Kawamura Y., Konishi F. et al. Pelvic drainage for anterior resection revisited: use of drains in anastomotic leaks. ANZ J Surg 2008;78(6):461–5.

55. Chuan L., Linfeng G., Hongchang L. et al. Short-term outcomes of pelvic floor peritoneum closure in endoscopic low anterior resection of rectal cancer: A propensity score matching analysis. J Surg Oncol 2021;123(1):271–7.

56. Wang Z.K., Xu J., Shang C.C. et al. Clinical significance of pelvic peritonizati on in laparoscopic dixon surgery. Chin Med J (Engl) 2018;131(3):289–94.

57. Kobayashi M., Okamoto K., Namikawa T. et al. Laparoscopic lymph node dissection around the inferior mesenteric artery for cancer in the lower sigmoid colon and rectum: is D3 lymph node dissection with preservation of the left colic artery feasible? Surg Endosc 2006;20:563–9.

58. Cirocchi R., Trastulli S., Farinella E. et al. High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a RCT is needed. Surg Oncol 2012;21(3):e111–23. DOI: 10.1016/j.suronc.2012.04.004.

59. Rouffet F., Hay J., Vacher B. et al. Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. Dis Colon Rectum 1994;37:651–9. DOI: 10.1007/BF02054407.

60. Zheng B., Wang N., Wu T. et al. Preservation of left colic artery in laparoscopic radical operation for rectal cancer. Zhonghua Wei Chang Wai Ke Za Zhi 2016;19(8):886–91.

61. Fan Y.-Ch., Ning F.-L., Zhang Ch.-D., Dai D.-Q. Preservation versus non-preservation of left colic artery in sigmoid and rectal cancer surgery: A meta-analysis. Int J Surgery 2018;52:269–77. DOI: 10.1016/j.ijsu.2018.02.054.

62. Chen Z.-F., Liu X., Jiang W., Guan G. Laparoscopic double-stapled colorectal anastomosis without “dog-ears”. Tech Coloproctol 2016;20(4):243–7. DOI: 10.1007/s10151-016-1437-3.


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