Causes and Current Situations of Prevention and Treatment for Anastomotic Leakage after Low Anterior Resection for Rectal Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 PENGChang-bing ,  ZHUANGWen

Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

ZHUANGWen, Email: zw4794@163.com

Keywords：

Low rectal cancer; Anastomotic leakage; Prevention; Treatment

DOI：

10.7507/1007-9424.20140061

Video：

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Objective To analyze the common reasons of anastomotic leakage following sphincter preservation for rectal cancer, and to explore the better prevention and treatment strategies. Method The related literatures of the definition, common causes, and prevention and treatment status of anastomotic leakage were reviewed. Results Currently rectal cancer was one of common malignant tumors, including about 2/3 low rectal cancer.Recently, sphincter preserving surgery had become the preferred surgical procedure.However, the incidence of anastomotic leakage keeping in higher was still the most serious and common complications.Through improving the general condition of the patients, improving surgical techniques, and standardized treatment could effectively reduce the incidence of anastomotic leakage. Conclusion Reasonable preoperative assessment for the basic situation of patients with rectal cancer, standardized and individualized treatments, contribute to reduce incidence of anastomotic leakage and improve clinical outcomes in patients with low rectal cancer.

Citation： PENGChang-bing, ZHUANGWen. Causes and Current Situations of Prevention and Treatment for Anastomotic Leakage after Low Anterior Resection for Rectal Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(2): 251-255. doi: 10.7507/1007-9424.20140061 Copy

1.	Makin GB, Breen DJ, Monson JR.The impact of new technology on surgery for colorectal cancer[J].World J Gastroenterol, 2001, 7(5):612-621.
2.	Tzardi M.Role of total mesorectal excision and of circumferential resection margin in local recurrence and survival of patients with rectal carcinoma[J].Dig Dis, 2007, 25(1):51-55.
3.	Mirnezami A, Mirnezami R, Chandrakumaran K, et al.Increased local recurrence and reduced survival from colorectal cancer follo-wing anastomotic leak:systematic review and meta-analysis[J].Ann Surg, 2011, 253(5):890-899.
4.	Killingback M, Barron P, Dent OF.Local recurrence after curative resection of cancer of the rectum without total mesorectal excision[J].Dis Colon Rectum, 2001, 44(4):473-486.
5.	Boccola MA, Buettner PG, Rozen WM, et al.Risk factors and outcomes for anastomotic leakage in colorectal surgery:a single-institution analysis of 1576 patients[J].World J Surg, 2011, 35(1):186-195.
6.	Branagan G, Finnis D; Wessex Colorectal Cancer Audit Working Group.Prognosis after anastomotic leakage in colorectal surgery[J].Dis Colon Rectum, 2005, 48(5):1021-1026.
7.	Walker KG, Bell SW, Rickard MJ, et al.Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer[J].Ann Surg, 2004, 240(2):255-259.
8.	Smith JD, Paty PB, Guillem JG, et al.Anastomotic leak is not associated with oncologic outcome in patients undergoing low anterior resection for rectal cancer[J].Ann Surg, 2012, 256(6):1034-1038.
9.	张长山, 蔡丰波, 魏东.腹腔镜直肠癌前切除术后吻合口瘘的危险因素及治疗方法分析[J].河南科技大学学报:医学版, 2011, 29(4):269-271.
10.	邰建东, 刘玉石, 王广义.直肠癌保肛术后发生吻合口瘘的影响因素及其处理[J].中华胃肠外科杂志, 2007, 10(2):153-156.
11.	周灿, 陈武科, 何建军, 等.国内直肠癌术后吻合口瘘危险因素的Meta分析[J].西安交通大学学报:医学版, 2010, 31(1):115-121.
12.	Leichtle SW, Mouawad NJ, Welch KB, et al.Risk factors for anastomotic leakage after colectomy[J].Dis Colon Rectum, 2012, 55(5):569-575.
13.	Taflampas P, Christodoulakis M, Tsiftsis DD.Anastomotic leakage after low anterior resection for rectal cancer:facts, obscurity, and fiction[J].Surg Today, 2009, 39(3):183-188.
14.	Richards CH, Campbell V, Ho C, et al.Smoking is a major risk factor for anastomotic leak in patients undergoing low anterior resection[J].Colorectal Dis, 2012, 14(5):628-633.
15.	赵航, 宋燕, 姜洋, 等.老年直肠癌Dixon术后吻合口漏159例临床分析[J].中国老年学杂志, 2009, 29(7):854-855.
16.	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[J].Ann Surg, 2013, 257(4):665-671.
17.	黎成金, 王烈, 涂小煌, 等.大肠癌患者术前肠内营养对单核细胞功能影响[J].世界华人消化杂志, 2004, 12(10):2500-2502.
18.	徐红, 庄文, 周勇.消化道肿瘤病人术后应用肠内营养的临床研究[J].华西医学, 2004, 19(1):60-61.
19.	Trencheva K, Morrissey KP, Wells M, et al.Identifying important predictors for anastomotic leak after colon and rectal resection:prospective study on 616 patients[J].Ann Surg, 2013, 257(1):108-113.
20.	Ziegler MA, Catto JA, Riggs TW, et al.Risk factors for anasto-motic leak and mortality in diabetic patients undergoing colectomy:analysis from a statewide surgical quality collaborative[J].Arch Surg, 2012, 147(7):600-605.
21.	赵广法, 师英强, 莫善兢.直肠全系膜切除术后吻合口漏的危险因素分析和对策[J].肿瘤, 2004, 24(6):596-597.
22.	张玉茹, 贾山, 于洪顺, 等.直肠癌全直肠系膜切除术后吻合口漏危险因素的临床分析[J].临床外科杂志, 2009, 17(5):326-327.
23.	Glynne-Jones R, Harrison M.Locally advanced rectal cancer:what is the evidence for induction chemoradiation?[J].Oncologist, 2007, 12(11):1309-1318.
24.	Helbling D, Bodoky G, Gautschi O, et al.Neoadjuvant chemoradiotherapy with or without panitumumab in patients with wild-type KRAS, locally advanced rectal cancer (LARC):a randomized, multicenter, phaseⅡtrial SAKK 41/07[J].Ann Oncol, 2013, 24(3):718-725.
25.	Akiyoshi T, Kuroyanagi H, Oya M, et al.Safety of laparoscopic total mesorectal excision for low rectal cancer with preoperative chemoradiation therapy[J].J Gastrointest Surg, 2009, 13(3):521-525.
26.	Bretagnol F, Panis Y, Rullier E, et al.Rectal cancer surgery with or without bowel preparation:The French GRECCARⅢmul-ticenter single-blinded randomized trial[J].Ann Surg, 2010, 252(5):863-868.
27.	Yeh CY, Changchien CR, Wang JY, et al.Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients:a prospective study of 978 patients[J].Ann Surg, 2005, 241(1):9-13.
28.	Ferenschild FT, Dawson I, de Wilt JH, et al.Total mesorectal excision for rectal cancer in an unselected population:quality assessment in a low volume center[J].Int J Colorectal Dis, 2009, 24(8):923-929.
29.	Carlsen E, Schlichting E, Guldvog I, et al.Effect of the introduc-tion of total mesorectal excision for the treatment of rectal cancer[J].Br J Surg, 1998, 85(4):526-529.
30.	李德川, 冯海洋, 刘勇, 等.超低位直肠癌保肛手术的可行性研究[J].肿瘤研究与临床, 2003, 15(4):242-244.
31.	Choi GS, Park IJ, Kang BM, et al.A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer[J].Surg Endosc, 2009, 23(12):2831-2835.
32.	Laurent C, Paumet T, Leblanc F, et al.Intersphincteric resection for low rectal cancer:laparoscopic vs open surgery approach[J].Colorectal Dis, 2012, 14(1):35-42.
33.	van der Pas MH, Haglind E, Cuesta MA, et al.Laparoscopic versus open surgery for rectal cancer (COLORⅡ):short-term outcomes of a randomised, phase 3 trial[J].Lancet Oncol, 2013, 14(3):210-218.
34.	Kuroyanagi H, Oya M, Ueno M, et al.Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection[J].Surg Endosc, 2008, 22(2):557-561.
35.	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[J].Int J Colorectal Dis, 2008, 23(7):703-707.
36.	梁正, 孙晓光.低位直肠癌保肛术后吻合口瘘的防治对策[J].中国现代医学杂志, 2008, 18(22):3352-3353.
37.	Buchs NC, Gervaz P, Secic M, et al.Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery:a prospective monocentric study[J].Int J Colorectal Dis, 2008, 23(3):265-270.
38.	王永亮, 赵瑛.直肠癌全系膜切除术[J/CD].中华普通外科学文献:电子版, 2011, 5(3):188-190.
39.	Averbach AM, Chang D, Koslow EP, et al.Anastomotic leak after double-stapled low colorectal resection[J].Dis Colon Rec-tum, 1996, 39(7):780-787.
40.	Peeters KC, Tollenaar RA, Marijnen CA, et al.Risk factors for anastomotic failure after total mesorectal excision of rectal cancer[J].Br J Surg, 2005, 92(2):211-216.
41.	Machado M, Hallböök O, Goldman S, et al.Defunctioning stoma in low anterior resection with colonic pouch for rectal cancer:a comparison between two hospitals with a different policy[J].Dis Colon Rectum, 2002, 45(7):940-945.
42.	Rullier E, Le Toux N, Laurent C, et al.Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery[J].World J Surg, 2001, 25(3):274-277.
43.	Cong ZJ, Fu CG, Wang HT, et al.Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer[J].World J Surg, 2009, 33(6):1292-1297.
44.	Nurkin S, Kakarla VR, Ruiz DE, et al.The role of faecal diver-sion in low rectal cancer:a review of 1791 patients having rectal resection with anastomosis for cancer, with and without a proximal stoma[J].Colorectal Dis, 2013, 15(6):309-316.

1. Makin GB, Breen DJ, Monson JR.The impact of new technology on surgery for colorectal cancer[J].World J Gastroenterol, 2001, 7(5):612-621.
2. Tzardi M.Role of total mesorectal excision and of circumferential resection margin in local recurrence and survival of patients with rectal carcinoma[J].Dig Dis, 2007, 25(1):51-55.
3. Mirnezami A, Mirnezami R, Chandrakumaran K, et al.Increased local recurrence and reduced survival from colorectal cancer follo-wing anastomotic leak:systematic review and meta-analysis[J].Ann Surg, 2011, 253(5):890-899.
4. Killingback M, Barron P, Dent OF.Local recurrence after curative resection of cancer of the rectum without total mesorectal excision[J].Dis Colon Rectum, 2001, 44(4):473-486.
5. Boccola MA, Buettner PG, Rozen WM, et al.Risk factors and outcomes for anastomotic leakage in colorectal surgery:a single-institution analysis of 1576 patients[J].World J Surg, 2011, 35(1):186-195.
6. Branagan G, Finnis D; Wessex Colorectal Cancer Audit Working Group.Prognosis after anastomotic leakage in colorectal surgery[J].Dis Colon Rectum, 2005, 48(5):1021-1026.
7. Walker KG, Bell SW, Rickard MJ, et al.Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer[J].Ann Surg, 2004, 240(2):255-259.
8. Smith JD, Paty PB, Guillem JG, et al.Anastomotic leak is not associated with oncologic outcome in patients undergoing low anterior resection for rectal cancer[J].Ann Surg, 2012, 256(6):1034-1038.
9. 张长山, 蔡丰波, 魏东.腹腔镜直肠癌前切除术后吻合口瘘的危险因素及治疗方法分析[J].河南科技大学学报:医学版, 2011, 29(4):269-271.
10. 邰建东, 刘玉石, 王广义.直肠癌保肛术后发生吻合口瘘的影响因素及其处理[J].中华胃肠外科杂志, 2007, 10(2):153-156.
11. 周灿, 陈武科, 何建军, 等.国内直肠癌术后吻合口瘘危险因素的Meta分析[J].西安交通大学学报:医学版, 2010, 31(1):115-121.
12. Leichtle SW, Mouawad NJ, Welch KB, et al.Risk factors for anastomotic leakage after colectomy[J].Dis Colon Rectum, 2012, 55(5):569-575.
13. Taflampas P, Christodoulakis M, Tsiftsis DD.Anastomotic leakage after low anterior resection for rectal cancer:facts, obscurity, and fiction[J].Surg Today, 2009, 39(3):183-188.
14. Richards CH, Campbell V, Ho C, et al.Smoking is a major risk factor for anastomotic leak in patients undergoing low anterior resection[J].Colorectal Dis, 2012, 14(5):628-633.
15. 赵航, 宋燕, 姜洋, 等.老年直肠癌Dixon术后吻合口漏159例临床分析[J].中国老年学杂志, 2009, 29(7):854-855.
16. 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[J].Ann Surg, 2013, 257(4):665-671.
17. 黎成金, 王烈, 涂小煌, 等.大肠癌患者术前肠内营养对单核细胞功能影响[J].世界华人消化杂志, 2004, 12(10):2500-2502.
18. 徐红, 庄文, 周勇.消化道肿瘤病人术后应用肠内营养的临床研究[J].华西医学, 2004, 19(1):60-61.
19. Trencheva K, Morrissey KP, Wells M, et al.Identifying important predictors for anastomotic leak after colon and rectal resection:prospective study on 616 patients[J].Ann Surg, 2013, 257(1):108-113.
20. Ziegler MA, Catto JA, Riggs TW, et al.Risk factors for anasto-motic leak and mortality in diabetic patients undergoing colectomy:analysis from a statewide surgical quality collaborative[J].Arch Surg, 2012, 147(7):600-605.
21. 赵广法, 师英强, 莫善兢.直肠全系膜切除术后吻合口漏的危险因素分析和对策[J].肿瘤, 2004, 24(6):596-597.
22. 张玉茹, 贾山, 于洪顺, 等.直肠癌全直肠系膜切除术后吻合口漏危险因素的临床分析[J].临床外科杂志, 2009, 17(5):326-327.
23. Glynne-Jones R, Harrison M.Locally advanced rectal cancer:what is the evidence for induction chemoradiation?[J].Oncologist, 2007, 12(11):1309-1318.
24. Helbling D, Bodoky G, Gautschi O, et al.Neoadjuvant chemoradiotherapy with or without panitumumab in patients with wild-type KRAS, locally advanced rectal cancer (LARC):a randomized, multicenter, phaseⅡtrial SAKK 41/07[J].Ann Oncol, 2013, 24(3):718-725.
25. Akiyoshi T, Kuroyanagi H, Oya M, et al.Safety of laparoscopic total mesorectal excision for low rectal cancer with preoperative chemoradiation therapy[J].J Gastrointest Surg, 2009, 13(3):521-525.
26. Bretagnol F, Panis Y, Rullier E, et al.Rectal cancer surgery with or without bowel preparation:The French GRECCARⅢmul-ticenter single-blinded randomized trial[J].Ann Surg, 2010, 252(5):863-868.
27. Yeh CY, Changchien CR, Wang JY, et al.Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients:a prospective study of 978 patients[J].Ann Surg, 2005, 241(1):9-13.
28. Ferenschild FT, Dawson I, de Wilt JH, et al.Total mesorectal excision for rectal cancer in an unselected population:quality assessment in a low volume center[J].Int J Colorectal Dis, 2009, 24(8):923-929.
29. Carlsen E, Schlichting E, Guldvog I, et al.Effect of the introduc-tion of total mesorectal excision for the treatment of rectal cancer[J].Br J Surg, 1998, 85(4):526-529.
30. 李德川, 冯海洋, 刘勇, 等.超低位直肠癌保肛手术的可行性研究[J].肿瘤研究与临床, 2003, 15(4):242-244.
31. Choi GS, Park IJ, Kang BM, et al.A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer[J].Surg Endosc, 2009, 23(12):2831-2835.
32. Laurent C, Paumet T, Leblanc F, et al.Intersphincteric resection for low rectal cancer:laparoscopic vs open surgery approach[J].Colorectal Dis, 2012, 14(1):35-42.
33. van der Pas MH, Haglind E, Cuesta MA, et al.Laparoscopic versus open surgery for rectal cancer (COLORⅡ):short-term outcomes of a randomised, phase 3 trial[J].Lancet Oncol, 2013, 14(3):210-218.
34. Kuroyanagi H, Oya M, Ueno M, et al.Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection[J].Surg Endosc, 2008, 22(2):557-561.
35. 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[J].Int J Colorectal Dis, 2008, 23(7):703-707.
36. 梁正, 孙晓光.低位直肠癌保肛术后吻合口瘘的防治对策[J].中国现代医学杂志, 2008, 18(22):3352-3353.
37. Buchs NC, Gervaz P, Secic M, et al.Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery:a prospective monocentric study[J].Int J Colorectal Dis, 2008, 23(3):265-270.
38. 王永亮, 赵瑛.直肠癌全系膜切除术[J/CD].中华普通外科学文献:电子版, 2011, 5(3):188-190.
39. Averbach AM, Chang D, Koslow EP, et al.Anastomotic leak after double-stapled low colorectal resection[J].Dis Colon Rec-tum, 1996, 39(7):780-787.
40. Peeters KC, Tollenaar RA, Marijnen CA, et al.Risk factors for anastomotic failure after total mesorectal excision of rectal cancer[J].Br J Surg, 2005, 92(2):211-216.
41. Machado M, Hallböök O, Goldman S, et al.Defunctioning stoma in low anterior resection with colonic pouch for rectal cancer:a comparison between two hospitals with a different policy[J].Dis Colon Rectum, 2002, 45(7):940-945.
42. Rullier E, Le Toux N, Laurent C, et al.Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery[J].World J Surg, 2001, 25(3):274-277.
43. Cong ZJ, Fu CG, Wang HT, et al.Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer[J].World J Surg, 2009, 33(6):1292-1297.
44. Nurkin S, Kakarla VR, Ruiz DE, et al.The role of faecal diver-sion in low rectal cancer:a review of 1791 patients having rectal resection with anastomosis for cancer, with and without a proximal stoma[J].Colorectal Dis, 2013, 15(6):309-316.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Causes and Current Situations of Prevention and Treatment for Anastomotic Leakage after Low Anterior Resection for Rectal Cancer

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