Diagnostic value of intra-intestinal angiography CT in patients with anastomotic leakage after rectal cancer resection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Weijin ¹ , LIN Zhixiong ^1,2 , SONG Junchuan ^1,3 , FANG Yongchao ^1,3 , WU Weihang ¹ , LIN Nan ¹ , LIN Chen ¹ ,  WANG Yu ¹

1. Department of General Surgery Gastroenteric Ward, No.900 Hospital of The Joint Logistics Team, Fuzhou 350025, P. R. China;
2. Clinical Institute of Fuzhou General Hospital, Fujian Medical University, Fuzhou 350025, P. R. China;
3. Department of General Surgery Gastroenteric Ward, Dongfang Hospital, Xiamen University, Fuzhou 350025, P. R. China;

Corresponding author：

WANG Yu, Email: flyfishwang@hotmail.com

Keywords：

anastomotic leakage; computed tomography; retrograde contrast enema; diagnostic value

DOI：

10.7507/1007-9424.201901056

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the diagnostic value of intra-intestinal angiography CT in patients with anastomotic leakage (AL) after rectal cancer resection.Methods Patients who admitted to The Department of General Surgery of The No. 900 Hospital of The Joint Logistic Team from January 2013 to October 2018, who were diagnosed with rectal cancer and underwent rectal cancer resection with sphincter preserving surgery, were retrospectively collected in the study. All patients underwent routine imaging examination on the 7^th day after rectal cancer operation. The retrograde contrast enema (RCE) was performed to obtain the abdominal X-ray film, then the pelvic CT scan was performed to get the CT image of the intestinal lumen. The films were reviewed by 2 senior radiologists, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RCE and intra-intestinal angiography CT in the diagnosis of AL after rectal cancer resection were evaluated. Evaluated the sensitivity of the CT image feature to predict AL after rectal cancer resection.Results The sensitivity, specificity, PPV, and NPV of RCE in the diagnosis of AL after the rectal cancer resection were 69.23% (18/26), 98.64% (218/221), 85.71% (18/21), and 96.46% (218/226) respectively. The sensitivity, specificity, PPV, and NPV of intra-intestinal angiography CT were 96.15% (25/26), 99.09% (219/221), 92.59% (25/27), and 99.54% (219/220) respectively. The sensitivity and NPV of intra-intestinal angiography CT in diagnosis of AL were significantly higher than those of RCE (P<0.05). The sensitivity of contrast agent leakage to diagnosis of AL was the highest, reaching 96.15% (25/26).Conclusions The sensitivity of intra-intestinal angiography CT in the diagnosis of AL is high and the overall diagnostic efficiency is better than RCE, and the leakage of contrast agent is the main imaging feature of AL. It is significant to guide the clinical practice.

Citation： YANG Weijin, LIN Zhixiong, SONG Junchuan, FANG Yongchao, WU Weihang, LIN Nan, LIN Chen, WANG Yu. Diagnostic value of intra-intestinal angiography CT in patients with anastomotic leakage after rectal cancer resection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(5): 568-572. doi: 10.7507/1007-9424.201901056 Copy

1.	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(3): 339-351.
2.	Kornmann VN, Treskes N, Hoonhout LH, et al. Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis, 2013, 28(4): 437-445.
3.	Marres CCM, van de Ven AWH, Leijssen LGJ, et al. Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Tech Coloproctol, 2017, 21(9): 709-714.
4.	Alves A, Panis Y, Pocard M, et al. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg, 1999, 189(6): 554-559.
5.	Tsujinaka S, Kawamura YJ, Tan KY, et al. Proximal bowel necrosis after high ligation of the inferior mesenteric artery in colorectal surgery. Scand J Surg, 2012, 101(1): 21-25.
6.	尚克中. 胃肠道造影原理与诊断. 上海: 科学技术文献出版社, 1995: 302-303.
7.	Kauv P, Benadjaoud S, Curis E, et al. Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT. Eur Radiol, 2015, 25(12): 3543-3551.
8.	Shearer R, Gale M, Aly OE, et al. Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years? Colorectal Dis, 2013, 15(10): 1211-1226.
9.	Kawada K, Sakai Y. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis. World J Gastroentero, 2016, 22(25): 5718-5727.
10.	Kang CY, Halabi WJ, Chaudhry OO, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg, 2013, 148(1): 65-71.
11.	邓凯, 张建立, 江秀丽, 等. 直肠癌前切除术后吻合口漏风险因素分析. 中华胃肠外科杂志, 2018, 21(4): 425-430.
12.	孔杰, 甘从存, 徐士杰, 等. 中低位直肠癌全直肠系膜切除术后吻合口瘘的危险因素分析. 中国普外基础与临床杂志, 2016, 23(2): 210-213.
13.	Wu Z, van de Haar RC, Sparreboom CL, et al. Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis. Int J Colorectal Dis, 2016, 31(8): 1409-1417.
14.	陈玉祥, 黄卫, 李俊, 等. 直肠充气试验+美蓝试验在直肠癌 TME 术中的应用研究. 中国普外基础与临床杂志, 2013, 20(9): 1034-1037.
15.	DuBrow RA, David CL, Curley SA. Anastomotic leaks after low anterior resection for rectal carcinoma: evaluation with CT and barium enema. AJR Am J Roentgenol, 1995, 165(3): 567-571.
16.	Garcia-Granero A, Frasson M, Flor-Lorente B, et al. Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum, 2013, 56(4): 475-483.
17.	Daams F, Wu Z, Lahaye MJ, et al. Prediction and diagnosis of colorectal anastomotic leakage: a systematic review of literature. World J Gastrointest Surg, 2014, 6(2): 14-26.
18.	McDermott FD, Heeney A, Kelly ME, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg, 2015, 102(5): 462-479.
19.	Hoffmann J, Jensen RH, Shokouh-Amiri MH, et al. Clinical value of water-soluble contrast enema in assessing the integrity of left colonic anastomoses. J R Coll Surg Edinb, 1988, 33(1): 23-24.
20.	Carucci LR, Turner MA, Yu J. Imaging evaluation following Roux-en-Y gastric bypass surgery for morbid obesity. Radiol Clin North Am, 2007, 45(2): 247-260.
21.	Esmailzadeh H, Powell W, Lourie D. Use of computed tomography in diagnosis of major postoperative gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery. Am Surg, 2004, 70(11): 964-966.
22.	Nicksa GA, Dring RV, Johnson KH, et al. Anastomotic leaks: what is the best diagnostic imaging study? Dis Colon Rectum, 2007, 50(2): 197-203.
23.	Hirst NA, Tiernan JP, Millner PA, et al. Systematic review of methods to predict and detect anastomotic leakage in colorectal surgery. Colorectal Dis, 2014, 16(2): 95-109.
24.	Akyol AM, McGregor JR, Galloway DJ, et al. Early postoperative contrast radiology in the assessment of colorectal anastomotic integrity. Int J Colorectal Dis, 1992, 7(3): 141-143.
25.	Huiberts AA, Dijksman LM, Boer SA, et al. Contrast medium at the site of the anastomosis is crucial in detecting anastomotic leakage with CT imaging after colorectal surgery. Int J Colorectal Dis, 2015, 30(6): 843-848.
26.	Eckmann C, Kujath P, Schiedeck TH, et al. Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis, 2004, 19(2): 128-133.
27.	Katory M, McLean R, Osman K, et al. The novel appearance of low rectal anastomosis on contrast enema following laparoscopic anterior resection: discriminating anastomotic leaks from " dog-ears” on water-soluble contrast enema and flexible sigm-oidoscopy. Abdom Radiol (NY), 2017, 42(2): 435-441.
28.	Killeen S, Souroullas P, Ho Tin H, et al. Outcomes of asymp-tomatic anastomotic leaks found on routine postoperative water-soluble enema following anterior resection for cancer. World J Surg, 2013, 37(11): 2700-2704.
29.	Kornmann VN, van Ramshorst B, Smits AB, et al. Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis, 2014, 29(4): 445-451.

1. 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(3): 339-351.
2. Kornmann VN, Treskes N, Hoonhout LH, et al. Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis, 2013, 28(4): 437-445.
3. Marres CCM, van de Ven AWH, Leijssen LGJ, et al. Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Tech Coloproctol, 2017, 21(9): 709-714.
4. Alves A, Panis Y, Pocard M, et al. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg, 1999, 189(6): 554-559.
5. Tsujinaka S, Kawamura YJ, Tan KY, et al. Proximal bowel necrosis after high ligation of the inferior mesenteric artery in colorectal surgery. Scand J Surg, 2012, 101(1): 21-25.
6. 尚克中. 胃肠道造影原理与诊断. 上海: 科学技术文献出版社, 1995: 302-303.
7. Kauv P, Benadjaoud S, Curis E, et al. Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT. Eur Radiol, 2015, 25(12): 3543-3551.
8. Shearer R, Gale M, Aly OE, et al. Have early postoperative complications from laparoscopic rectal cancer surgery improved over the past 20 years? Colorectal Dis, 2013, 15(10): 1211-1226.
9. Kawada K, Sakai Y. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis. World J Gastroentero, 2016, 22(25): 5718-5727.
10. Kang CY, Halabi WJ, Chaudhry OO, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg, 2013, 148(1): 65-71.
11. 邓凯, 张建立, 江秀丽, 等. 直肠癌前切除术后吻合口漏风险因素分析. 中华胃肠外科杂志, 2018, 21(4): 425-430.
12. 孔杰, 甘从存, 徐士杰, 等. 中低位直肠癌全直肠系膜切除术后吻合口瘘的危险因素分析. 中国普外基础与临床杂志, 2016, 23(2): 210-213.
13. Wu Z, van de Haar RC, Sparreboom CL, et al. Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis. Int J Colorectal Dis, 2016, 31(8): 1409-1417.
14. 陈玉祥, 黄卫, 李俊, 等. 直肠充气试验+美蓝试验在直肠癌 TME 术中的应用研究. 中国普外基础与临床杂志, 2013, 20(9): 1034-1037.
15. DuBrow RA, David CL, Curley SA. Anastomotic leaks after low anterior resection for rectal carcinoma: evaluation with CT and barium enema. AJR Am J Roentgenol, 1995, 165(3): 567-571.
16. Garcia-Granero A, Frasson M, Flor-Lorente B, et al. Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum, 2013, 56(4): 475-483.
17. Daams F, Wu Z, Lahaye MJ, et al. Prediction and diagnosis of colorectal anastomotic leakage: a systematic review of literature. World J Gastrointest Surg, 2014, 6(2): 14-26.
18. McDermott FD, Heeney A, Kelly ME, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg, 2015, 102(5): 462-479.
19. Hoffmann J, Jensen RH, Shokouh-Amiri MH, et al. Clinical value of water-soluble contrast enema in assessing the integrity of left colonic anastomoses. J R Coll Surg Edinb, 1988, 33(1): 23-24.
20. Carucci LR, Turner MA, Yu J. Imaging evaluation following Roux-en-Y gastric bypass surgery for morbid obesity. Radiol Clin North Am, 2007, 45(2): 247-260.
21. Esmailzadeh H, Powell W, Lourie D. Use of computed tomography in diagnosis of major postoperative gastrointestinal complications of laparoscopic Roux-en-Y gastric bypass surgery. Am Surg, 2004, 70(11): 964-966.
22. Nicksa GA, Dring RV, Johnson KH, et al. Anastomotic leaks: what is the best diagnostic imaging study? Dis Colon Rectum, 2007, 50(2): 197-203.
23. Hirst NA, Tiernan JP, Millner PA, et al. Systematic review of methods to predict and detect anastomotic leakage in colorectal surgery. Colorectal Dis, 2014, 16(2): 95-109.
24. Akyol AM, McGregor JR, Galloway DJ, et al. Early postoperative contrast radiology in the assessment of colorectal anastomotic integrity. Int J Colorectal Dis, 1992, 7(3): 141-143.
25. Huiberts AA, Dijksman LM, Boer SA, et al. Contrast medium at the site of the anastomosis is crucial in detecting anastomotic leakage with CT imaging after colorectal surgery. Int J Colorectal Dis, 2015, 30(6): 843-848.
26. Eckmann C, Kujath P, Schiedeck TH, et al. Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis, 2004, 19(2): 128-133.
27. Katory M, McLean R, Osman K, et al. The novel appearance of low rectal anastomosis on contrast enema following laparoscopic anterior resection: discriminating anastomotic leaks from " dog-ears” on water-soluble contrast enema and flexible sigm-oidoscopy. Abdom Radiol (NY), 2017, 42(2): 435-441.
28. Killeen S, Souroullas P, Ho Tin H, et al. Outcomes of asymp-tomatic anastomotic leaks found on routine postoperative water-soluble enema following anterior resection for cancer. World J Surg, 2013, 37(11): 2700-2704.
29. Kornmann VN, van Ramshorst B, Smits AB, et al. Beware of false-negative CT scan for anastomotic leakage after colonic surgery. Int J Colorectal Dis, 2014, 29(4): 445-451.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnostic value of intra-intestinal angiography CT in patients with anastomotic leakage after rectal cancer resection

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content