Prevention of anastomotic leakage after operation for middle-low rectal cancer by fecal drainage on rectal anastomosis: a retrospective clinical study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN zhongbiao , CHEN Xingyu , YE Ruifeng , GAO Qin ,  TU Xiaohuang

Department of General Surgical Gastrointestinal Disease, The 900th Hospital of Joint Logistic Support Force, PLA, Fuzhou 350001, P. R. China;

Corresponding author：

TU Xiaohuang, Email: txhuang@126.com

Keywords：

middle-low rectal cancer; anastomotic leakage; fecal drainage; prophylactic end ileum stoma

DOI：

10.7507/1007-9424.201912026

Video：

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Objective To evaluate the efficacy, safety, and feasibility of fecal drainage technique on rectal anastomosis for preventing anastomotic leakage after operation for middle-low rectal cancer.Methods The retrospective analysis was used to collect the middle-low rectal cancer which completed operation in this hospital from 2014 to 2019. According to the way of preventing annstomotic leakage, the patients were divided into two groups: fecal drainage on rectal anastomosis group (Abbreviation: fecal drainage group) and end ileum prophylactic stoma group (Abbreviation: ileostomy group). The incidence of anastomotic leakage after operation and the different treatment methods following leakage were compared between the two groups.Results A total of 231 cases were recorded, including 84 cases in the fecal drainage group, 147 cases in the ileostomy group. There were no significant differences in the baseline data such as the gender, age, preoperative complications, operation mode, etc. between the two groups (P>0.050). There were no significant differences in the operation time, intraoperative blood loss, incision infection, postoperative intestinal obstruction, total hospitalization cost, death, anastomotic leakage (overall, each grade, treatment, and outcome) between the two groups (P>0.050). Although the length of hospital stay except the patients with anastomotic leakage in the fecal drainage group was significantly longer than that in the ileostomy group (P<0.001), there was no significant difference in the total length of hospital stay between the two groups (P>0.050), and the incidence of anastomotic stenosis in the fecal drainage group was significantly lower than that in the ileostomy group (P=0.029).Conclusion According to the results of this study, fecal drainage technique on rectal anastomosis is effective, safe, and feasible in preventing anastomotic leakage after operation for middle-low rectal cancer.

Citation： CHEN zhongbiao, CHEN Xingyu, YE Ruifeng, GAO Qin, TU Xiaohuang. Prevention of anastomotic leakage after operation for middle-low rectal cancer by fecal drainage on rectal anastomosis: a retrospective clinical study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(10): 1266-1271. doi: 10.7507/1007-9424.201912026 Copy

1.	郑荣寿, 孙可欣, 张思维, 等. 2015 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
2.	Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg, 1982, 69(10): 613-616.
3.	Pommergaard HC, Gessler B, Burcharth J, <italic>et al</italic>. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis, 2014, 16(9): 662-671.
4.	Boesen AK, Maeda Y, Rørbaek Madsen M. Perioperative fluid infusion and its influence on anastomotic leakage after rectal cancer surgery: implications for prevention strategies. Colorectal Dis, 2013, 15(9): e522-e527.
5.	Park JS, Choi GS, Kim SH, <italic>et al</italic>. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg, 2013, 257(4): 665-671.
6.	Cong ZJ, Hu LH, Bian ZQ, <italic>et al</italic>. Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One, 2013, 8(9): e75519.
7.	Hüser N, Michalski CW, Erkan M, <italic>et al</italic>. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg, 2008, 248(1): 52-60.
8.	Matthiessen P, Hallböök O, Rutegård J, <italic>et al</italic>. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg, 2007, 246(2): 207-214.
9.	Chude GG, Rayate NV, Patris V, <italic>et al</italic>. Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology, 2008, 55(86-87): 1562-1567.
10.	Shiomi A, Ito M, Maeda K, <italic>et al</italic>. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1 014 consecutive patients. J Am Coll Surg, 2015, 220(2): 186-194.
11.	D’Haeninck A, Wolthuis AM, Penninckx F, <italic>et al</italic>. Morbidity after closure of a defunctioning loop ileostomy. Acta Chir Belg, 2011, 111(3): 136-141.
12.	Rahbari NN, Weitz J, Hohenberger W, <italic>et al</italic>. Definition and grading of anas-tomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery, 2010, 147: 339-351.
13.	Rullier E, Laurent C, Garrelon JL, <italic>et al</italic>. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg, 1998, 85(3): 355-358.
14.	Dehni N, Schlegel RD, Cunningham C, <italic>et al</italic>. Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg, 1998, 85(8): 1114-1117.
15.	Rudinskaite G, Pavalkis D. Coloanal anastomosis in rectal cancer surgery. Medicina (Kaunas), 2002, 38(6): 624-630.
16.	Bülow S, Moesgaard FA, Billesbølle P, <italic>et al</italic>. Anastomotic leakage after low anterior resection for rectal cancer. Ugeskr Laeger, 1997, 159(3): 297-301.
17.	Mirnezami A, Mirnezami R, Chandrakumaran K, <italic>et al</italic>. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg, 2011, 253(5): 890-899.
18.	Boccola MA, Buettner PG, Rozen WM, <italic>et al</italic>. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1 576 patients. World J Surg, 2011, 35(1): 186-195.
19.	Lowry AC, Simmang CL, Boulos P, <italic>et al</italic>. Consensus statement of definitions for anorectal physiology and rectal cancer: report of the Tripartite Consensus Conference on Definitions for Anorectal Physiology and Rectal Cancer, Washington, D. C., May 1, 1999. Dis Colon Rectum, 2001, 44(7): 915-919.
20.	Jung SH, Yu CS, Choi PW, <italic>et al</italic>. Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum, 2008, 51(6): 902-908.
21.	Choi HK, Law WL, Ho JW. Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum, 2006, 49(11): 1719-1725.
22.	Poon RT, Chu KW, Ho JW, <italic>et al</italic>. Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg, 1999, 23(5): 463-467.
23.	Matthiessen P, Hallböök O, Andersson M, <italic>et al</italic>. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis, 2004, 6(6): 462-469.
24.	Buie WD, MacLean AR, Attard JA, <italic>et al</italic>. Neoadjuvant chemoradiation increases the risk of pelvic sepsis after radical excision of rectal cancer. Dis Colon Rectum, 2005, 48(10): 1868-1874.
25.	Zaharie F, Mocan L, Tomuş C, <italic>et al</italic>. Risk factors for anastomotic leakage following colorectal resection for cancer. Chirurgia (Bucur), 2012, 107(1): 27-32.
26.	Martel G, Al-Suhaibani Y, Moloo H, <italic>et al</italic>. Neoadjuvant therapy and anastomotic leak after tumor-specific mesorectal excision for rectal cancer. Dis Colon Rectum, 2008, 51(8): 1195-1201.
27.	Law WI, Chu KW, Ho JW, <italic>et al</italic>. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg, 2000, 179(2): 92-96.
28.	Fawcett A, Vashisht R, Shankar A, <italic>et al</italic>. Microvascular disease and anastomotic dehiscence in the colon. Br J Surg, 1995, 82(11): 1483-1485.
29.	Kaidar-Person O, Person B, Wexner SD. Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg, 2005, 201(5): 759-773.
30.	Williams LA, Sagar PM, Finan PJ, <italic>et al</italic>. The outcome of loop ileostomy closure: a prospective study. Colorectal Dis, 2008, 10(5): 460-464.
31.	Chow A, Tilney HS, Paraskeva P, <italic>et al</italic>. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6107 cases. Int J Colorectal Dis, 2009, 24(6): 711-723.
32.	Mala T, Nesbakken A. Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis, 2008, 10(8): 785-788.
33.	Winslet MC, Cooke P, Obeid ML. Transcaecal ileal diversion in the management of the ‘at risk' distal colonic anastomosis. Int J Colorectal Dis, 1993, 8(2): 57-59.
34.	Hanju H, Jiahe X, Caizhao L, <italic>et al</italic>. Use of cannula ileostomy to protect a low colorectal anastomosis in patients having preoperative neoadjuvant chemoradiotherapy. Colorectal Dis, 2014, 16(3): O117-O122.
35.	涂小煌, 张再重, 宋京翔, 等. 大口径肛管预防直肠癌术后吻合口漏的对比研究. 中国普外基础与临床杂志, 2009, 16(10): 830-833.

1. 郑荣寿, 孙可欣, 张思维, 等. 2015 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
2. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg, 1982, 69(10): 613-616.
3. Pommergaard HC, Gessler B, Burcharth J, <italic>et al</italic>. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis, 2014, 16(9): 662-671.
4. Boesen AK, Maeda Y, Rørbaek Madsen M. Perioperative fluid infusion and its influence on anastomotic leakage after rectal cancer surgery: implications for prevention strategies. Colorectal Dis, 2013, 15(9): e522-e527.
5. Park JS, Choi GS, Kim SH, <italic>et al</italic>. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg, 2013, 257(4): 665-671.
6. Cong ZJ, Hu LH, Bian ZQ, <italic>et al</italic>. Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One, 2013, 8(9): e75519.
7. Hüser N, Michalski CW, Erkan M, <italic>et al</italic>. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg, 2008, 248(1): 52-60.
8. Matthiessen P, Hallböök O, Rutegård J, <italic>et al</italic>. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg, 2007, 246(2): 207-214.
9. Chude GG, Rayate NV, Patris V, <italic>et al</italic>. Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology, 2008, 55(86-87): 1562-1567.
10. Shiomi A, Ito M, Maeda K, <italic>et al</italic>. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1 014 consecutive patients. J Am Coll Surg, 2015, 220(2): 186-194.
11. D’Haeninck A, Wolthuis AM, Penninckx F, <italic>et al</italic>. Morbidity after closure of a defunctioning loop ileostomy. Acta Chir Belg, 2011, 111(3): 136-141.
12. Rahbari NN, Weitz J, Hohenberger W, <italic>et al</italic>. Definition and grading of anas-tomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery, 2010, 147: 339-351.
13. Rullier E, Laurent C, Garrelon JL, <italic>et al</italic>. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg, 1998, 85(3): 355-358.
14. Dehni N, Schlegel RD, Cunningham C, <italic>et al</italic>. Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg, 1998, 85(8): 1114-1117.
15. Rudinskaite G, Pavalkis D. Coloanal anastomosis in rectal cancer surgery. Medicina (Kaunas), 2002, 38(6): 624-630.
16. Bülow S, Moesgaard FA, Billesbølle P, <italic>et al</italic>. Anastomotic leakage after low anterior resection for rectal cancer. Ugeskr Laeger, 1997, 159(3): 297-301.
17. Mirnezami A, Mirnezami R, Chandrakumaran K, <italic>et al</italic>. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg, 2011, 253(5): 890-899.
18. Boccola MA, Buettner PG, Rozen WM, <italic>et al</italic>. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1 576 patients. World J Surg, 2011, 35(1): 186-195.
19. Lowry AC, Simmang CL, Boulos P, <italic>et al</italic>. Consensus statement of definitions for anorectal physiology and rectal cancer: report of the Tripartite Consensus Conference on Definitions for Anorectal Physiology and Rectal Cancer, Washington, D. C., May 1, 1999. Dis Colon Rectum, 2001, 44(7): 915-919.
20. Jung SH, Yu CS, Choi PW, <italic>et al</italic>. Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum, 2008, 51(6): 902-908.
21. Choi HK, Law WL, Ho JW. Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum, 2006, 49(11): 1719-1725.
22. Poon RT, Chu KW, Ho JW, <italic>et al</italic>. Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg, 1999, 23(5): 463-467.
23. Matthiessen P, Hallböök O, Andersson M, <italic>et al</italic>. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis, 2004, 6(6): 462-469.
24. Buie WD, MacLean AR, Attard JA, <italic>et al</italic>. Neoadjuvant chemoradiation increases the risk of pelvic sepsis after radical excision of rectal cancer. Dis Colon Rectum, 2005, 48(10): 1868-1874.
25. Zaharie F, Mocan L, Tomuş C, <italic>et al</italic>. Risk factors for anastomotic leakage following colorectal resection for cancer. Chirurgia (Bucur), 2012, 107(1): 27-32.
26. Martel G, Al-Suhaibani Y, Moloo H, <italic>et al</italic>. Neoadjuvant therapy and anastomotic leak after tumor-specific mesorectal excision for rectal cancer. Dis Colon Rectum, 2008, 51(8): 1195-1201.
27. Law WI, Chu KW, Ho JW, <italic>et al</italic>. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg, 2000, 179(2): 92-96.
28. Fawcett A, Vashisht R, Shankar A, <italic>et al</italic>. Microvascular disease and anastomotic dehiscence in the colon. Br J Surg, 1995, 82(11): 1483-1485.
29. Kaidar-Person O, Person B, Wexner SD. Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg, 2005, 201(5): 759-773.
30. Williams LA, Sagar PM, Finan PJ, <italic>et al</italic>. The outcome of loop ileostomy closure: a prospective study. Colorectal Dis, 2008, 10(5): 460-464.
31. Chow A, Tilney HS, Paraskeva P, <italic>et al</italic>. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6107 cases. Int J Colorectal Dis, 2009, 24(6): 711-723.
32. Mala T, Nesbakken A. Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis, 2008, 10(8): 785-788.
33. Winslet MC, Cooke P, Obeid ML. Transcaecal ileal diversion in the management of the ‘at risk' distal colonic anastomosis. Int J Colorectal Dis, 1993, 8(2): 57-59.
34. Hanju H, Jiahe X, Caizhao L, <italic>et al</italic>. Use of cannula ileostomy to protect a low colorectal anastomosis in patients having preoperative neoadjuvant chemoradiotherapy. Colorectal Dis, 2014, 16(3): O117-O122.
35. 涂小煌, 张再重, 宋京翔, 等. 大口径肛管预防直肠癌术后吻合口漏的对比研究. 中国普外基础与临床杂志, 2009, 16(10): 830-833.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prevention of anastomotic leakage after operation for middle-low rectal cancer by fecal drainage on rectal anastomosis: a retrospective clinical study

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