Martine A Frouws1, Heleen S Snijders, Steve H Malm, Gerrit-Jan Liefers, Cornelis J H Van de Velde, Peter A Neijenhuis, Hidde M Kroon. 1. 1 Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands 2 Dutch Surgical Colorectal Audit, Dutch Institute for Clinical Auditing, Leiden University Medical Center, Leiden, the Netherlands 3 Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands 4 Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
Abstract
BACKGROUND: Anastomotic leakage is a severe complication after low anterior resection for rectal cancer. With a global increase in registration initiatives, adapting uniform definitions and grading systems is highly relevant. OBJECTIVE: This study aimed to provide clinical parameters to categorize anastomotic leakage into subcategories according to the International Study Group of Rectal Cancer. DESIGN: All of the patients who underwent a low anterior resection in the Netherlands with primary anastomosis were included using the population-based Dutch Surgical Colorectal Audit. SETTINGS: Data were derived from the Dutch Surgical Colorectal Audit. MAIN OUTCOME MEASURES: The development of grade B anastomotic leakage (requiring invasive treatment but no surgery) versus grade C anastomotic leakage (requiring reoperation) was measured. RESULTS: Overall, 4287 patients underwent low anterior resection with primary anastomosis. A total of 159 patients (4%) were diagnosed with grade B anastomotic leakage versus 259 (6%) with grade C. Hospital stay and intensive care unit visits were significantly higher in patients with grade C anastomotic leakage compared with patients with grade B leakage. Mortality in patients with grade C leakage was higher compared with grade B leakage, although nonsignificant (5.8% vs 2.5%; p = 0.12). Multivariate analysis showed that patients with diverting stomas (n = 2866) had a decreased risk of developing grade C leakage compared with grade B (OR = 0.17 (95% CI, 0.10-0.29)). Male patients had an increased risk of developing grade C anastomotic leakage, and patients receiving neoadjuvant treatment before surgery had an increased risk of developing grade B anastomotic leakage. LIMITATIONS: Some possibly relevant variables, such as smoking and nutritional status, were not recorded in the database. CONCLUSIONS: Anastomotic leakage after low anterior resection for rectal cancer was a frequent observed complication in this cohort. Differences in clinical outcome suggest that grade B and C leakage should be considered separate entities in future registrations. In patients with a diverting stoma, the chances of experiencing grade C anastomotic leakage were reduced. See Video Abstract at http://links.lww.com/DCR/A315.
BACKGROUND:Anastomotic leakage is a severe complication after low anterior resection for rectal cancer. With a global increase in registration initiatives, adapting uniform definitions and grading systems is highly relevant. OBJECTIVE: This study aimed to provide clinical parameters to categorize anastomotic leakage into subcategories according to the International Study Group of Rectal Cancer. DESIGN: All of the patients who underwent a low anterior resection in the Netherlands with primary anastomosis were included using the population-based Dutch Surgical Colorectal Audit. SETTINGS: Data were derived from the Dutch Surgical Colorectal Audit. MAIN OUTCOME MEASURES: The development of grade B anastomotic leakage (requiring invasive treatment but no surgery) versus grade C anastomotic leakage (requiring reoperation) was measured. RESULTS: Overall, 4287 patients underwent low anterior resection with primary anastomosis. A total of 159 patients (4%) were diagnosed with grade B anastomotic leakage versus 259 (6%) with grade C. Hospital stay and intensive care unit visits were significantly higher in patients with grade C anastomotic leakage compared with patients with grade B leakage. Mortality in patients with grade C leakage was higher compared with grade B leakage, although nonsignificant (5.8% vs 2.5%; p = 0.12). Multivariate analysis showed that patients with diverting stomas (n = 2866) had a decreased risk of developing grade C leakage compared with grade B (OR = 0.17 (95% CI, 0.10-0.29)). Male patients had an increased risk of developing grade C anastomotic leakage, and patients receiving neoadjuvant treatment before surgery had an increased risk of developing grade B anastomotic leakage. LIMITATIONS: Some possibly relevant variables, such as smoking and nutritional status, were not recorded in the database. CONCLUSIONS:Anastomotic leakage after low anterior resection for rectal cancer was a frequent observed complication in this cohort. Differences in clinical outcome suggest that grade B and C leakage should be considered separate entities in future registrations. In patients with a diverting stoma, the chances of experiencing grade C anastomotic leakage were reduced. See Video Abstract at http://links.lww.com/DCR/A315.
Authors: Vera E M Grupa; Hidde M Kroon; Izel Ozmen; Sergei Bedrikovetski; Nagendra N Dudi-Venkata; Ronald A Hunter; Tarik Sammour Journal: Colorectal Dis Date: 2021-03-18 Impact factor: 3.788
Authors: Vincent T Hoek; Cloë L Sparreboom; Albert M Wolthuis; Anand G Menon; Gert-Jan Kleinrensink; André D'Hoore; Niels Komen; Johan F Lange Journal: Colorectal Dis Date: 2021-11-07 Impact factor: 3.917
Authors: Magdalena Pisarska; Natalia Gajewska; Piotr Małczak; Michał Wysocki; Jan Witowski; Grzegorz Torbicz; Piotr Major; Magdalena Mizera; Marcin Dembiński; Marcin Migaczewski; Andrzej Budzyński; Michał Pędziwiatr Journal: Oncotarget Date: 2018-04-17
Authors: C L Sparreboom; N Komen; D Rizopoulos; A P Verhaar; W A Dik; Z Wu; H L van Westreenen; P G Doornebosch; J W T Dekker; A G Menon; F Daams; D Lips; W M U van Grevenstein; T M Karsten; Y Bayon; M P Peppelenbosch; A M Wolthuis; A D'Hoore; J F Lange Journal: Colorectal Dis Date: 2019-08-09 Impact factor: 3.788