Emma Westerduin1, Hossam Elfeki, Alice Frontali, Zaher Lakkis, Søren Laurberg, Pieter J Tanis, Albert M Wolthuis, Yves Panis, Andre D'Hoore, Willem A Bemelman, Therese Juul. 1. Department of Surgery, Amsterdam UMC, University of Amsterdam, G4, Post box 22660, 1100 DD Amsterdam, the Netherlands Department of Abdominal Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium Department of Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France Department of surgery, Tergooi Hospital, The Netherlands, Post box 10016, 1201 DA Hilversum, the Netherlands Department of surgery, Mansoura University Hospital, Gomhouria street 60, 35516, Mansoura, Egypt.
Abstract
BACKGROUND: Redo anastomosis can be considered in selected patients with persistent leakage, stenosis, or local recurrence. This is technically challenging and little is known about the functional outcomes after this seldomly performed type of surgery. OBJECTIVE: The aim of this study was to compare functional outcomes and quality of life between redo anastomosis and primary successful anastomosis following total mesorectal excision (TME) for rectal cancer. DESIGN: This study was designed as an international multicenter comparative cohort study. SETTINGS: The study was conducted in three tertiary referral centers in the Netherlands, Belgium and France. PATIENTS: Patients undergoing redo anastomosis were compared to patients with a primary successful anastomosis after TME for rectal cancer. MAIN OUTCOME MEASURES: Low Anterior Resection Syndrome (LARS) Score, EORTC QLQ-C30, and QLQ-CR29 questionnaires were used to assess outcomes. RESULTS: In total, 170 patients were included; 52 redo anastomosis and 118 controls. Major LARS occurred in 73% after redo anastomosis compared to 68% following primary successful anastomosis (p=0.52). The redo group had worse EORTC QLQ-CR29 mean scores for fecal incontinence (p=0.03) and flatulence (p=0.008). There were no differences in urinary (p=0.48) or sexual dysfunction, neither in men (p=0.83) nor in women (p=0.76). Significantly worse scores in the redo group were found for global health (p=0.002), role- (p=0.049), and social function (p=0.006), body image (p=0.03) and anxiety (p=0.02). LIMITATIONS: Limitation of this study is the possible response bias. CONCLUSIONS: Redo anastomosis is associated with significantly worse quality of life when compared to patients with primary successful anastomosis. However, major LARS was comparable between groups and should not be a reason to preclude restoration of bowel continuity in highly motivated patients. See Video Abstract at http://links.lww.com/DCR/B565 .
BACKGROUND: Redo anastomosis can be considered in selected patients with persistent leakage, stenosis, or local recurrence. This is technically challenging and little is known about the functional outcomes after this seldomly performed type of surgery. OBJECTIVE: The aim of this study was to compare functional outcomes and quality of life between redo anastomosis and primary successful anastomosis following total mesorectal excision (TME) for rectal cancer. DESIGN: This study was designed as an international multicenter comparative cohort study. SETTINGS: The study was conducted in three tertiary referral centers in the Netherlands, Belgium and France. PATIENTS: Patients undergoing redo anastomosis were compared to patients with a primary successful anastomosis after TME for rectal cancer. MAIN OUTCOME MEASURES: Low Anterior Resection Syndrome (LARS) Score, EORTC QLQ-C30, and QLQ-CR29 questionnaires were used to assess outcomes. RESULTS: In total, 170 patients were included; 52 redo anastomosis and 118 controls. Major LARS occurred in 73% after redo anastomosis compared to 68% following primary successful anastomosis (p=0.52). The redo group had worse EORTC QLQ-CR29 mean scores for fecal incontinence (p=0.03) and flatulence (p=0.008). There were no differences in urinary (p=0.48) or sexual dysfunction, neither in men (p=0.83) nor in women (p=0.76). Significantly worse scores in the redo group were found for global health (p=0.002), role- (p=0.049), and social function (p=0.006), body image (p=0.03) and anxiety (p=0.02). LIMITATIONS: Limitation of this study is the possible response bias. CONCLUSIONS: Redo anastomosis is associated with significantly worse quality of life when compared to patients with primary successful anastomosis. However, major LARS was comparable between groups and should not be a reason to preclude restoration of bowel continuity in highly motivated patients. See Video Abstract at http://links.lww.com/DCR/B565 .
Authors: Kevin Talboom; Nynke G Greijdanus; Frans van Workum; Sander Ubels; Camiel Rosman; Roel Hompes; Johannes H W de Wilt; Pieter J Tanis Journal: Int J Colorectal Dis Date: 2022-08-24 Impact factor: 2.796