Comparison of proactive and conventional treatment of anastomotic leakage in rectal cancer surgery; a multicenter retrospective cohort series
EAES Academy. Talboom K. 07/05/22; 363018; P062
Mr. Kevin Talboom
Contributions
Contributions
Abstract
Background:
Comparative studies on efficacy of treatment strategies for anastomotic leakage (AL) after low anterior resection (LAR) are almost non-existing. This study aimed to compare different proactive and conservative treatment approaches for AL after LAR.
Methods:
This retrospective cohort study included all patients (Feb 2009 - Apr 2020) with AL after LAR in three university hospitals. Different treatment approaches were compared, including a pair-wise comparison of conventional treatment and endoscopic vacuum assisted surgical closure (EVASC). Primary outcomes were healed and functional anastomosis rates at het end of follow-up.
Results:
Overall, 103 patients were included, of which 59 underwent conventional treatment and 23 EVASC. Median number of reinterventions was 1 after conventional treatment, compared to 7 after EVASC (p<0.01). Median follow-up was 39 and 25 months, respectively. Healed anastomosis rate was 61% after conventional treatment, compare to 78% after EVASC (p=0.139) and functional anastomosis rate was higher after EVASC, compared to conventional treatment (78% vs 54%, p=0.045). Total length of stay was median 30 days after EVASC, compared to 19 days after conventional treatment (p=0.004). Early initiation of EVASC in the first week after primary surgery, resulted in better functional anastomosis rate compared to late initiation (100% vs 55%, p=0.008).
Conclusion:
Pro-active treatment of AL consisting of EVASC resulted in improved healed and functional anastomosis rates for AL after LAR for rectal cancer, compared to conventional treatment. If EVASC was initiated within the first week after index surgery, a 100% functional anastomosis rate was achievable.
Comparative studies on efficacy of treatment strategies for anastomotic leakage (AL) after low anterior resection (LAR) are almost non-existing. This study aimed to compare different proactive and conservative treatment approaches for AL after LAR.
Methods:
This retrospective cohort study included all patients (Feb 2009 - Apr 2020) with AL after LAR in three university hospitals. Different treatment approaches were compared, including a pair-wise comparison of conventional treatment and endoscopic vacuum assisted surgical closure (EVASC). Primary outcomes were healed and functional anastomosis rates at het end of follow-up.
Results:
Overall, 103 patients were included, of which 59 underwent conventional treatment and 23 EVASC. Median number of reinterventions was 1 after conventional treatment, compared to 7 after EVASC (p<0.01). Median follow-up was 39 and 25 months, respectively. Healed anastomosis rate was 61% after conventional treatment, compare to 78% after EVASC (p=0.139) and functional anastomosis rate was higher after EVASC, compared to conventional treatment (78% vs 54%, p=0.045). Total length of stay was median 30 days after EVASC, compared to 19 days after conventional treatment (p=0.004). Early initiation of EVASC in the first week after primary surgery, resulted in better functional anastomosis rate compared to late initiation (100% vs 55%, p=0.008).
Conclusion:
Pro-active treatment of AL consisting of EVASC resulted in improved healed and functional anastomosis rates for AL after LAR for rectal cancer, compared to conventional treatment. If EVASC was initiated within the first week after index surgery, a 100% functional anastomosis rate was achievable.
Background:
Comparative studies on efficacy of treatment strategies for anastomotic leakage (AL) after low anterior resection (LAR) are almost non-existing. This study aimed to compare different proactive and conservative treatment approaches for AL after LAR.
Methods:
This retrospective cohort study included all patients (Feb 2009 - Apr 2020) with AL after LAR in three university hospitals. Different treatment approaches were compared, including a pair-wise comparison of conventional treatment and endoscopic vacuum assisted surgical closure (EVASC). Primary outcomes were healed and functional anastomosis rates at het end of follow-up.
Results:
Overall, 103 patients were included, of which 59 underwent conventional treatment and 23 EVASC. Median number of reinterventions was 1 after conventional treatment, compared to 7 after EVASC (p<0.01). Median follow-up was 39 and 25 months, respectively. Healed anastomosis rate was 61% after conventional treatment, compare to 78% after EVASC (p=0.139) and functional anastomosis rate was higher after EVASC, compared to conventional treatment (78% vs 54%, p=0.045). Total length of stay was median 30 days after EVASC, compared to 19 days after conventional treatment (p=0.004). Early initiation of EVASC in the first week after primary surgery, resulted in better functional anastomosis rate compared to late initiation (100% vs 55%, p=0.008).
Conclusion:
Pro-active treatment of AL consisting of EVASC resulted in improved healed and functional anastomosis rates for AL after LAR for rectal cancer, compared to conventional treatment. If EVASC was initiated within the first week after index surgery, a 100% functional anastomosis rate was achievable.
Comparative studies on efficacy of treatment strategies for anastomotic leakage (AL) after low anterior resection (LAR) are almost non-existing. This study aimed to compare different proactive and conservative treatment approaches for AL after LAR.
Methods:
This retrospective cohort study included all patients (Feb 2009 - Apr 2020) with AL after LAR in three university hospitals. Different treatment approaches were compared, including a pair-wise comparison of conventional treatment and endoscopic vacuum assisted surgical closure (EVASC). Primary outcomes were healed and functional anastomosis rates at het end of follow-up.
Results:
Overall, 103 patients were included, of which 59 underwent conventional treatment and 23 EVASC. Median number of reinterventions was 1 after conventional treatment, compared to 7 after EVASC (p<0.01). Median follow-up was 39 and 25 months, respectively. Healed anastomosis rate was 61% after conventional treatment, compare to 78% after EVASC (p=0.139) and functional anastomosis rate was higher after EVASC, compared to conventional treatment (78% vs 54%, p=0.045). Total length of stay was median 30 days after EVASC, compared to 19 days after conventional treatment (p=0.004). Early initiation of EVASC in the first week after primary surgery, resulted in better functional anastomosis rate compared to late initiation (100% vs 55%, p=0.008).
Conclusion:
Pro-active treatment of AL consisting of EVASC resulted in improved healed and functional anastomosis rates for AL after LAR for rectal cancer, compared to conventional treatment. If EVASC was initiated within the first week after index surgery, a 100% functional anastomosis rate was achievable.
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