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Clin Colon Rectal Surg 2021; 34(06): 431-438
DOI: 10.1055/s-0041-1736465
Review Article

Treatment Modalities for Anastomotic Leakage in Rectal Cancer Surgery

Deborah S. Keller
1   Division of Colorectal Surgery, Department of Surgery, University of California at Davis Medical Center, Sacramento, California
,
K. Talboom
2   Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
,
C.P.M van Helsdingen
2   Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
,
Roel Hompes
2   Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
› Institutsangaben Funding None.
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Abstract

Despite advances in rectal cancer surgery, anastomotic leakage (AL) remains a common complication with a significant impact on patient recovery, health care costs, and oncologic outcomes. The spectrum of clinical severity associated with AL is broad, and treatment options are diverse with highly variable practices across the colorectal community. To be effective, the treatment must match not only the patient's current status but also the type of leak, the surgeon's skill, and the resources available. In this chapter, we will review the current and emergent treatment modalities for AL after rectal cancer surgery.

Keywords

colorectal surgery - rectal cancer - anastomotic leak - endosponge - postoperative complication


Publikationsverlauf

Artikel online veröffentlicht:
23. November 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Lee SW, Gregory D, Cool CL. Clinical and economic burden of colorectal and bariatric anastomotic leaks. Surg Endosc 2020; 34 (10) 4374-4381
    CrossrefPubMedSuche in Google Scholar
  • 2 Kverneng Hultberg D, Svensson J, Jutesten H. et al. The impact of anastomotic leakage on long-term function after anterior resection for rectal cancer. Dis Colon Rectum 2020; 63 (05) 619-628
    CrossrefPubMedSuche in Google Scholar
  • 3 Yang J, Chen Q, Jindou L, Cheng Y. The influence of anastomotic leakage for rectal cancer oncologic outcome: a systematic review and meta-analysis. J Surg Oncol 2020; 121 (08) 1283-1297
    CrossrefPubMedSuche in Google Scholar
  • 4 Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011; 253 (05) 890-899
    CrossrefPubMedSuche in Google Scholar
  • 5 La Regina D, Di Giuseppe M, Lucchelli M. et al. Financial impact of anastomotic leakage in colorectal surgery. J Gastrointest Surg 2019; 23 (03) 580-586
    CrossrefPubMedSuche in Google Scholar
  • 6 Peel AL, Taylor EW. Surgical Infection Study Group. Proposed definitions for the audit of postoperative infection: a discussion paper. Ann R Coll Surg Engl 1991; 73 (06) 385-388
    PubMedSuche in Google Scholar
  • 7 Lichthardt S, Wagner J, Löb S. et al. Pathological complete response due to a prolonged time interval between preoperative chemoradiation and surgery in locally advanced rectal cancer: analysis from the German StuDoQ|Rectalcarcinoma registry. BMC Cancer 2020; 20 (01) 49
    CrossrefPubMedSuche in Google Scholar
  • 8 Rutegård M, Kverneng Hultberg D, Angenete E, Lydrup ML. Substantial underreporting of anastomotic leakage after anterior resection for rectal cancer in the Swedish Colorectal Cancer Registry. Acta Oncol 2017; 56 (12) 1741-1745
    CrossrefPubMedSuche in Google Scholar
  • 9 Penna M, Hompes R, Arnold S. et al; International TaTME Registry Collaborative. Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the International TaTME Registry. Ann Surg 2019; 269 (04) 700-711
    CrossrefPubMedSuche in Google Scholar
  • 10 Borstlap WAA, Westerduin E, Aukema TS, Bemelman WA, Tanis PJ. Dutch Snapshot Research Group. Anastomotic leakage and chronic presacral sinus formation after low anterior resection: results from a large cross-sectional study. Ann Surg 2017; 266 (05) 870-877
    CrossrefPubMedSuche in Google Scholar
  • 11 McDermott FD, Arora S, Smith J, Steele RJC, Carlson GL, Winter DC. (on behalf of the joint ASGBI/ACPGBI). Anastomotic leakage working group issues in professional practice. prevention, diagnosis and management of colorectal anastomotic leakage. March 2016. Accessed December 2020 at: https://www.asgbi.org.uk/publications/professional-practice-booklets-members-only
    PubMed
  • 12 van Helsdingen CP, Jongen AC, de Jonge WJ, Bouvy ND, Derikx JP. Consensus on the definition of colorectal anastomotic leakage: a modified Delphi study. World J Gastroenterol 2020; 26 (23) 3293-3303
    CrossrefPubMedSuche in Google Scholar
  • 13 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 (03) 339-351
    CrossrefPubMedSuche in Google Scholar
  • 14 Kennedy R, Jenkins I, Finan PJ. Controversial topics in surgery: splenic flexure mobilisation for anterior resection performed for sigmoid and rectal cancer. Ann R Coll Surg Engl 2008; 90 (08) 638-642
    CrossrefPubMedSuche in Google Scholar
  • 15 Vennix S, Bakker OJ, Prins HA, Lips DJ. Re-interventions following laparoscopic surgery for colorectal cancer: data from 818 individuals from the Dutch surgical colorectal audit. J Laparoendosc Adv Surg Tech A 2014; 24 (11) 751-755
    CrossrefPubMedSuche in Google Scholar
  • 16 Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg 2014; 101 (04) 339-346
    CrossrefPubMedSuche in Google Scholar
  • 17 Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D. Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis 2013; 28 (04) 437-445
    CrossrefPubMedSuche in Google Scholar
  • 18 Kauv P, Benadjaoud S, Curis E, Boulay-Coletta I, Loriau J, Zins M. Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT. Eur Radiol 2015; 25 (12) 3543-3551
    CrossrefPubMedSuche in Google Scholar
  • 19 Habib K, Gupta A, White D, Mazari FAK, Wilson TR. Utility of contrast enema to assess anastomotic integrity and the natural history of radiological leaks after low rectal surgery: systematic review and meta-analysis. Int J Colorectal Dis 2015; 30 (08) 1007-1014
    CrossrefPubMedSuche in Google Scholar
  • 20 Solomkin JS, Mazuski JE, Bradley JS. et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010; 50 (02) 133-164
    CrossrefPubMedSuche in Google Scholar
  • 21 Yang G, Kim CW, Lee SH. Patterns of antibiotics and pathogens for anastomotic leakage after colorectal cancer surgery. Korean J Clin Oncol 2019; 15 (02) 79-85
    CrossrefPubMedSuche in Google Scholar
  • 22 Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach D. A review of ten years of the Study for Monitoring Antimicrobial Resistance Trends (SMART) from 2002 to 2011. Pharmaceuticals (Basel) 2013; 6 (11) 1335-1346
    CrossrefPubMedSuche in Google Scholar
  • 23 Creavin B, Ryan EJ, Kelly ME. et al. Minimally invasive approaches to the management of anastomotic leakage following restorative rectal cancer resection. Colorectal Dis 2019; 21 (12) 1364-1371
    CrossrefPubMedSuche in Google Scholar
  • 24 Blumetti J, Chaudhry V, Cintron JR. et al. Management of anastomotic leak: lessons learned from a large colon and rectal surgery training program. World J Surg 2014; 38 (04) 985-991
    CrossrefPubMedSuche in Google Scholar
  • 25 Maggiori L, Bretagnol F, Lefèvre JH, Ferron M, Vicaut E, Panis Y. Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Colorectal Dis 2011; 13 (06) 632-637
    CrossrefPubMedSuche in Google Scholar
  • 26 Harisinghani MG, Gervais DA, Maher MM. et al. Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology 2003; 228 (03) 701-705
    CrossrefPubMedSuche in Google Scholar
  • 27 Robert B, Chivot C, Rebibo L, Sabbagh C, Regimbeau JM, Yzet T. Percutaneous transgluteal drainage of pelvic abscesses in interventional radiology: a safe alternative to surgery. J Visc Surg 2016; 153 (01) 3-7
    CrossrefPubMedSuche in Google Scholar
  • 28 Challine A, Lefèvre JH, Creavin B. et al. Can a local drainage salvage a failed colorectal or coloanal anastomosis? A prospective cohort of 54 patients. Dis Colon Rectum 2020; 63 (01) 93-100
    CrossrefPubMedSuche in Google Scholar
  • 29 Sirois-Giguère E, Boulanger-Gobeil C, Bouchard A. et al. Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option. Dis Colon Rectum 2013; 56 (05) 586-592
    CrossrefPubMedSuche in Google Scholar
  • 30 Shalaby M, Thabet W, Buonomo O. et al. Transanal tube drainage as a conservative treatment for anastomotic leakage following a rectal resection. Ann Coloproctol 2018; 34 (06) 317-321
    CrossrefPubMedSuche in Google Scholar
  • 31 Lamazza A, Sterpetti AV, De Cesare A, Schillaci A, Antoniozzi A, Fiori E. Endoscopic placement of self-expanding stents in patients with symptomatic anastomotic leakage after colorectal resection for cancer: long-term results. Endoscopy 2015; 47 (03) 270-272
    Thieme ConnectPubMedSuche in Google Scholar
  • 32 Pérez Roldán F, González Carro P, Villafáñez García MC. et al. Usefulness of biodegradable polydioxanone stents in the treatment of postsurgical colorectal strictures and fistulas. Endoscopy 2012; 44 (03) 297-300
    Thieme ConnectPubMedSuche in Google Scholar
  • 33 Lamazza A, Sterpetti AV, De Cesare A, Schillaci A, Antoniozzi A, Fiori E. Endoscopic placement of self-expanding stents in patients with symptomatic anastomotic leakage after colorectal resection for cancer: long-term results. Endoscopy 2015; 47 (03) 270-272
    Thieme ConnectPubMedSuche in Google Scholar
  • 34 Abbas MA. Endoscopic management of acute colorectal anastomotic complications with temporary stent. JSLS 2009; 13 (03) 420-424
    PubMedSuche in Google Scholar
  • 35 Chorti A, Stavrou G, Stelmach V. et al. Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: a systematic review. Asian J Endosc Surg 2020; 13 (02) 141-146
    CrossrefPubMedSuche in Google Scholar
  • 36 Chopra SS, Mrak K, Hünerbein M. The effect of endoscopic treatment on healing of anastomotic leaks after anterior resection of rectal cancer. Surgery 2009; 145 (02) 182-188
    CrossrefPubMedSuche in Google Scholar
  • 37 Lippert E, Klebl FH, Schweller F. et al. Fibrin glue in the endoscopic treatment of fistulae and anastomotic leakages of the gastrointestinal tract. Int J Colorectal Dis 2011; 26 (03) 303-311
    CrossrefPubMedSuche in Google Scholar
  • 38 Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 2008; 22 (08) 1818-1825
    CrossrefPubMedSuche in Google Scholar
  • 39 Gardenbroek TJ, Musters GD, Buskens CJ. et al. Early reconstruction of the leaking ileal pouch-anal anastomosis: a novel solution to an old problem. Colorectal Dis 2015; 17 (05) 426-432
    CrossrefPubMedSuche in Google Scholar
  • 40 Borstlap WAA, Musters GD, Stassen LPS. et al. Vacuum-assisted early transanal closure of leaking low colorectal anastomoses: the CLEAN study. Surg Endosc 2018; 32 (01) 315-327
    CrossrefPubMedSuche in Google Scholar
  • 41 Talboom K, van Kesteren J, Sonneveld DJA, Tanis PJ, Bemelman WA, Hompes R. Early transanal closure after vacuum-assisted drainage for anastomotic leakage in rectal cancer surgery—a video vignette. Colorectal Dis 2020; 22 (08) 973-974
    CrossrefPubMedSuche in Google Scholar
  • 42 Shalaby M, Emile S, Elfeki H, Sakr A, Wexner SD, Sileri P. Systematic review of endoluminal vacuum-assisted therapy as salvage treatment for rectal anastomotic leakage. BJS Open 2018; 3 (02) 153-160
    CrossrefPubMedSuche in Google Scholar
  • 43 Abdalla S, Cotte E, Epin A. et al; on behalf the French GRECCAR group. Short-term and long-term outcome of endoluminal vacuum therapy for colorectal or coloanal anastomotic leakage: results of a nationwide multicenter cohort study from the French GRECCAR Group. Dis Colon Rectum 2020; 63 (03) 371-380
    CrossrefPubMedSuche in Google Scholar
  • 44 Huisman JF, van Westreenen HL, van der Wouden EJ. et al. Effectiveness of endosponge therapy for the management of presacral abscesses following rectal surgery. Tech Coloproctol 2019; 23 (06) 551-557
    CrossrefPubMedSuche in Google Scholar
  • 45 Kühn F, Janisch F, Schwandner F. et al. Comparison between endoscopic vacuum therapy and conventional treatment for leakage after rectal resection. World J Surg 2020; 44 (04) 1277-1282
    CrossrefPubMedSuche in Google Scholar
  • 46 Westerduin E, Borstlap WAA, Musters GD. et al. Redo coloanal anastomosis for anastomotic leakage after low anterior resection for rectal cancer: an analysis of 59 cases. Colorectal Dis 2018; 20 (01) 35-43
    CrossrefPubMedSuche in Google Scholar
  • 47 Woo IT, Park JS, Choi GS, Park SY, Kim HJ, Park IK. Clinical outcomes of a redo for a failed colorectal or coloanal anastomosis. Ann Coloproctol 2018; 34 (05) 259-265
    CrossrefPubMedSuche in Google Scholar
  • 48 Boullenois H, Lefevre JH, Creavin B. et al. Long-term functional results and quality of life after redo rectal surgery: delayed versus immediate colo-anal anastomosis. Colorectal Dis 2020; 22 (08) 885-893
    CrossrefPubMedSuche in Google Scholar
  • 49 Westerduin E, Klaver CEL, van Geloven AAW, Westerterp M, Bemelman WA, Tanis PJ. Outcome after redo surgery for complicated colorectal and coloanal anastomosis: a systematic review. Dis Colon Rectum 2018; 61 (08) 988-998
    CrossrefPubMedSuche in Google Scholar
  • 50 Borel Rinkes IH, Wiggers T. Gracilis muscle flap in the treatment of persistent, infected pelvic necrosis. Eur J Surg 1999; 165 (04) 390-391
    CrossrefPubMedSuche in Google Scholar
  • 51 Musters GD, Borstlap WA, Bemelman WA, Buskens CJ, Tanis PJ. Intersphincteric completion proctectomy with omentoplasty for chronic presacral sinus after low anterior resection for rectal cancer. Colorectal Dis 2016; 18 (02) 147-154
    CrossrefPubMedSuche in Google Scholar
  • 52 Goldsmith HS, Griffith AL, Kupferman A, Catsimpoolas N. Lipid angiogenic factor from omentum. JAMA 1984; 252 (15) 2034-2036
    CrossrefPubMedSuche in Google Scholar
  • 53 Meza-Perez S, Randall TD. Immunological functions of the omentum. Trends Immunol 2017; 38 (07) 526-536
    CrossrefPubMedSuche in Google Scholar
  • 54 Swain BT, Ellis CN. Fibrin glue treatment of low rectal and pouch-anal anastomotic sinuses. Dis Colon Rectum 2004; 47 (02) 253-255
    CrossrefPubMedSuche in Google Scholar
  • 55 Alsanea N, Alabbad S. Use of the endostapler for the treatment of non-healing sinus secondary to a dehisced colorectal anastomosis. Tech Coloproctol 2010; 14 (03) 249-251
    CrossrefPubMedSuche in Google Scholar
  • 56 Abild N, Bulut O, Nielsen CB. Endoscopic stapled marsupialisation of chronic presacral sinus following low anterior resection: a simple option in selected cases. Scand J Surg 2012; 101 (04) 307-310
    CrossrefPubMedSuche in Google Scholar