MANAGEMENT OF COLORECTAL ANASTOMOTIC LEAK: IS IT POSSIBLE TO SAVE ANASTOMOSIS?
https://doi.org/10.21294/1814-4861-2018-17-1-92-98
Abstract
Nowadays, colorectal anastomotic leak is a threatening surgical complication, especially in low and ultralow rectal resections. Attempts to resolve this problem fultimately lead to the creation of permanent stoma. Preservation of rectal anastomosis is an important task, because in case of its leakage, more than 50 % of patients will have the need for permanent stoma. In this article the authors review various treatment options for anastomotic leakage. Methods of treating presacral sinuses that resulted from mesorectumectomy and techniques of their drainage, as well as the effectiveness of endoscopic methods with biologic glue were discussed. Methods that do not lead to anastomotic leak are more preferable in terms of improvement of quality of life of patients and further prognosis.
About the Authors
F. Sh. Akhmetzyanov
Tatarstan Regional Clinical Cancer Center; Kazan State Medical University
Russian Federation
Russian Federation
Foat Sh. Akhmetzyanov - MD, DSc, Professor, Head of Oncology, Radiation Therapy and Diagnostic Imaging Department, SPIN-code: 8908-4761.
29, Sibirskiy trakt, 420029-Kazan; 49, Butlerov Street, 420000-Kazan
V. I. Egorov
Tatarstan Regional Clinical Cancer Center; Kazan State Medical University
Russian Federation
Russian Federation
Vasiliy I. Egorov - MD, PhD, Assistant Head of Oncology, Radiation Therapy and Diagnostic Imaging Department, SPIN-code: 7794-4210.
29, Sibirskiy trakt, 420029-Kazan; 49, Butlerov Street, 420000-Kazan
A. I. Valeev
Kazan State Medical University
Russian Federation
Russian Federation
Almaz I. Valeev – Student, SPIN-code: 8150-7841.
49, Butlerov Street, 420000-Kazan
V. A. Bukhalova
Kazan State Medical University
Russian Federation
Russian Federation
Veronika A. Bukhalova – Student, SPIN-code: 7584-7631.
49, Butlerov Street, 420000-Kazan
References
1. Aleksandrov V.B. Rectal cancer. Moscow, 2001. 208. [in Russian]
2. Hanevich M.D., Shasholin M.A., Zjazin A.A. Colorectal cancer: surgical preparation of colon. Moscow, Petrozavodsk, 2003. 136. [in Russian]
3. Holdin S.A. Rectal and sigmoidal neoplasms. Moscow, 1977. 504. [in Russian]
4. Warschkow R., Steffen T., Thierbach J., Bruckner T., Lange J., Tarantino I. Risk Factors for Anastomotic Leakage after Rectal Cancer Resection and Reconstruction with Colorectostomy. A Retrospective Study with Bootstrap Analysis. Ann. Surg. Oncol. 2011 Oct; 18 (10): 2772–82. doi: 10.1245/s10434-011-1696-1.
5. Yang L., Huang X.E., Zhou J.N. Risk Assessment on Anastomotic Leakage after Rectal Cancer Surgery: An Analysis of 753 Patients. Asian Pac J Cancer Prev. 2013; 14 (7): 4447–53.
6. Tsar’kov P.V., Ermakov D.F., Tulina I.A. Risk factors of development failure of hardware anastomosis after performing an anterior and low anterior rectal resection. Pirogov’s Surgical Week. SPb., 2010; 416–417. [in Russian]
7. Tsar’kov P.V., Kravchenko A.Yu., Tulina I.A., Tsugulya P.B. Is it alwaysthe formation of hardware at the anastomosis anterior resection recovery ensures the continuity of the bowel? Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2012; 4: 7380. [in Russian]
8. Kotel’nikova L.P., Shatrova N.A. Risk factors of sigmoidorectal anastomotic leak. Modern Problems of Science and Education. 2015; 5: 148. [in Russian]
9. Asteria C.R., Gagliardi G., Pucciarelli S., Romano G., Infantino A., La Torre F., Tonelli F., Martin F., Pulica C., Ripetti V., Diana G., Amicucci G., Carlini M., Sommariva A., Vinciguerra G., Poddie D.B., Amato A., Bassi R., Galleano R., Veronese E., Mancini S., Pescio G., Occelli G.L., Bracchitta S., Castagnola M., Pontillo T., Cimmino G., Prati U., Vincenti R. Anastomotic leaks after anterior resection for mid and low rectal cancer: survey of the Italian of Colorectal Surgery. Tech Coloproctol. 2008 Jun; 12 (2): 103–10. doi: 10.1007/s10151-008-0407-9.
10. Aytac E., Lavery I.C., Kalady M.F., Kiran R.P. Impact of obesity on operation performed, complications, and long-term outcomes in terms of restoration of intestinal continuity for patients with mid and low rectal cancer. Dis Colon Rectum. 2013 Jun; 56 (6): 689–97. doi: 10.1097/DCR.0b013e3182880ffa.
11. Garlipp B., Ptok H., Schmidt U., Meyer F., Gastinger I., Lippert H. Neoadjuvant chemoradiotherapy for rectal carcinoma: effects onanastomotic leak rate and postoperative bladder dysfunction after nonemergency sphincter-preserving anterior rectal resection. Results of the Quality Assurance in Rectal Cancer Surgery multicenter observational trial. Langenbecks Arch Surg. 2010 Nov; 395 (8): 1031–8. doi: 10.1007/s00423-010-0708-0.
12. Kim M.J., Shin R., Oh H.K., Park J.W., Jeong S.Y., Park J.G. The impact of heavy smoking on anastomotic leakage and stricture after low anterior resection in rectal cancer patients. World J Surg. 2011 Dec; 35 (12): 2806–10. doi: 10.1007/s00268-011-1286-1.
13. Hojo K., Koyama Y., Moriya Y. Lymphatic spread and its prognostic value in patients with rectal cancer. Am J Surg. 1982 Sep; 144 (3):350–4.
14. Huh J.W., Kim H.R., Kim Y.J. Anastomotic leakage after laparoscopic resection of rectal cancer: the impact of fibrin glue. Am J Surg. 2010 Apr; 199 (4): 435–41. doi: 10.1016/j.amjsurg.2009.01.018.
15. Pommergaard H.C., Gessler B., Burcharth J., Angenete E., Haglind E., Rosenberg J. Preoperative risk factors for anastomotic leakage afterresection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis. 2014 Sep; 16 (9): 662–71. doi: 10.1111/codi.12618.
16. Zaharie F., Mocan L., Tomuş C., Mocan T., Zaharie R., Bartoş D., Bartoş A., Vlad L., Iancu C. Risk factors for anastomotic leakage followingcolorectal resection for cancer. Chirurgia (Bucur). 2012 Jan-Feb; 107 (1): 27–32.
17. Kawada K., Hasegawa S., Hida K., Hirai K., Okoshi K., Nomura A., Kawamura J., Nagayama S., Sakai Y. Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc. 2014 Oct; 28 (10): 2988–95. doi: 10.1007/s00464-014-3564-0.
18. Park J.S., Choi G.S., Kim S.H., Kim H.R., Kim N.K., Lee K.Y., Kang S.B., Kim J.Y., Lee K.Y., Kim B.C., Bae B.N., Son G.M., Lee S.I., Kang H. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg. 2013 Apr; 257 (4): 665–71. doi: 10.1097/SLA.0b013e31827b8ed9.
19. Gu W.L., Wu S.W. Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies. World J Surg Oncol. 2015 Jan 24; 13: 9. doi: 10.1186/s12957-014-0417-1.
20. Hong J., Han Y.D., Zhu X.C., Li X.N., Li C., Yang J., Shi L.S. Indications of preventive ileostomy in sphincter-preserving surgery for patients with rectal cancer. Int J Clin Exp Med. 2016; 9 (5): 8506–8513.
21. Borstlap W.A.A., Westerduin E., Aukema T.S., Bemelman W.A., Tanis P.J.; 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 Nov; 266 (5): 870–877. doi: 10.1097/SLA.0000000000002429.
22. Sloothaak D.A., Buskens C.J., Bemelman W.A., Tanis P.J. Treatment of chronic presacral sinus after low anterior resection. Colorectal Dis. 2013 Jun; 15 (6): 727–32. doi: 10.1111/codi.12094.
23. Blumetti J., Abcarian H. Management of low colorectal anastomotic leak: Preserving the anastomosis. World J Gastrointest Surg. 2015 Dec 27; 7 (12): 378–83. doi: 10.4240/wjgs.v7.i12.378.
24. Musters G.D., Borstlap W.A., Bemelman W.A., Buskens C.J., Tanis P.J. Intersphincteric completion proctectomy with omentoplasty for chronic presacral sinus after low anterior resection for rectal cancer. Colorectal Dis. 2016 Feb; 18 (2): 147–54. doi: 10.1111/codi.13086.
25. Abelevich A.I., Komarov D.V., Larin A.A., Dezortsev I.L., Patsenker E.N. Low anterior rectal resection. Surgery. N.I. Pirogov Journal. 2008; 6: 63–66. [in Russian]
26. Abelevich A.I. Low anterior rectal resections in malignant tumors. Medical Almanac. 2010; 1: 173–176. [in Russian]
27. Akhmetzyanov F.Sh., Shaikhutdinov N.T., Akhmetzyanova F.F., Valiev N.A., Shemeunova Z.N., Egorov V.I. Aspirating drainage of the cavity of the lesser pelvis as a way of conservative treatment of low-lying colorectal anastomotic leak. Colorectal oncology. 2015; 1: 43–48. doi: 10.17650/2220-3478-2015-1-43-48. [in Russian]
28. Weidenhagen R., Gruetzner K.U., Wiecken T., Spelsberg F., Jauch K.W. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc. 2008 Aug; 22 (8): 1818–25. doi: 10.1007/s00464-007-9706-x.
29. Strangio G., Zullo A., Ferrara E.C., Anderloni A., Carlino A., Jovani M., Ciscato C., Hassan C., Repici A. Endo-sponge therapy for management of anastomotic leakages after colorectal surgery: A case series and review of literature. Dig Liver Dis. 2015 Jun; 47 (6): 465–9. doi: 10.1016/j.dld.2015.02.007.
30. Riss S., Stift A., Meier M., Haiden E., Grünberger T., Bergmann M. Endo-sponge assisted treatment of anastomotic leakage following colorectal surgery. Colorectal Dis. 2010 Jul; 12 (7 Online): e104–8. doi: 10.1111/j.1463-1318.2009.01885.x.
31. Nerup N., Johansen J.L., Alkhefagie G.A., Maina P., Jensen K.H. Promising results after endoscopic vacuum treatment of anastomotic leakage following resection of rectal cancer with ileostomy. Dan Med J. 2013 Apr; 60 (4): A4604.
32. Srinivasamurthy D., Wood C., Slater R., Garner J. An initial experience using transanal vacuum therapy in pelvic anastomotic leakage. Tech Coloproctol. 2013 Jun; 17 (3): 275–81. doi: 10.1007/s10151-012-0911-9.
33. Verlaan T., Bartels S.A., van Berge Henegouwen M.I., Tanis P.J., Fockens P., Bemelman W.A. Early, minimally invasive closure of anastomotic leaks: a new concept. Colorectal Dis. 2011 Nov; 13 Suppl 7: 18–22. doi: 10.1111/j.1463-1318.2011.02775.x.
34. Arezzo A., Miegge A., Garbarini A., Morino M. Endoluminal vacuum therapy for anastomotic leaks after rectal surgery. Tech Coloproctol. 2010 Sep; 14(3): 279–81. doi: 10.1007/s10151-010-0569-0.
35. Swain B.T., Ellis C.N. Fibrin glue treatment of low rectal and pouch-anal anastomotic sinuses. Dis Colon Rectum. 2004 Feb; 47 (2): 253–5.
36. Lorentzen T., Nolsøe C., Skjoldbye B. Ultrasound-guided drainage of deep pelvic abscesses: experience with 33 cases. Ultrasound Med Biol. 2011 May; 37 (5): 723–8. doi: 10.1016/j.ultrasmedbio.2011.02.004.
37. Chen Y.S., Bo X.B., Gu D.Y., Gao W.D., Sheng W.Z., Zhang B. Outcomes of laparoscopic abdominoperineal resection in low rectal cancer using different pelvic drainages. Asian Pac J Cancer Prev. 2015; 16 (1): 153–5.
38. Aliev S.A. Tactics of surgical treatment of postsurgical complications in patients with colon obstruction of cancer. I.I. Grekov Herald of Surgery. 1999; 3: 66–70. [in Russian]
39. Bryusov P.G., Inoyatov I.M., Perekhodov S.N. Prevention of sigmorectal anastomotic leak after anterior rectal resection because of cancer. Surgery. 1996; 2: 45–48. [in Russian]
40. Yanovoi V.V., Zhukov O.I., Krivsha Yu.V. Full intestinal irrigation in complex treatment of colorectal anastomotic leak. I.I. Grekov Herald of Surgery. 1987; 8: 48–50. [in Russian]
41. Fedorov V.D., Vorob’ev G.I., Rivkin V.L. Surgical coloproctology: doctors manual. Moscow, 1994. 432. [in Russian]
42. Linev K.A., Vysotskii A.A. Tactics of surgical management of colorectal anastomotic leak. Herald of Urgent and Restorative Medicine. 2013; 4: 474–478. [in Russian]
43. Zhao W.T., Hu F.L., Li Y.Y., Li H.J., Luo W.M., Sun F. Use of a transanal drainage tube for prevention of anastomotic leakage and bleeding after anterior resection for rectal cancer. World J Surg. 2013 Jan; 37 (1): 227–32. doi: 10.1007/s00268-012-1812-9.
44. Hidaka E., Ishida F., Mukai S., Nakahara K., Takayanagi D., Maeda C., Takehara Y., Tanaka J., Kudo S.E. Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: a retrospective cohort study in a single institution. Surg Endosc. 2015 Apr; 29 (4): 863–7. doi: 10.1007/s00464-014-3740-2.
45. Chopra S.S., Mrak K., Hünerbein M. The effect of endoscopic treatment on healing of anastomotic leaks after anterior resection of rectal cancer. Surgery. 2009 Feb; 145 (2): 182–8. doi: 10.1016/j.surg.2008.09.012.
46. Cooper C.J., Morales A., Othman M.O. Outcomes of the use of fully covered esophageal self-expandable stent in the management of colorectal anastomotic strictures and leaks. Diagn Ther Endosc. 2014; 2014: 187541. doi: 10.1155/2014/187541.
47. DiMaio C.J., Dorfman M.P., Gardner G.J., Nash G.M., Schattner M.A., Markowitz A.J., Chi D.S., Gerdes H. Covered esophageal selfexpandable metal stents in the nonoperative management of postoperative colorectal anastomotic leaks. Gastrointest Endosc. 2012 Aug; 76 (2): 431–5. doi: 10.1016/j.gie.2012.03.1393.
48. Pérez Roldán F., González Carro P., Villafáñez García M.C., Aoufi Rabih S., Legaz Huidobro M.L., Bernardos Martín E., Villanueva Hernández R., Tebar Romero E., Ruiz Carrillo F. Endoscopic treatment of postsurgical colorectal anastomotic leak (with videos). Gastrointest Endosc. 2013 Jun; 77 (6): 967–71. doi: 10.1016/j.gie.2013.01.043.
49. Cereatti F., Fiocca F., Dumont J.L., Ceci V., Vergeau B.M., Tuszynski T., Meduri B., Donatelli G. Fully covered self-expendable metal stent in the treatment of postsurgical colorectal diseases: outcome in 29 patients. Therap Adv Gastroenterol. 2016 Mar; 9 (2): 180–8. doi: 10.1177/1756283X15610052.
50. Arezzo A., Verra M., Reddavid R., Cravero F., Bonino M.A., Morino M. Efficacy of the over-the-scope clip (OTSC) for treatment of colorectalpostsurgical leaks and fistulas. Surg Endosc. 2012 Nov; 26 (11): 3330–3. doi: 10.1007/s00464-012-2340-2.
51. Mennigen R., Colombo-Benkmann M., Senninger N., Laukoetter M. Endoscopic closure of postoperative gastrointestinal leakages and fistulas with the Over-the-Scope Clip (OTSC). World J Gastroenterol. 2014 Jun 28; 20 (24): 7767–76. doi: 10.3748/wjg.v20.i24.7767.
52. Kobayashi H., Kikuchi A., Okazaki S., Ishiguro M., Ishikawa T., Iida S., Uetake H., Sugihara K. Over-the-scope-clipping system for anastomotic leak after colorectal surgery: report of two cases. World J Gastroenterol. 2014 Jun 28; 20 (24): 7984–7. doi: 10.3748/wjg.v20.i24.7984.
53. Haito-Chavez Y., Law J.K., Kratt T., Arezzo A., Verra M., Morino M., Sharaiha R.Z., Poley J.W., Kahaleh M., Thompson C.C., Ryan M.B., Choksi N., Elmunzer B.J., Gosain S., Goldberg E.M., Modayil R.J., Stavropoulos S.N., Schembre D.B., DiMaio C.J., Chandrasekhara V., Hasan M.K., VaradarajuluS., Hawes R., Gomez V., Woodward T.A., Rubel-Cohen S., Fluxa F., Vleggaar F.P., Akshintala V.S., Raju G.S., Khashab M.A. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc. 2014 Oct; 80 (4): 610–22. doi: 10.1016/j.gie.2014.03.049.
54. Beunis A., Pauli S., Van Cleemput M. Anastomotic leakage of a colorectal anastomosis treated by transanal endoscopic microsurgery. Acta Chir Belg. 2008 Jul-Aug; 108 (4): 474–6.
55. Akhmetzyanov F.Sh., Egorov V.I., Shaikhutdinov N.T., Akhmetzyanova F.F., Akhmetzyanova A.F. Drainage of the pelvic cavity through retroperitoneal space during operations on the pelvic organs. Russian Oncology Journal. 2015; 20 (5): 22–27. [in Russian]
56. Akhmetzyanov F.Sh., Shaikhutdinov N.T., Valiev N.A., Shemeunova Z.N., Egorov V.I. Aspiration drainage in the prevention of postoperative septic complications in rectum sphincter-sparing abdominoperitoneal resection. Kazan Medical Journal. 2015; 96 (6): 935–939. [in Russian]
57. Lindgren R., Hallböök O., Rutegård J., Sjödahl R., Matthiessen P. What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum. 2011 Jan; 54 (1): 41–7. doi: 10.1007/DCR.0b013e3181fd2948.
Review
For citations:
Akhmetzyanov F.Sh., Egorov V.I., Valeev A.I., Bukhalova V.A. MANAGEMENT OF COLORECTAL ANASTOMOTIC LEAK: IS IT POSSIBLE TO SAVE ANASTOMOSIS? Siberian journal of oncology. 2018;17(1):92-98. (In Russ.) https://doi.org/10.21294/1814-4861-2018-17-1-92-98
Views:
2370
Email this article 
