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Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities?
Region Örebro län.
Linköping University Hospital, Linköping, Sweden.
Umeå University Hospital, Umeå, Sweden.
Linköping University Hospital, Linköping, Sweden.
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2013 (Engelska)Ingår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 15, nr 3, s. 334-340Artikel i tidskrift (Refereegranskat) Published
Resurstyp
Text
Abstract [en]

Aim: The aim of the study was to compare patients with symptomatic anastomotic leakage following low anterior resection of the rectum (LAR) for cancer diagnosed during the initial hospital stay with those in whom leakage was diagnosed after hospital discharge.

Method: Forty-five patients undergoing LAR (n=234) entered into a randomized multicentre trial (NCT 00636948), who developed symptomatic anastomotic leakage, were identified. A comparison was made between patients diagnosed during the initial hospital stay on median postoperative day 8 (early leakage, EL; n=27) and patients diagnosed after hospital discharge at median postoperative day 22 (late leakage, LL; n=18). Patient characteristics, operative details, postoperative course and anatomical localization of the leakage were analysed.

Results: Leakage from the circular stapler line of an end-to-end anastomosis was more common in EL, while leakage from the stapler line of the efferent limb of the J-pouch or side-to-end anastomosis tended to be more frequent in LL (P=0.057). Intra-operative blood loss (P=0.006) and operation time (P=0.071) were increased in EL compared with LL. On postoperative day 5, EL performed worse than LL with regard to temperature (P=0.021), oral intake (P=0.006) and recovery of bowel activity (P=0.054). Anastomotic leakage was diagnosed most often by a rectal contrast study in EL and by CT scan in LL. The median initial hospital stay was 28days for EL and 10days for LL (P<0.001).

Conclusion: The present study has demonstrated that symptomatic anastomotic leakage can present before and after hospital discharge and raises the question of whether early and late leakage after LAR may be different entities.

Ort, förlag, år, upplaga, sidor
2013. Vol. 15, nr 3, s. 334-340
Nyckelord [en]
Symptomatic anastomotic leakage, early leakage, late leakage, low anterior resection of the rectum, postoperative course, hospital stay
Nationell ämneskategori
Kirurgi
Identifikatorer
URN: urn:nbn:se:oru:diva-50042DOI: 10.1111/j.1463-1318.2012.03195.xISI: 000315519300022PubMedID: 22889325Scopus ID: 2-s2.0-84874375872OAI: oai:DiVA.org:oru-50042DiVA, id: diva2:924818
Tillgänglig från: 2016-04-29 Skapad: 2016-04-29 Senast uppdaterad: 2017-11-30Bibliografiskt granskad
Ingår i avhandling
1. Defunctioning stoma in low anterior resection of the rectum for cancer: Aspects of stoma reversal, anastomotic leakage, anorectal function, and cost-effectiveness
Öppna denna publikation i ny flik eller fönster >>Defunctioning stoma in low anterior resection of the rectum for cancer: Aspects of stoma reversal, anastomotic leakage, anorectal function, and cost-effectiveness
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Rectal cancer is a common malignancy treated with surgical resection and curative intent in the majority of cases. One treatment option is low anterior resection (LAR) with preserved bowel continuity, often involving the formation of a temporary defunctioning stoma (DS).

The general aim of this thesis was to improve understanding of the role of DS in rectal cancer surgery with regard to timing of stoma reversal and development of anastomotic leakage (AL), impact on long-term anorectal function (AF), as well as aspects of cost-effectiveness.

Study I addressed the timing of stoma reversal following LAR. We found that 19% of reversed patients were reversed within 4 months of LAR, while 81% of reversals were delayed. In 58% of delayed reversals the delay was due to low priority on surgical waiting lists.

Studies II-IV were based on 234 patients randomized to receive a DS or no DS following LAR. Study II compared patients with AL following LAR diagnosed during the initial hospital stay (early leakage, EL) with patients diagnosed after hospital discharge (late leakage, LL). LL was more common in females, and originated more frequently from the transverse stapler line. EL was more common in males, and originated more frequently from the circular stapler line. Study III assessed AF 5 years after LAR with regard to whether patients initially had a DS or no DS. We found no difference in AF between the two randomized groups. When comparing with a 1-year follow-up in the same patient cohort, there were no further changes in AF over time. Study III assessed necessary healthcare resources and cost within 5 years of LAR, depending on whether patients initially had a DS or no DS. The overall cost analysis revealed a higher cost for patients randomized to DS, regardless of the cost-savings associated with a reduced frequency of anastomotic leakage.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro university, 2016. s. 56
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 143
Nyckelord
rectal cancer, low anterior resection, defunctioning stoma, stoma reversal, anastomotic leakage, anorectal function, costs, resources
Nationell ämneskategori
Kirurgi
Forskningsämne
Kirurgi
Identifikatorer
urn:nbn:se:oru:diva-49021 (URN)978-91-7529-139-0 (ISBN)
Disputation
2016-05-27, Universitetssjukhuset, Bomanssonsalen, Södra Grev Rosengatan, Örebro, 09:15 (Engelska)
Opponent
Handledare
Tillgänglig från: 2016-03-08 Skapad: 2016-03-08 Senast uppdaterad: 2017-10-17Bibliografiskt granskad

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