Background The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied.Methods Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1).Results Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days).Conclusion Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.The optimal treatment strategy for anastomotic leakage after restorative rectal cancer surgery remains unknown. This large, international collaborative study investigated various outcomes after four predefined treatment strategies for anastomotic leakage. Substantial differences were observed in patient and leakage characteristics, as well as outcomes following the four treatment strategies. However, no statistically significant differences were reported in stoma-free survival rates between active (vacuum) drainage and passive drainage.

Nynke G, G., Kiedo, W., Sander, U., Kevin, T., Gerjon, H., Albert, W., F Borja, D. L., Jérémie H, L., Michael, S., Matteo, F., Nicolas, R., Quentin, D., Rodrigo O, P., Tsuyoshi, K., Yves, P., Martin, R., Roel, H., Camiel, R., Frans, V. W., Pieter J, T., Johannes H W, D. W., A Bremers, A. J., T Ferenschild, F., De Vriendt, S., D'Hoore, A., Bislenghi, G., Farguell, J., M Lacy, A., González Atienza, P., S Van Kessel, C., Parc, Y., Voron, T., K Collard, M., Sancho Muriel, J., Cholewa, H., A Mattioni, L., Frontali, A., W Polle, S., Polat, F., J Obihara, N., B Vailati, B., Kusters, M., B Tuynmann, J., A Hazen, S. J., J Grüter, A. A., Amano, T., Fujiwara, H., Salomon, M., Ruiz, H., Gonzalez, R., Estefanía, D., Avellaneda, N., Carrie, A., Santillan, M., A Pantoja Pachajoa, D., Parodi, M., Gielis, M., Binder, A., Gürtler, T., Riedl, P., Badiani, S., Berney, C., Morgan, M., Hollington, P., Da Silva, N., Nair, G., M Ho, Y., Lamparelli, M., Kapadia, R., M Kroon, H., N Dudi-Venkata, N., Liu, J., Sammour, T., Flamey, N., Pattyn, P., Chaoui, A., Vansteenbrugge, L., J Van Den Broek, N. E., Vanclooster, P., De Gheldere, C., Pletinckx, P., Defoort, B., Dewulf, M., Slavchev, M., Belev, N., Atanasov, B., Krastev, P., Sokolov, M., Maslyankov, S., Gribnev, P., Pavlov, V., Ivanov, T., Karamanliev, M., Filipov, E., Tonchev, P., Aigner, F., Mitteregger, M., Allmer, C., Seitinger, G., Colucci, N., Buchs, N., Ris, F., Toso, C., Gialamas, E., Vuagniaux, A., Chautems, R., Sauvain, M., Daester, S., Von Flüe, M., Guenin, M., Taha-Mehlitz, S., F Hess, G., Martínek, L., Skrovina, M., Machackova, M., Benčurik, V., Uluk, D., Pratschke, J., S Dittrich, L., Guel-Klein, S., Perez, D., Grass, J., Melling, N., Mueller, S., H Iversen, L., D Eriksen, J., Baatrup, G., Al-Najami, I., Bjørsum-Meyer, T., Teras, J., M Teras, R., A Monib, F., Eldin Abu Elnga Ahmed, N., Alkady, E., K Ali, A., Abd Elatti Khedr, G., Samir Abdelaal, A., M Bassyouni Ashoush, F., Ewedah, M., M Elshennawy, E., Hussein, M., Fernández-Martínez, D., J García-Flórez, L., Fernández-Hevia, M., Suárez-Sánchez, A., Del Hoyo Aretxabala, I., Losada Docampo, I., Gómez Zabala, J., Tejedor, P., T Morales Bernaldo De Quirós, J., Bodega Quiroga, I., Navarro-Sánchez, A., Soto Darias, I., López Fernández, C., De La Cruz Cuadrado, C., Sánchez-Guillén, L., López-Rodríguez-Arias, F., Soler-Silva, Á., Arroyo, A., C Bernal-Sprekelsen, J., Á Gómez-Abril, S., Gonzálvez, P., T Torres, M., Rubio Sánchez, T., Blanco Antona, F., E Sánchez Lara, J., A Alcázar Montero, J., Mendoza-Moreno, F., Díez-Alonso, M., Matías-García, B., Quiroga-Valcárcel, A., Colás-Ruiz, E., M Tasende-Presedo, M., Fernández-Hurtado, I., A Cifuentes-Ródenas, J., Castro Suárez, M., Losada, M., Hernández, M., Alonso, A., Diéguez, B., Serralta, D., E Medina Quintana, R., M Gil Lopez, J., Lima Pinto, F., Nieto-Moreno, E., Correa Bonito, A., Cerdán Santacruz, C., Bermejo Marcos, E., García Septiem, J., Calero-Lillo, A., Alanez-Saavedra, J., Muñoz-Collado, S., López-Lara, M., Labalde Martínez, M., Ferrero Herrero, E., Javier García Borda, F., García Villar, Ó., Escartín, J., L Blas, J., Ferrer, R., García Egea, J., Rodríguez-Infante, A., Mínguez-Ruiz, G., Carreño-Villarreal, G., Pire-Abaitua, G., Dziakova, J., Sáez-Cazallas Rodríguez, C., J Pizarro Aranda, M., M Muguerza Huguet, J., Borda-Arrizabalaga, N., M Enriquez-Navascués, J., Elorza Echaniz, G., Saralegui Ansorena, Y., Estaire-Gómez, M., Martínez-Pinedo, C., Barbero-Valenzuela, A., Ruíz-García, P., Kraft, M., J Gómez-Jurado, M., Pellino, G., Espín-Basany, E., Cotte, E., Panel, N., Goutard, C., Deángelis, N., Lauka, L., Shaikh, S., Osborne, L., Ramsay, G., Nichita, V., Bhandari, S., Sarmah, P., M Bethune, R., M Pringle, H. C., Massey, L., E Fowler, G., S Hamid, H. K., D De Simone, B., Kynaston, J., Bradley, N., M Stienstra, R., Gurjar, S., Mukherjee, T., Chandio, A., Ahmed, S., Singh, B., Runau, F., Chaudhri, S., Siaw, O., Sarveswaran, J., Miu, V., Ashmore, D., Darwich, H., Singh-Ranger, D., Singh, N., Shaban, M., Gareb, F., Petropolou, T., Polydorou, A., Dattani, M., Afzal, A., Bavikatte, A., Sebastian, B., Ward, N., Mishra, A., Manatakis, D., Agalianos Nikolaos Tasis, C., Antonopoulou, M., Karavokyros, I., Charalabopoulos, A., Schizas, D., Baili, E., Syllaios, A., Karydakis, L., Vailas, M., Balalis, D., Korkolis, D., Plastiras, A., Rompou, A., Xenaki, S., Xynos, E., Chrysos, E., Venianaki, M., Christodoulidis, G., Perivoliotis, K., Tzovaras, G., Baloyiannis, I., Ho, M., Siu-Man Ng, S., Wing-Chung Mak, T., Futaba, K., Šantak, G., Šimleša, D., Ćosić, J., Zukanović, G., E Kelly, M., O Larkin, J., H Mccormick, P., J Mehigan, B., M Connelly, T., Neary, P., Ryan, J., Mccullough, P., A Al-Juaifari, M., Hammoodi, H., Hashim Abbood, A., Calabrò, M., Muratore, A., La Terra, A., Farnesi, F., V Feo, C., Fabbri, N., Pesce, A., Fazzin, M., Roscio, F., Clerici, F., Lucchi, A., Vittori, L., Agostinelli, L., Cristina Ripoli, M., Sambucci, D., Porta, A., Sinibaldi, G., Crescentini, G., Larcinese, A., Picone, E., Persiani, R., Biondi, A., Pezzuto, R., Lorenzon, L., Rizzo, G., Coco, C., D'Agostino, L., Spinelli, A., M Sacchi, M., Carvello, M., Foppa, C., Spinelli, A., M Sacchi, M., Carvello, M., Foppa, C., Maroli, A., M Palini, G., Garulli, G., Zanini, N., Delrio, P., Rega, D., Carbone, F., Aversano, A., Pirozzolo, G., Recordare, A., D'Alimonte, L., Vignotto, C., Corbellini, C., M Sampietro, G., Lorusso, L., A Manzo, C., Ghignone, F., Ugolini, G., Montroni, I., Pasini, F., Pasini, F., Ballabio, M., Bisagni, P., T Armao, F., Longhi, M., Ghazouani, O., Galleano, R., Tamini, N., Oldani, M., Nespoli, L., Picciariello, A., F Altomare, D., Tomasicchio, G., Lantone, G., Catena, F., Giuffrida, M., Annicchiarico, A., Perrone, G., Grossi, U., A Santoro, G., Zanus Alessandro Iacomino, G., Novello, S., Passuello, N., Zucchella, M., Puca, L., Degiuli, M., Reddavid, R., Scabini, S., Aprile, A., Soriero, D., Fioravanti, E., Rottoli, M., Romano, A., Tanzanu, M., Belvedere, A., M Mariani, N., P Ceretti, A., Opocher, E., Gallo, G., Sammarco, G., De Paola, G., Pucciarelli, S., Marchegiani, F., Spolverato, G., Buzzi, G., Di Saverio, S., Meroni, P., Parise, C., I Bottazzoli, E., Lapolla, P., Brachini, G., Cirillo, B., Mingoli, A., Sica, G., Siragusa, L., Bellato, V., Cerbo, D., A De Pasqual, C., De Manzoni, G., A Di Cosmo, M., H Alrayes, B. 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S., Negoi, I., Ciubotaru, C., Stoica, B., Tanase, I., Stoica, B., Ciubotaru, C., M Negoita, V., Florea, S., Macau, F., Vasile, M., Stefanescu, V., Dimofte, G., Luncă, S., Roată, C., Mușină, A., Garmanova, T., N Agapov, M., G Markaryan, D., Eduard, G., Yanishev, A., Abelevich, A., Bazaev, A., V Rodimov, S., B Filimonov, V., A Melnikov, A., A Suchkov, I., S Drozdov, E., N Kostromitskiy, D., Sjöström, O., Matthiessen, P., Baban, B., Gadan, S., Dehlaghi Jadid, K., Staffan, M., M Park, J., Rydbeck, D., Lydrup, M., Buchwald, P., Jutesten, H., Darlin, L., Lindqvist, E., Nilsson, K., Larsson, P., Jangmalm, S., A Košir, J., Tomažič, A., Grosek, J., Košir Božič, T., Zazo, A., Zazo, R., Fares, H., Ayoub, K., Niazi, A., Mansour, A., Abbas, A., Tantoura, M., Hamdan, A., Hassan, N., Hasan, B., Saad, A., Sebai, A., Haddad, A., Maghrebi, H., Kacem, M., Yalkın, Ö., Veysi Samsa, M., Atak, I., Balci, B., Haberal, E., Dogan, L., E Gecim, I., Akyol, C., A Koc, M., Sivrikoz, E., Piyadeoğlu, D., O Larkin, J., O Avanagh, D., Sökmen, S., Bişgin, T., Günenç, E., Güzel, M., Leventoğlu, S., Yüksel, O., Kozan, R., Göbüt, H., Cengiz, F., Erdinc, K., Coşgun Acar, N., Kamer, E., Özgür, I., Aydın, O., Keskin, M., Türker Bulut, M., B Kulle, C., Kara, Y., Sıbıç, O., H Özata, I., Buğra, D., Balık, E., B Kulle, C., Çakır, M., Alhardan, A., Colak, E., B Ciftciengin Aybar, A., Can Sari, A., Demirli Atici, S., Kaya, T., Dursun, A., Calik, B., Faruk Özkan, Ö., Şeyda Ülgür, H., Düzgün, Ö., Monson, J., George, S., Woods, K., Al-Eryani, F., Albakry, R., Coetzee, E., Boutall, A., Herman, A., Warden, C., Mugla, N., Forgan, T., Mia, I., Lambrechts, A., Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients, <<BRITISH JOURNAL OF SURGERY>>, 2023; 110 (12): 1863-1876. [doi:10.1093/bjs/znad311] [https://hdl.handle.net/10807/297699]

Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Persiani, Roberto;Biondi, Alberto;Pezzuto, Roberto;Lorenzon, Laura;Rizzo, Gianluca;Coco, Claudio;
2023

Abstract

Background The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied.Methods Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1).Results Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days).Conclusion Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.The optimal treatment strategy for anastomotic leakage after restorative rectal cancer surgery remains unknown. This large, international collaborative study investigated various outcomes after four predefined treatment strategies for anastomotic leakage. Substantial differences were observed in patient and leakage characteristics, as well as outcomes following the four treatment strategies. However, no statistically significant differences were reported in stoma-free survival rates between active (vacuum) drainage and passive drainage.
2023
Inglese
Nynke G, G., Kiedo, W., Sander, U., Kevin, T., Gerjon, H., Albert, W., F Borja, D. L., Jérémie H, L., Michael, S., Matteo, F., Nicolas, R., Quentin, D., Rodrigo O, P., Tsuyoshi, K., Yves, P., Martin, R., Roel, H., Camiel, R., Frans, V. W., Pieter J, T., Johannes H W, D. W., A Bremers, A. J., T Ferenschild, F., De Vriendt, S., D'Hoore, A., Bislenghi, G., Farguell, J., M Lacy, A., González Atienza, P., S Van Kessel, C., Parc, Y., Voron, T., K Collard, M., Sancho Muriel, J., Cholewa, H., A Mattioni, L., Frontali, A., W Polle, S., Polat, F., J Obihara, N., B Vailati, B., Kusters, M., B Tuynmann, J., A Hazen, S. J., J Grüter, A. A., Amano, T., Fujiwara, H., Salomon, M., Ruiz, H., Gonzalez, R., Estefanía, D., Avellaneda, N., Carrie, A., Santillan, M., A Pantoja Pachajoa, D., Parodi, M., Gielis, M., Binder, A., Gürtler, T., Riedl, P., Badiani, S., Berney, C., Morgan, M., Hollington, P., Da Silva, N., Nair, G., M Ho, Y., Lamparelli, M., Kapadia, R., M Kroon, H., N Dudi-Venkata, N., Liu, J., Sammour, T., Flamey, N., Pattyn, P., Chaoui, A., Vansteenbrugge, L., J Van Den Broek, N. 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[doi:10.1093/bjs/znad311] [https://hdl.handle.net/10807/297699]
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