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Tailored treatment of anastomotic leak after rectal cancer surgery according to the presence of a diverting stoma

Annals of Surgical Treatment and Research 2020년 99권 3호 p.171 ~ 179
김창현, 이자람, 곽한덕, 이수영, 주재균, 김형록,
소속 상세정보
김창현 ( Kim Chang-Hyun ) - Chonnam National University Hwasun Hospital Department of Surgery
이자람 ( Lee Ja-Ram ) - Chonnam National University Hwasun Hospital Department of Surgery
곽한덕 ( Kwak Han-Deok ) - Chonnam National University Hospital Department of Surgery
이수영 ( Lee Soo-Young ) - Chonnam National University Hwasun Hospital Department of Surgery
주재균 ( Ju Jae-Kyun ) - Chonnam National University Hospital Department of Surgery
김형록 ( Kim Hyeong-Rok ) - Chonnam National University Hwasun Hospital Department of Surgery

Abstract


Purpose: A variety of clinical features of anastomotic leak occur during the surgical treatment of rectal cancer. However, little information regarding management of leakage is available and treatment guidelines have not been validated. The aim of this study was to evaluate the validity of currently proposed expert opinions on the management of anastomotic leak, after low anterior resection for rectal cancer.

Methods: A retrospective analysis was conducted for 1,786 patients who underwent sphincter-preserving surgery for rectal cancer between 2005 and 2015. Clinical outcomes including anastomotic leak-associated mortality and permanent stoma were analyzed.

Results: The overall incidence of anastomotic leak was 6.8% (122 of 1,786), including 6.1% (30 of 493 patients) with diverting stoma and 7.1% (92 of 1,293 patients) without diverting stoma (P = 0.505). A majority of patients without diversion were treated with diverting stoma (76 of 88 patients [86.4%]); 1 mortality (0.8%) was observed in this group. Treatments in the diversion group mainly included conservative treatment, local drainage, and/or transanal repair (26 of 30 patients [86.7%]). The anastomotic failure rates were 20.7% (19 of 92 patients) in the no diversion group and 53.3% (16 of 30 patients) in the diversion group. In the multivariate analysis, preoperative chemoradiotherapy (P < 0.001) and delayed diagnosis of anastomotic leak (P = 0.036) were independent risk factors for permanent stoma.

Conclusion: Management of anastomotic leak should be tailored to individual patients. When anastomotic leak occurred, preoperative chemoradiotherapy and delayed diagnosis seemed to be associated with permanent stoma.

키워드

Anastomotic leak; Colorectal surgery; Risk factors; Surgical stoma

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