ObjectiveTo investigate the association between the preoperative nutritional risk and anastomotic leakage following anterior resection for the rectal cancer.
MethodsA total of 321 patients with rectal cancer underwent anterior resection in our hospital between January 2008 and December 2013 were retrospectively analyzed. Preoperative nutritional status was evaluated using NRS 2002. Correlation of clinicopathologic characteristics with postoperative anastomotic leakage was evaluated using single factor analysis and Logistic regression model.
ResultsAmong the 321 patients, the incidence of postoperative anastomotic leakage was 5.6% (18/321). Single factor analysis showed that the NRS2002 score≥3, clinicalpathologic stage (Ⅲ-Ⅳstage) and distance of tumor from the anal verge were the risk factors of anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Logistic regression analysis revealed that the NRS2002 score (OR=4.125, 95% CI=2.062-7.004), clinicalpathologic stage (OR=3.334, 95% CI=2.062-7.004) and the distance of tumor from the anal verge (OR=2.341, 95% CI=2.559-15.838) were the independent risk factors for anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Conciusions Preoperative NRS2002 score is helpful to predict the risk of anastomotic leakage after anterior resection of rectal cancer. Nutrition education should be strengthened to decrease the morbidity of the anastomotic leakage following anterior resection for the patients who's NRS2002 score≥3.
Objective To investigate the application of air leak test combined with methylene blue solution leak test in the detection of anastomotic leakage after total mesorectal excision （TME） in rectal cancer. Methods In total of132 patients with rectal cancer underwent Dixon according to TME in our hospital from Mar. 2010 to Mar. 2013 were enrolled. All patients were randomly divided into air leak test group （n=65） and air leak＋methylene blue solution leak test group （n=67）. The intestinal anastomosis of patients in air leak test group were clamped at 2 cm from the upper endof bowel， then injecting 500 mL distilled water to pelvic， and placing 24# Foley catheter through the anus. The catheter balloon was injected with water to close anus， and then injected with 50 mL gas to find the anastomotic leakage where bubbles happened， and then repaired it. Patients of air leak＋methylene blue solution leak test group were treated with methylene blue solution test in addition. After sucking out of the distilled water in pelvic and gas in the rectum， 1 bottle of methylene blue solution （20 mg） and 50 mL saline were injected， observing the location where the methylene blue solutionleaking out and repaired it. Results Three cases （4.62%） of anastomotic leakage were found during operation in air leak test group， and 9 cases （13.85%） were found after operation. Of the 9 cases， 5 cases were cured with placement of adeq-uate drainage and symptomatic treatment， 3 cases were cured with anal patch， and 1 case was cured with transverse colon fistula and drainage. In total of 15 cases （22.39%） were found anastomotic leakage， 2 cases of them were found by air leak test and another 13 cases were found by methylene blue solution leak test during operation in air leak＋methylene bluesolution leak test group， but no one suffered anastomotic leakage after operation. Compared with air test group， detectionrate of anastomotic leakage during operation was higher （P＜0.05）， and incidence rate of anastomotic leakage after opera-tion was lower in air leak＋methylene blue solution leak test group （P＜0.05）. Conclusions Large anastomotic leakage can be found by using air leak test， and small and hidden leakage can be found by using methylene blue solution leak test， combination method of the two experiments is better. Repair can be performed effectively under direct vision.
Objective To assess the effectiveness and safety of hand-suture vs. stapling anastomosis in esophagogastrostomy. Methods The following databases such as CBM (1978 to February 2012), VIP (1989 to February 2012), CNKI (1994 to February 2012), WanFang Data (1980 to February 2012), The Cochrane Library, PubMed (1966 to February 2012), EMbase (1974 to February 2012), and relevant webs of clinical trials were searched to collect the randomized controlled trials (RCTs) and quasi-RCTs about hand-suture vs. stapling anastomosis in the incidence of anastomotic leakage following esophagogastrostomy. Moreover, relevant references and grey literature were retrieved on web engines including Google Scholar and Medical Martix, and the Chinese periodicals e.g. Chinese Journal of Oncology were also handsearched. According to the inclusion and exclusion criteria, the literature, was screened, the data were extracted, and the quality of the included studies was assessed. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 9 RCTs involving 2 202 patients were included. The result of meta-analysis was as follows: the incidence of anastomotic leakage in the stapling anastomosis group was lower than that in the hand-suture anastomosis group (OR=0.43, 95%CI 0.26 to 0.71, Plt;0.01). Conclusion Stapling anastomosis is superior to hand-suture anastomosis in reducing the incidence of anastomotic leakage following esophagogastrostomy. For the limited quality and quantity of the included studies, this conclusion has to be further proved by more high-quality studies.
Objective To investigate the measures to prevent the anastomotic leakage following anterior resection of rectum. Methods A series of seventy-four patients with rectal cancer undergoing anterior resection from January 1991 to October 1998 were analyzed.Results The clinical anastomotic leakage rate was 4.05 per cent (3/74). The causes of leakage were presacral infection and insufficiency of blood supply in incisional margin. Conclusion The proximal colon must be completely mobilized and blood supply of incisional margin should be sufficient. Persistent postoperative presacral suction must be performed to protect fluid accumulation resulting in infection. Intracolonic drainage is an important factor in prevention of anastomotic leakage. Temporary stoma is not necessary.
ObjectiveTo analyze the common reasons of anastomotic leakage following sphincter preservation for rectal cancer, and to explore the better prevention and treatment strategies.
MethodThe related literatures of the definition, common causes, and prevention and treatment status of anastomotic leakage were reviewed.
ResultsCurrently rectal cancer was one of common malignant tumors, including about 2/3 low rectal cancer.Recently, sphincter preserving surgery had become the preferred surgical procedure.However, the incidence of anastomotic leakage keeping in higher was still the most serious and common complications.Through improving the general condition of the patients, improving surgical techniques, and standardized treatment could effectively reduce the incidence of anastomotic leakage.
ConclusionReasonable preoperative assessment for the basic situation of patients with rectal cancer, standardized and individualized treatments, contribute to reduce incidence of anastomotic leakage and improve clinical outcomes in patients with low rectal cancer.
Objective To explore an effective and minimal invasive drainage procedure for intrathoracic anastomotic leakage after esophagectomy.
Method A total of 14 patients (10 males and 4 females, aged 48 to 70 years) with encapsulated effusion due to thoracic anastomotic leakage after esophagectomy were performed accurate thoracic drainage which was guided by ultrasonography in Renji Hospital from January 2012 through December 2014. The J shape flexible catheter was placed into the effusion cavity near the leakage. Gasric drainage and enteral nutrition support were conducted as well.
Result All the patients with leakage healed smoothly. The hospital stay was 27 to 94 days. Time of drainage was 17 to 89 days. The drainage volume was 5-260 ml per day. No complication related to drainage occurred.
Conclusion Placing the J shape flexible catheter for plural drainage guided by ultrasonography or chest CT scan is a desirable and less injured therapy for intrathoracic leakage after esophagectomy.
Objective To evaluate the role of curved-cutter-stapler in anus-preserving for low rectal cancer. Methods The clinical data of 32 patients with low rectal cancer from June 2007 to December 2008 who received low anterior resection and ultra low anterior resection by using curved-cutter-stapler were reviewed retrospectively. Results No operation death case, complete cutting and safe closure in all cases, one case was complicated with anastomotic leakage, and one case of rectovaginal fistula. Thirty patients were followed up 4 to 22 months after the operation, with an average time of 12.6 months, no hemorrhea of pelvic cavity and anastomotic stoma or anastomotic stenosis cases. Conclusion Curved-cutter-stapler has the advantages of complete cutting, safe closure and low complications, and easy being used in anus-preserving operation for low rectal cancer, which can increase the rate of anus-preserving.
ObjectiveTo evaluate clinical value of colon leakage score (CLS), a preoperative predictive scoring system, for risk of anastomotic leakage after left-sided colorectal cancer surgery.
MethodsThe clinical data of 310 patients who underwent left-sided colorectal cancer surgery from January 2010 to December 2014 were studied retrospectively. Risk factors for postoperative anastomotic leakage were analyzed by univariate analysis. The sensitivity and specificity of CLS system were determined by receiver operating characteristic (ROC) curve analysis.
Resultsa total of 14 patients were diagnosed as anastomotic leakage. The point of CLS for the patients with anastomotic leakage was significantly higher than that for the patients without anastomotic leakage (14.21±5.76 versus 4.43±3.36, t=9.474, P=0.000). The results of ROC curve analysis showed that the sensitivity and specificity of the CLS system were 92.9% and 88.6%, respectively. The area under the curve was 0.957 (95% CI 0.924-0.991). The best cut off value of CLS was 10 (The Youden index was 0.867). The results of univariate analysis showed that the age, preoperative hemoglobin level, status of intestinal obstruction, and blood loss were associated with postoperative anastomotic leakage (P<0.05).
ConclusionThe preoperative predictive score system CLS could accurately predict occurrence of anastomotic leakage. While large, multicenter prospective randomized controlled trial is still needed to further confirm it.
ObjectiveTo explore the superiority of pleural tenting in Ivor-Lewis esophagogastrectomy.
MethodsWe prospectively included 200 esophagus cancer patients with Ivor-Lewis esophagogastrectomy in our hospital between 2013 and 2015 year. The patients were allocated into two groups including a trial group and a control group with 100 patients in each group. There were 72 males and 28 females at an average age of 54.76±6.62 years in the trial group and 66 males and 34 females at an average age of 55.72±6.38 years in the control group. In the trial group pleural tenting was used to cover the anastomotic stoma and gastric tube, while in the control group pleural tenting was not used. Postoperative complications after one year, pressure on the level of the anastomotic stoma, and the grade of quality of life were compared between the two groups.
ResultNo statistically significant differences were found in preoperative epidemiological and postoperative pathological characteristics, as well as the postoperative complications and the one-year survival rate (P > 0.05). Quality of life was better in the trial group than that of the control group.
ConclusionPleural tenting is a simple, safe, and effective technique for improving quality of life of the patients.
【Abstract】ObjectiveTo study the positive effect of recombinant human epidermal growth factor (rhEGF) on rabbit intestinal anastomotic wound healing after bowel resection. MethodsFortyeight white rabbits were randomly divided into study group in which rhEGF was injected and spinged in the submucosa and mucosa respectively during intestinal anastomosis after bowel resection, and control group in which only intestinal resection and anastomosis was performed. The leukocyte was counted. The incidence of anastomotic leakage and the synthesis of collagen fibrils and hydroxyproline were observed. ResultsThe leukocyte numbers in the anastomotic tissue in two groups rabbits increased slightly 3 d, 5 d and 7d after intestinal anastomosis, but the difference between study group and control group was insignificant (Pgt;0.05). The incidence of anastomotic leakage in the control group (16.7%) was higher than that of the study group (4.3%). The area of collagen fibrils 3 d, 5 d and 7d after intestinal anastomosis in the study group were significantly more than that in the control group (P＜0.05). Number of fibroblast was higher in the study group and the cells appeared bigger nucleus and dense colouration as well as enriched plasm. Angiogenesis in anastomosis tissue in the study group was significant and normal structure was present. Cell structure of anastomosis mucosa was damaged in the control group. Synthesis of hydroxyproline in anastomotic tissue 5 d and 7 d after anastomosis in the study group was more than that in the control group (P＜0.05).ConclusionInflammation was present in the whole process of wound healing, and local using of EGF had insignificant effect on system inflammation. EGF functions as chemoattractant and increases the recruitment of leukocytes, monocytes and fibroblasts into the wound area. EGF increases the production of collagen, angiogenesis and the synthesis of hydroxyproline. So EGF could promote wound healing and protect from anastomosis leakage in this study.
