| 1. |
- Jutesten, Henrik, et al.
(author)
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High Risk of Low Anterior Resection Syndrome in Long-term Follow-up After Anastomotic Leakage in Anterior Resection for Rectal Cancer
- 2022
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In: Diseases of the Colon and Rectum. - : Lippincott Williams & Wilkins. - 0012-3706 .- 1530-0358. ; 65:10, s. 1264-1273
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Journal article (peer-reviewed)abstract
- BACKGROUND: Low anterior resection syndrome is common after sphincter-sparing surgery, but it is unclear to what extent anastomotic leakage after anterior resection contributes to this condition. OBJECTIVE: The aim of this study is to assess the long-term effect of anastomotic leakage on the occurrence of major low anterior resection syndrome. DESIGN: This is a retrospective observational cohort study evaluating low anterior resection syndrome 4 to 11 years after index surgery. After propensity score-matching using the covariates sex, age, tumor stage, comorbidity, neoadjuvant treatment, extent of mesorectal excision, and defunctioning stoma at index surgery, the effect of anastomotic leakage on low anterior resection syndrome was investigated using relative risk and 95% CI. SETTINGS: This multicenter study included patients from 15 Swedish hospitals between 2007 and 2013. PATIENTS: Patients who underwent anterior resection for rectal cancer were included. MAIN OUTCOME MEASURES: Outcome measures included patient-reported major low anterior resection syndrome, obtained via a postal questionnaire that included a question on stoma status. RESULTS: Among 1099 patients, 653 (59.4%) responded in at a median of 83.5 (interquartile range 66 to 110) months postoperatively. After excluding patients with residual stoma or incomplete responses, 544 remained; of these, 42 had anastomotic leakage. Patients with anastomotic leakage were more likely to have major low anterior resection syndrome (66.7% [28/42]) than patients without leakage (45.8% [230/502]). After matching, anastomotic leakage was significantly related to major low anterior resection syndrome (relative risk 2.3; 95% CI 1.4-3.9) and the individual symptom of urgency (relative risk 2.1; 95% CI 1.1-4.1). LIMITATIONS: This study was limited by its retrospective observational study design. CONCLUSIONS: In long-term follow-up, major low anterior resection syndrome is common after anterior resection for rectal cancer. Anastomotic leakage appears to increase the risk of major low anterior resection syndrome, with urgency as a major contributing symptom. See Video Abstract at http://links.lww.com/DCR/B868.
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| 2. |
- Jutesten, Henrik
(author)
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On long-term outcome of anastomotic leakage after anterior resection for rectal cancer
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Background: Anterior resection has the benefit of enabling bowel continuity, but suffer from a common complication in anastomotic leakage.There is a paucity in previous research of long-term implications of anastomotic leakage after anterior resection.Aims: To gain general knowledge of the morbidity related to anastomotic leakage after anterior resection for rectal cancer, specific aims were:I.To investigate late detected anastomotic leakage after anterior resection regarding incidence, and evaluate its clinical features and clinical variables associated to late detected anastomotic leakage.II.To evaluate how often bowel continuity is restored in long-term follow-up after anastomotic leakage in anterior resection and clinical factors related to a permanent stoma.III.To explore rectal contrast studies of patients with anastomotic leakage for predicitve features related to an outcome of permanent stoma.IV.To evaluate the effect of anastomotic leakage after anterior resection on long-term bowel dysfunctionV.To evaluate the effect of anastomotic leakage after anterior resection on Quality of Life, as well as to evaluate the effect of maintained bowel continuity in anastomotic leakage patients on Quality of Life.Methods: Paper I-III, a retrospective cohort of patients subjected to anterior resection in the Southern healthcare region of Sweden was used to identify patients with anastomotic leakage according to a study protocol definition. This group of anastomotic leakage patients was investigated with respect to late leakage, permanent stoma in long-term follow-up and radiological features associated with an outcome of permanent stoma. In paper IV and V a retrospective cohort of patients subjected to anterior resection in the Southern, Western and Northern healthcare regions of Sweden 2007-2013 was used, the effect of anastomotic leakage on bowel dysfunction and Quality of Life was investigated using propensity score matching models.Results and conclusions: Anastomotic leakage after anterior resection is associated with signifcant long-term morbidity. Late detected anastomotic leakage after anterior resection is common and related to use of a defunctioning stoma at anterior resection. Two-thirds of all patients with anastomotic leakage after anterior resection end up with a permanent stoma in long-term follow-up, wheras in patients with bowel continuity there is a doubled risk of severe bowel dysfunction. However, no superiority in Quality of Life related to outcome in bowel continuity could be demonstrated.
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| 3. |
- Jutesten, Henrik, et al.
(author)
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Radiological findings in anastomotic leakage after anterior resection may predict a permanent stoma
- 2020
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In: Acta Radiologica Open. - : SAGE Publications. - 2058-4601. ; 9:1
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Journal article (peer-reviewed)abstract
- Background: Permanent stoma (PS) is common following treatment of anastomotic leakage (AL) after anterior resection (AR) and ways of predicting successful treatment outcome are missing.Purpose: To explore radiological variables in rectal contrast studies in their relation to end-result of PS following treatment for AL after AR.Material and Methods: The Swedish Cancer Registry (SCRCR) was explored for AL cases after AR for rectal cancer in patients operated in the region of Skåne from 1 January 2001 to 31 December 2011. Among identified AL cases, patients subjected to radiological imaging consistent with AL were evaluated according to a predetermined set of radiological variables. Information of PS as the end-result after AL treatment were retrieved from medical records.Results: Thirty-two patients had radiological imaging available for analysis confirming AL after AR; PS rate after a median follow-up of 87 months (range = 21-165) after AR was 62%. Radiological findings compatible with abscess (P = 0.023) and a leak size ≤6 mm (P = 0.049) were significantly associated with PS.Conclusion: In this limited explorative study, our findings suggest that abscess status and leak size could correspond to outcome of PS in treatment for AL after AR. Additional studies are warranted to further explore this subject.
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| 4. |
- Kverneng Hultberg, Daniel, et al.
(author)
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The Impact of Anastomotic Leakage on Long-Term Function after Anterior Resection for Rectal Cancer
- 2020
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In: Diseases of the Colon & Rectum. - : American Society of Colon & Rectal Surgeons. - 0012-3706 .- 1530-0358. ; 63:5, s. 619-628
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Journal article (peer-reviewed)abstract
- Background: It is still not clear whether anastomotic leakage after anterior resection for rectal cancer affects long-term functional outcome.Objective: To evaluate how anastomotic leakage following anterior resection for rectal cancer influences defecatory, urinary and sexual function.Design: In this retrospective population-based cohort study, patients were identified through the Swedish Colorectal Cancer Registry, which was also used for information on the exposure variable anastomotic leakage, and covariates.Settings: A nationwide register was used for including patients.Patients: All patients undergoing anterior resection for rectal cancer in Sweden from April 2011– June 2013 were included.Main Outcome Measures: Outcome was any defecatory, sexual or urinary dysfunction, assessed two years after surgery by a postal questionnaire. The association between anastomotic leakage and function was assessed in multivariable logistic and linear regression models, with adjustment for confounding.Results: Response rate was 82%, resulting in 1180 included patients. Anastomotic leakage occurred in 7.5%. A permanent stoma was more common among leak patients (44% vs. 9%; p<0.001). Leakage patients had an increased risk of aid use for fecal incontinence (OR 2.27; 95% CI 1.20-4.30) and reduced sexual activity (90% vs. 82%; p=0.003), while the risk of urinary incontinence was decreased (OR 0.53; 95% CI 0.31-0.90). A sensitivity analysis assuming that a permanent stoma was created due to anorectal dysfunction strengthened the negative impact of leakage on defecatory dysfunction.Limitations: Limitations include the used questionnaire not having been previously validated, underreporting of anastomotic leakage in the register, and small patient numbers in the analysis of sexual symptoms.Conclusions:a Anastomotic leakage was found to statistically significantly increase the risk of aid use due to fecal incontinence and reduced sexual activity, though the impact on defecatory dysfunction might be underestimated, as permanent stomas are sometimes fashioned due to anorectal dysfunction. Further research is warranted, especially regarding urogenital function.
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| 5. |
- Munshi, Eihab, et al.
(author)
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Long-term Outcomes of Endoscopic Vacuum Therapy and Transanal Drainage for Anastomotic Leakage After Anterior Resection
- 2022
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In: In Vivo. - : Anticancer Research USA Inc.. - 0258-851X .- 1791-7549. ; 36:5, s. 2275-2278
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Journal article (peer-reviewed)abstract
- Background/Aim: Anastomotic leakage (AL) after anterior resection for rectal cancer occurs in up to 26% of patients. In the last decade, endoscopic vacuum therapy (EVT) has gained interest as a treatment option for AL. This study aimed to compare the clinical success rate of EVT versus transanal drainage (TD) in AL treatment and investigate whether the frequency of bowel continuity differed. Patients and Methods: Patients treated for rectal cancer at the Skåne University Hospital, Sweden between 2009-2018 were identified through the Swedish Colorectal Cancer Registry (SCRCR). Patient characteristics, operative and AL data were retrieved by SCRCR and chart review. Results: Out of 1,095 patients subjected to rectal cancer surgery, 361 patients had undergone anterior resection. AL occurred in 39 patients, of these 14 patients were treated with EVT and 17 with TD. Bowel continuity was achieved in 50% of patients treated with EVT and 65% of patients treated with TD (p=0.28). The patients were under treatment for a median period of 24.5 days (IQR=11-36 days) when treated with EVT and 37 days (IQR=17-51 days) with TD. Conclusion: No superiority of EVT treatment could be shown in restoring bowel continuity. This questions the role of EVT in AL treatment after anterior resection.
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| 6. |
- Rutegård, Martin, 1982-, et al.
(author)
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Minor impact of anastomotic leakage in anterior resection for rectal cancer on long-term male urinary and sexual function
- 2024
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In: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 39:1
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Journal article (peer-reviewed)abstract
- PURPOSE: Anastomotic leakage after anterior resection for rectal cancer induces bowel dysfunction, but the influence on urinary and sexual function is largely unknown. This cross-sectional cohort study evaluated long-term effect of anastomotic leakage on urinary and sexual function in male patients.METHODS: Patients operated with anterior resection for rectal cancer in 15 Swedish hospitals 2007-2013 were identified. Anastomotic leakage and other clinical variables were retrieved from the Swedish Colorectal Cancer Registry and medical records. Urinary and sexual dysfunction were evaluated at 4 to 11 years after surgery using the International Prostate Symptom Score, International Index of Erectile Function, and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire CR29. The effect of anastomotic leakage on average scores of urinary and sexual dysfunction was evaluated as a primary outcome, and the single items permanent urinary catheter and sexual inactivity as secondary outcomes. The association of anastomotic leakage and functional outcomes was analyzed using regression models with adjustment for confounders.RESULTS: After a median follow-up of 84 months (interquartile range: 67-110), 379 out of 864 eligible men were included. Fifty-nine (16%) patients had anastomotic leakage. Urinary incontinence was more common in the leakage group, with an adjusted mean score difference measured by EORTC QLQ ColoRectal-29 of 8.69 (95% confidence interval: 0.72-16.67). The higher risks of urinary frequency, permanent urinary catheter, and sexual inactivity did not reach significance.CONCLUSION: Anastomotic leakage after anterior resection had a minor negative impact on urinary and sexual function in men.
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| 7. |
- Valdimarsson, Valentinus, et al.
(author)
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Diverting ostomy prior to neoadjuvant treatment in rectal cancer should be used selectively : A retrospective single-center cohort study
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In: Scandinavian Journal of Surgery. - 1799-7267.
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Journal article (peer-reviewed)abstract
- Background:Rectal cancer patients commonly benefit from neoadjuvant therapy before resection surgery. For these patients, an elective ostomy diversion is frequently considered, despite the absence of conclusive evidence when a diversion is advantageous. This is a retrospective observational single-center study on a 4-year consecutive rectal cancer cohort undergoing neoadjuvant therapy, aiming at improving the understanding of risks and benefits associated with ostomy diversion.Material and Method:Baseline characteristics, tumor-specific data, clinical events, and outcomes were collected using the Swedish Colorectal Cancer Registry and medical records.Results:Thirty-two (30.2%) of the 106 included patients presented with endoscopic impassable tumors at diagnosis, of which 18 (56.2%) had diverting ostomy. Three out of 14 with impassable tumor and no diversion developed a bowel obstruction. None of the patients with an endoscopically passable tumor at diagnosis (n = 74) experienced a bowel obstruction. The elective diversions (n = 40) were not associated with serious complications (Clavien–Dindo grade ⩾ 3b). Patients with a diverting ostomy (n = 30) had similar time intervals from diagnosis to neoadjuvant treatment and to definite tumor resection as those without diversion but experienced more complex primary tumor resections in terms of blood loss and operation time.Conclusion:An elective diverting ostomy is a relatively safe procedure in rectal cancer patients requiring neoadjuvant therapy. More than one out of five non-diverted patients with endoscopically impassable rectal tumors developed bowel obstruction and would potentially have benefited from an elective diversion.
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