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

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

Greijdanus, Nynke G. (författare): Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands

Wienholts, Kiedo (författare): Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands

Ubels, Sander (författare): Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands

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Talboom, Kevin (författare): Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands

Hannink, Gerjon (författare): Department of Medical Imaging, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands

Wolthuis, Albert (författare): Department of Surgery, UZ Leuven, Leuven, Belgium

de Lacy, F Borja (författare): Gastrointestinal Surgery Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain

Lefevre, Jérémie H (författare): Department of Digestive Surgery, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France

Solomon, Michael (författare): Department of Surgery, University of Sydney Central Clinical School, Camperdown, NSW, Australia

Frasson, Matteo (författare): Department of Surgery, Valencia University Hospital La Fe, Valencia, Spain

Rotholtz, Nicolas (författare): Department of Surgery, Hospital Alemán, Buenos Aires, Argentina

Denost, Quentin (författare): Clinique Tivoli, Bordeaux, France

Perez, Rodrigo O. (författare): Colorectal Surgery, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil

Konishi, Tsuyoshi (författare): Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center, TX, Anderson, United States

Panis, Yves (författare): Colorectal Surgery Centre, Groupe Hospitalier Privé Ambroise Paré-Hartmann, Neuilly Seine, France

Rutegård, Martin, 1982- (författare): Umeå universitet,Institutionen för kirurgisk och perioperativ vetenskap,Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM)

Hompes, Roel (författare): Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands

Rosman, Camiel (författare): Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands

van Workum, Frans (författare): Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, Netherlands

Tanis, Pieter J. (författare): Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands; Cancer Centre Amsterdam, Treatment and Quality of Life, Amsterdam, Netherlands; Cancer Centre Amsterdam, Amsterdam, Netherlands; Erasmus Medical Centre, Department of Surgical Oncology and Gastrointestinal Surgery, Rotterdam, Netherlands

de Wilt, Johannes H W (författare): Department of Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Netherlands

Tsuyoshi, T (författare)

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Oxford University Press, 2023
2023
Engelska.
Ingår i: British Journal of Surgery. - : Oxford University Press. - 0007-1323 .- 1365-2168. ; 110:12, s. 1863-1876

Relaterad länk:: https://doi.org/10.1...; visa fler...; https://umu.diva-por... (primary) (Raw object); https://urn.kb.se/re...; https://doi.org/10.1...; http://kipublication...; http://kipublication...; visa färre...

Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

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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.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Nyckelord

Anastomosis
Surgical
Anastomotic Leak
Cohort Studies
Humans
Rectal Neoplasms
Rectum
Retrospective Studies

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

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Av lärosätet: Umeå universitet; Karolinska Institutet

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