Mucosal blood flow in the remaining rectal stump is more affected by total than partial mesorectal excision in patients undergoing anterior resection: a key to understanding differing rates of anastomotic leakage?

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Mucosal blood flow in the remaining rectal stump is more affected by total than partial mesorectal excision in patients undergoing anterior resection : a key to understanding differing rates of anastomotic leakage?

Back, Erik (författare): Umeå universitet,Kirurgi

Brännström, Fredrik (författare): Umeå universitet,Kirurgi,Department of Surgery, Södertälje Hospital, Södertälje, Sweden

Svensson, Johan, 1978- (författare): Umeå universitet,Kirurgi,Statistik

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Rutegård, Jörgen, 1948- (författare): Umeå universitet,Kirurgi

Matthiessen, Peter, 1957- (författare): Örebro universitet,Institutionen för medicinska vetenskaper

Haapamäki, Markku M (författare): Umeå universitet,Kirurgi

Rutegård, Martin, 1982- (författare): Umeå universitet,Kirurgi,Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM)

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2021-05-18
2021
Engelska.
Ingår i: Langenbeck's archives of surgery (Print). - : Springer. - 1435-2443 .- 1435-2451. ; 406:6, s. 1971-1977

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

Tidskriftsartikel (refereegranskat)

Abstract Ämnesord

Stäng

PURPOSE: Anterior resection is the procedure of choice for tumours in the mid and upper rectum. Depending on tumour height, a total mesorectal excision (TME) or partial mesorectal excision (PME) can be performed. Low anastomoses in particular have a high risk of developing anastomotic leakage, which might be explained by blood perfusion compromise. A pilot study indicated a worse blood flow in TME patients in an open setting. The aim of this study was to further evaluate perianastomotic blood perfusion changes in relation to TME and PME in a predominantly laparoscopic context.METHOD: In this prospective cohort study, laser Doppler flowmetry was used to evaluate the perianastomotic colonic and rectal perfusion before and after surgery. The two surgical techniques were compared in terms of mean differences of perfusion units using a repeated measures ANOVA design, which also enabled interaction analyses between type of mesorectal excision and location of measurement. Anastomotic leakage until 90 days after surgery was reported for descriptive purposes.RESULTS: Some 28 patients were available for analysis: 17 TME and 11 PME patients. TME patients had a reduced blood perfusion postoperatively compared to PME patients in the aboral posterior area (mean difference: -57 vs 18 perfusion units; p = 0.010). An interaction between mesorectal excision type and anterior/posterior location was detected at the aboral level (p = 0.007). Two patients developed a minor leakage, diagnosed after discharge.CONCLUSION: Patients operated on using TME have a decreased blood flow in the aboral posterior quadrant of the rectum postoperatively compared to patients operated on using PME. This might explain differing rates of anastomotic leakage.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02401100.

Ämnesord

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

Nyckelord

Flowmetry
Laser Doppler
PME
Perfusion
Rectal cancer
TME

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Av författaren/redakt...: Back, Erik; Brännström, Fred ...; Svensson, Johan, ...; Rutegård, Jörgen ...; Matthiessen, Pet ...; Haapamäki, Markk ...; visa fler...; Rutegård, Martin ...; visa färre...

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

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Av lärosätet: Örebro universitet; Umeå universitet

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