Impact of anastomotic leakage on postoperative survival of patients with colorectal cancer: A meta-analysis using propensity score matching studies

Risk factors for postoperative anastomotic leakage in obstructive left colonic carcinoma

Anastomotic leakage (AL) is one of the most severe complications of colon carcinoma surgery. This study aims to investigate the related factors of AL and evaluate the independent risk factors in predicting AL after one-stage resection and primary anastomosis (RPA) for obstructive left colonic carcinoma (OLCC) patients. The demographic and clinical data, intra-operative indexes, pathologic characteristics, and ileocecal valve status shown on CT of the patients with OLCC who submitted to one-stage RPA were retrospectively analyzed. They were divided into AL group and no AL group. All indexes of the two groups were compared and the independent risk factors for AL were investigated. Receiver operating characteristic (ROC) curve analysis was used to explore the ability of the statistically significant parameters to predict AL. A total of 141 patients (AL group, 15; no AL group, 126) were enrolled. There were no statistical differences in these indexes between the two groups except for BMI (P = 0.001), ALB (P = 0.020), lymphatic metastasis (P = 0.027), and ileocecal valve status (P < 0.001). BMI, ALB, and ileocecal valve status shown on CT were the independent risk factors for AL. A BMI and ALB cutoff value of 22.2 kg/m2 and 27.9 g/L showed the area under the curve (AUC 0.765; 95% CI 0.686-0.832 and 0.684; 95% CI 0.601-0.760) in predicting AL, separately. Higher BMI, lower ALB, and incontinent ileocecal valve shown on preoperative CT may indicate an increased risk of postoperative AL after one-stage RPA for OLCC patients.

Mesenteric Artery Stenosis is a Risk Factor for Anastomotic Leakage in Colorectal Surgery

OBJECTIVE

Anastomotic leakage (AL) after colorectal surgery leads to substantial morbidity and mortality rates. Theoretically, compromised blood flow caused by mesenteric artery (MA) stenosis may create suboptimal healing conditions at the anastomotic site, increasing susceptibility to AL. The association between MA stenosis on pre-operative computed tomography (CT) scan and AL in patients undergoing colorectal surgery was investigated.

METHODS

A multicentre, retrospective, frequency matched, nested 1:5 case control study was conducted in the Netherlands. For each patient with AL, five controls without AL were recruited from the same database matched for age and body mass index. Pre-operative CT scans were assessed blindly to identify MA stenosis ≥ 50% as the primary outcome and atherosclerotic burden and vascular pathology as secondary outcomes.

RESULTS

One hundred and thirty patients with AL and 627 matched controls without AL were included. The prevalence of stenosis ≥ 50% in the superior mesenteric artery (SMA) was higher in patients with AL compared with controls (13.8% vs. 2.2%; p < .001). A stenosis ≥ 50% in the inferior mesenteric artery (IMA) was also more common in patients with AL (24.6% vs. 12.1%; p < .001). Multivariable regression analysis showed a 5.9 times higher risk (95% confidence interval [CI] 2.78 - 12.60; p < .001) of AL in patients with SMA stenosis and 2.1 times higher risk for patients with IMA stenosis (95% CI 1.11 - 3.63; p = .007). Stenosis ≥ 50% of the coeliac artery was not associated with AL.

CONCLUSION

The presence of SMA or IMA stenosis ≥ 50% on pre-operative CT scans is associated with a six and two times higher odds of AL, respectively, when corrected for known risk factors for AL. Whether preventive stent placement reduces the risk of AL still needs to be investigated.

A restrictive stoma policy after colorectal anastomosis in ovarian cancer based on ghost ileostomy use

BACKGROUND

The incidence of anastomotic leak after colorectal anastomosis in ovarian cancer has been reported to be much lower than that in colorectal cancer patients. Regarding the use of protective manoeuvres (diverting ileostomy) as suggested by clinical guidelines, the goal should be the implementation of a restrictive stoma policy for ovarian cancer patients, given the low rate of anastomotic leakage in this population.

MATERIAL AND METHODS

Patients who underwent cytoreduction surgery in a single centre (University Hospital La Fe, Valencia Spain) due to ovarian cancer between January 2010 and June 2023 were classified according to two groups: a non-restrictive stoma policy group (Group A) and a restrictive stoma policy group (Group B).

RESULTS

A total of 256 patients were included in the analysis (group A 52 % vs group B 48 %). The use of protective diverting ileostomy was lower in the restrictive stoma policy group (14 % vs 6.6 %), and the use of ghost ileostomy was 32 % vs 87 % in groups A and B, respectively (p < 0.00001). No differences were found in the anastomotic leak rate, which was 5.2 % in the non-restrictive group and 3.2 % in the restrictive stoma policy group (p = 0.54).

CONCLUSION

The use of a restrictive stoma policy based on the use of ghost ileostomy reduces the rate of diverting ileostomy in patients with ovarian cancer after colorectal resection and anastomosis. Furthermore, this policy is not associated with an increased rate of anastomotic leakage nor with an increased rate of morbi-mortality related to the leak.

Survival and cancer recurrence after short-course perioperative probiotics in a randomized trial

BACKGROUND & AIMS

The long-term impact of perioperative probiotics remains understudied while mounting evidence links microbiome and oncogenesis. Therefore, we analyzed overall survival and cancer recurrence among patients enrolled in a randomized trial of perioperative probiotics.

METHODS

6-year follow-up of surgical patients participating in a randomized trial evaluating short-course perioperative oral probiotic VSL#3 (n = 57) or placebo (n = 63).

RESULTS

Study groups did not differ in age, preoperative hemoglobin, ASA status, and Charlson comorbidity index. There was a significant difference in preoperative serum albumin (placebo group 4.0 ± 0.1 vs. 3.7 ± 0.1 g/dL in the probiotic group, p = 0.030). Thirty-seven deaths (30.8 %) have occurred during a median follow-up of 6.2 years. Overall survival stratified on preoperative serum albumin and surgical specialty was similar between groups (p = 0.691). Age (aHR = 1.081, p = 0.001), serum albumin (aHR = 0.162, p = 0.001), and surgical specialty (aHR = 0.304, p < 0.001) were the only predictors of overall survival in the multivariate model, while the placebo/probiotic group (aHR = 0.808, p = 0.726) was not predictive. The progression rate among cancer patients was similar in the probiotic group (30.3 %, 10/33) compared to the placebo group (21.2 %, 7/33; p = 0.398). The progression-free survival was not significantly different (unstratified p = 0.270, stratified p = 0.317).

CONCLUSIONS

Perioperative short-course use of VSL#3 probiotics does not influence overall or progression-free survival after complex surgery for visceral malignancy.

Left colic artery diameter is an important factor affecting anastomotic blood supply in sigmoid colon cancer or rectal cancer surgery: a pilot study

BACKGROUND

Anastomotic blood supply is vital to anastomotic healing. The aim of this study was to demonstrate the effect of the left colic artery (LCA) on blood supply in the anastomotic area, explore the relationship between individual differences in the LCA and blood supply in the anastomotic area, and elucidate the relevant indications for LCA retention during radical resection for sigmoid or rectal cancer.

METHOD

Radical sigmoid or rectal cancer resection with LCA retention was performed in 40 patients with colorectal cancer who participated in this study. Systemic pressure, LCA diameter, and the distance from the root of the LCA to the root of the inferior mesenteric artery were measured and recorded. The marginal artery stump pressure in the anastomotic colon before and after the LCA clamping was measured, respectively.

RESULTS

There is a significant difference between the marginal artery stump pressure before LCA ligation and after ligation (53.1 ± 12.38 vs 42.76 ± 12.71, p < 0.001). The anastomotic blood supply positively and linearly correlated with body mass index and systemic pressure. Receiver-operating curve analysis revealed that LCA diameter (area under the curve 0.971, cutoff 1.95 mm) was an effective predictor of LCA improving anastomosis blood supply. No relationship was found between the LCA root location and anastomotic blood supply.

CONCLUSION

Preserving the LCA is effective in improving blood supply in the anastomotic area, and larger LCA diameters result in a better blood supply to the anastomotic area.

The Effectiveness of Robot- vs. Virtual Reality-Based Gait Rehabilitation: A Propensity Score Matched Cohort

Robot assisted gait training (RAGT) and virtual reality plus treadmill training (VRTT) are two technologies that can support locomotion rehabilitation in children and adolescents affected by acquired brain injury (ABI). The literature provides evidence of their effectiveness in this population. However, a comparison between these methods is not available. This study aims at comparing the effectiveness of RAGT and VRTT for the gait rehabilitation of children and adolescents suffering from ABI. This is a prospective cohort study with propensity score matching. Between October 2016 and September 2018, all patients undergoing an intensive gait rehabilitation treatment based on RAGT or VRTT were prospectively observed. To minimize selection bias associated with the study design, patients who underwent RAGT or VRTT were retrospectively matched for age, gender, time elapsed from injury, level of impairment, and motor impairment using propensity score in a matching ratio of 1:1. Outcome measures were Gross Motor Function Mesure-88 (GMFM-88), six-min walking test (6MWT), Gillette Functional Assessment Questionnaire (FAQ), and three-dimensional gait analysis (GA). The FAQ and the GMFM-88 had a statistically significant increase in both groups while the 6MWT improved in the RAGT group only. GA highlighted changes at the proximal level in the RAGT group, and at the distal district in the VRTT group. Although preliminary, this work suggests that RAGT and VRTT protocols foster different motor improvements, thus recommending to couple the two therapies in the paediatric population with ABI.