Efficacy of endoluminal vacuum therapy in managing anastomotic leakage after neoadjuvant therapy in rectal cancer patients.

Abstract

Background: Anastomotic leakage is a significant complication following colorectal surgery, associated with increased morbidity and mortality. Endoluminal vacuum therapy (EVT) has emerged as a promising treatment option for managing such leaks, although stan-dardized guidelines are still lacking. This study aimed to evaluate the efficacy of EVT in managing anastomotic leakage after colorectal surgery, focusing on outcomes and contributing factors.

Methods: A retrospective analysis was conducted on 25 patients who underwent EVT for anastomotic leakage between 2018 and 2022 at our institution. Data collected included patient demographics, surgical details, timing of EVT initiation, number of EVT sessions, complications, and outcomes such as leak closure and subsequent surgical interventions. Statistical analyses were performed using Python packages.

Results: The study cohort had a mean age of 56.84 years, with 68% being male. All patients received neoadjuvant therapy followed by low anterior resection and diverting ileostomy; 80% underwent open surgery. EVT was initiated for postoperative anastomotic leak-age, with a mean hospital stay of 14.16 days and an average initiation time of 16.16 days post-surgery. Ileostomy closure was performed in 14 patients after endosponge therapy. The overall EVT success rate was 68%, with a mean follow-up period of 30.7 months for those who underwent ileostomy closure. No significant relationship was found between patients' age and the time to first EVT after anastomotic leakage (p=0.52). However, a significant association was observed between the timing of the first EVT and the duration of EVT termination (p=0.0003).

Conclusion: EVT is a viable option for managing anastomotic leakage following colorectal surgery, demonstrating high closure rates and low associated morbidity. Early initiation of EVT appears to be crucial for optimizing treatment outcomes. Further pro-spective studies are needed to establish standardized protocols and confirm the long-term benefits of EVT in this challenging clinical context.