Late anastomotic complication after laparoscopic surgery for clinical stage I low rectal cancers located within 5 cm of the anal verge: Sub-analysis of the ultimate trial

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Manabu Shimomura, Masanori Yoshimitsu, Yuichiro Tsukada, Hideki Ohdan, Jun Watanabe, Yosuke Fukunaga, Yasumitsu Hirano, Kazuhiro Sakamoto, Hiroki Hamamoto, Hisanaga Horie, Nobuhisa Matsuhashi, Yoshiaki Kuriu, Shuntaro Nagai, Madoka Hamada, Shinichi Yoshioka, Shinobu Ohnuma, Tamuro Hayama, Koki Otsuka, Yusuke Inoue, Kazuki Ueda, Yuji Toiyama, Satoshi Maruyama, Shigeki Yamaguchi, Keitaro Tanaka, Motoko Suzuki, Toshihiro Misumi, Takeshi Naitoh, Masahiko Watanabe, Masaaki Ito, Ultimate Trial Group
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Abstract

Background

Although extensive research has been conducted on early anastomotic leakage (AL) after sphincter-sparing surgery, the status of late anastomotic complications (post-30 days) has received limited attention. These late complications significantly affect a patient's quality of life and often lead to permanent stoma creation.

Methods

This study conducted a sub-analysis of a phase II trial assessing the outcomes of laparoscopic surgery for cStage I lower rectal adenocarcinoma (the ultimate trial). This study included 278 patients who underwent intestinal anastomosis and investigated the frequency, timing, and risk factors of late anastomotic complications (stenosis, fistula, and intestinal prolapse).

Results

Anastomotic stenosis occurred in 27 patients (9.7%), and the median time of occurrence was 274 days (range, 70–1226 days). Only early AL (p = 0.004) was identified as an independent risk factor. A late anastomotic fistula was observed in five patients (1.8%), and 18 patients (6.4%) requiring permanent stomas. A short distance from the lower tumor margin to the anal verge (AV) (p = 0.004) and the presence of stenosis or fistula (p < 0.0001) were independent risk factors.

Intestinal prolapse occurred in eight cases (3%), with a median occurrence of 221 days (range, 122–725 days). Intersphincteric resection (ISR) (p = 0.02) and splenic flexure takedown (p < 0.0001) were independent risk factors.

Conclusion

Anastomotic stenosis and late fistula formation frequently emerge as secondary consequences of early AL and represent significant complications linked to permanent stoma creation, often proving resistant to treatment. Intestinal prolapse is a characteristic anastomotic complication of ISR that can be caused by excessive intestinal mobilization.

Abstract Image

位于肛门边缘5cm内的临床I期低位直肠癌腹腔镜手术后晚期吻合口并发症:最终试验的亚分析
背景尽管对保留括约肌手术后早期吻合口瘘(AL)进行了广泛的研究,但后期吻合口并发症(30天后)的状况却很少得到关注。这些晚期并发症会严重影响患者的生活质量,并经常导致永久性造口。本研究对一项评估腹腔镜手术治疗I期下直肠腺癌疗效的II期试验(最终试验)进行了亚分析。本研究纳入278例行肠吻合术的患者,调查吻合口晚期并发症(狭窄、瘘管和肠脱垂)的发生频率、时间和危险因素。结果吻合口狭窄27例(9.7%),发生时间中位数为274天(范围70 ~ 1226天)。只有早期AL (p = 0.004)被确定为独立危险因素。5例(1.8%)患者出现晚期吻合口瘘,18例(6.4%)患者需要永久性吻合口。肿瘤下缘离肛缘(AV)较近(p = 0.004)和存在狭窄或瘘管(p < 0.0001)是独立危险因素。8例(3%)发生肠脱垂,中位发生时间221天(范围122-725天)。括约肌间切除(ISR) (p = 0.02)和脾屈曲切除(p < 0.0001)是独立危险因素。结论吻合口狭窄和晚期瘘管形成经常作为早期AL的继发性后果出现,并且是永久性造口相关的重要并发症,通常证明难以治疗。肠脱垂是ISR的特征性吻合口并发症,可由肠道过度动员引起。
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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
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