Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
Department of Surgery, Academic Hospital Maastricht, Maastricht, The Netherlands.
Surg Endosc. 2018 Jan;32(1):315-327. doi: 10.1007/s00464-017-5679-6. Epub 2017 Jun 29.
Non-healing of anastomotic leakage can be observed in up to 50% after total mesorectal excision for rectal cancer. This study investigates the efficacy of early transanal closure of anastomotic leakage after pre-treatment with the Endosponge therapy.
In this prospective, multicentre, feasibility study, transanal suturing of the anastomotic defect was performed after vacuum-assisted cleaning of the presacral cavity. Primary outcome was the proportion of patients with a healed anastomosis at 6 months after transanal closure. Secondary, healing at last follow-up, continuity, direct medical costs, functionality and quality of life were analysed.
Between July 2013 and July 2015, 30 rectal cancer patients with a leaking low colorectal anastomosis were included, of whom 22 underwent neoadjuvant radiotherapy. Median follow-up was 14 (7-29) months. At 6 months, the anastomosis had healed in 16 (53%) patients. At last follow-up, anastomotic integrity was found in 21 (70%) and continuity was restored in 20 (67%) patients. Non-healing at 12 months was observed in 10/29 (34%) patients overall, and in 3/14 (21%) when therapy started within three weeks following the index operation. Major LARS was reported in 12/15 (80%) patients. The direct medical costs were €8933 (95% CI 7268-10,707) per patient.
Vacuum-assisted early transanal closure of a leaking anastomosis after total mesorectal excision with 73% preoperative radiotherapy showed that acceptable anastomotic healing rates and stoma reversal rates can be achieved. Early diagnosis and start of treatment seems crucial.
直肠癌全直肠系膜切除术后吻合口漏的不愈合率可达 50%。本研究探讨了在术前使用 Endosponge 治疗后，通过经肛门早期闭合吻合口漏的疗效。
在这项前瞻性、多中心、可行性研究中，在真空辅助清洗骶前腔后，对吻合口缺陷进行经肛门缝合。主要结局是经肛门闭合后 6 个月时吻合口愈合的患者比例。次要结局包括最后一次随访时的愈合情况、连续性、直接医疗费用、功能和生活质量。
2013 年 7 月至 2015 年 7 月期间，共纳入 30 例低位直肠吻合口漏的直肠癌患者，其中 22 例行新辅助放疗。中位随访时间为 14 个月（7-29 个月）。在 6 个月时，16 例（53%）患者的吻合口愈合。在最后一次随访时，21 例（70%）患者的吻合口完整性得到保留，20 例（67%）患者的连续性得到恢复。29 例患者中有 10 例（34%）在 12 个月时未愈合，其中 3 例（21%）在指数手术后 3 周内开始治疗。15 例中有 12 例（80%）报告有严重的 LARS。每位患者的直接医疗费用为 8933 欧元（95%CI 7268-10707 欧元）。
术前放疗 73%的全直肠系膜切除术后，通过真空辅助早期经肛门闭合吻合口漏，吻合口愈合率和造口还纳率达到了可接受的水平。早期诊断和开始治疗似乎至关重要。
