Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Department of Surgery, Tergooi Hospital, Hilversum, the Netherlands.
Colorectal Dis. 2018 Jan;20(1):35-43. doi: 10.1111/codi.13844.
The construction of a new coloanal anastomosis (CAA) following anastomotic leakage after low anterior resection (LAR) is challenging. The available literature on this topic is scarce. The aim of this two-centre study was to determine the clinical success and morbidity after redo CAA.
This retrospective cohort study included all patients with anastomotic leakage after LAR for rectal cancer who underwent a redo CAA between 2010 and 2014 in two tertiary referral centres. Short- and long-term morbidity were analysed, including both anastomotic leakage and permanent stoma rates on completion of follow-up.
A total of 59 patients were included, of whom 45 (76%) were men, with a mean age of 59 years (SD ± 9.4). The median interval between index and redo surgery was 14 months [interquartile range (IQR) 8-27]. The median duration of follow-up was 27 months (IQR 17-36). The most frequent complication was anastomotic leakage of the redo CAA occurring in 24 patients (41%), resulting in a median of three reinterventions (IQR 2-4) per patient. At the end of follow-up, bowel continuity was restored in 39/59 (66%) patients. Fourteen (24%) patients received a definitive colostomy and six (10%) still had a diverting ileostomy. In a multivariable model, leakage of the redo CAA was the only risk factor for permanent stoma (OR 0.022; 95% CI 0.004-0.122).
Redo CAA is a viable option in selected patients with persisting leakage after LAR for rectal cancer who want their bowel continuity restored. However, patients should be fully informed about the relatively high morbidity and reintervention rates.
低位前切除术（LAR）后吻合口漏发生时，构建新的结肠直肠吻合（CAA）具有挑战性。关于该主题的可用文献很少。本两项中心研究的目的是确定再次 CAA 后的临床成功率和发病率。
这项回顾性队列研究纳入了 2010 年至 2014 年间在两个三级转诊中心接受 LAR 后吻合口漏行再次 CAA 的所有患者。分析了短期和长期发病率，包括完成随访时的吻合口漏和永久性造口率。
共纳入 59 例患者，其中 45 例（76%）为男性，平均年龄 59 岁（标准差 ± 9.4）。指数和再次手术之间的中位间隔为 14 个月[四分位距（IQR）8-27]。中位随访时间为 27 个月（IQR 17-36）。最常见的并发症是再次 CAA 的吻合口漏，24 例患者（41%）发生，每位患者平均需要进行三次再干预（IQR 2-4）。随访结束时，59 例患者中有 39 例（66%）恢复了肠道连续性。14 例（24%）患者接受了确定性结肠造口术，6 例（10%）仍有转流性回肠造口术。多变量模型中，再次 CAA 漏是永久性造口的唯一危险因素（OR 0.022；95%CI 0.004-0.122）。
对于希望恢复肠道连续性的 LAR 后持续性吻合口漏的选定患者，再次 CAA 是一种可行的选择。然而，患者应充分了解相对较高的发病率和再干预率。
