Talboom K, Greijdanus N G, Brinkman N, Blok R D, Roodbeen S X, Ponsioen C Y, Tanis P J, Bemelman W A, Cunningham C, de Lacy F B, Hompes Roel
Department of Surgery, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Gastro-Enterology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands.
Tech Coloproctol. 2023 Nov;27(11):1099-1108. doi: 10.1007/s10151-023-02808-z. Epub 2023 May 22.
Comparative studies on efficacy of treatment strategies for anastomotic leakage (AL) after low anterior resection (LAR) are almost non-existent. This study aimed to compare different proactive and conservative treatment approaches for AL after LAR.
This retrospective cohort study included all patients with AL after LAR in three university hospitals. Different treatment approaches were compared, including a pairwise comparison of conventional treatment and endoscopic vacuum-assisted surgical closure (EVASC). Primary outcomes were healed and functional anastomosis rates at end of follow-up.
Overall, 103 patients were included, of which 59 underwent conventional treatment and 23 EVASC. Median number of reinterventions was 1 after conventional treatment, compared to 7 after EVASC (p < 0.01). Median follow-up was 39 and 25 months, respectively. Healed anastomosis rate was 61% after conventional treatment, compared to 78% after EVASC (p = 0.139). Functional anastomosis rate was higher after EVASC, compared to conventional treatment (78% vs. 54%, p = 0.045). Early initiation of EVASC in the first week after primary surgery resulted in better functional anastomosis rate compared to later initiation (100% vs. 55%, p = 0.008).
Proactive treatment of AL consisting of EVASC resulted in improved healed and functional anastomosis rates for AL after LAR for rectal cancer, compared to conventional treatment. If EVASC was initiated within the first week after index surgery, a 100% functional anastomosis rate was achievable.
低位前切除术（LAR）后吻合口漏（AL）治疗策略疗效的比较研究几乎不存在。本研究旨在比较LAR后不同的积极和保守治疗方法。
这项回顾性队列研究纳入了三家大学医院中所有LAR后发生AL的患者。比较了不同的治疗方法，包括传统治疗与内镜真空辅助手术闭合（EVASC）的成对比较。主要结局是随访结束时吻合口愈合率和功能吻合率。
总体而言，共纳入103例患者，其中59例接受传统治疗，23例接受EVASC。传统治疗后再次干预的中位数为1次，而EVASC后为7次（p <0.01）。中位随访时间分别为39个月和25个月。传统治疗后吻合口愈合率为61%，而EVASC后为78%（p = 0.139）。与传统治疗相比，EVASC后的功能吻合率更高（78%对54%，p = 0.045）。与后期开始相比，在初次手术后第一周早期开始EVASC可获得更好的功能吻合率（100%对55%，p = 0.008）。
与传统治疗相比，由EVASC组成的AL积极治疗可提高直肠癌LAR后AL的吻合口愈合率和功能吻合率。如果在初次手术后第一周内开始EVASC，则可实现100%的功能吻合率。
