Kollmann Catherine, Kusnezov Beata, Kollmann Lars, Schmitt Jasmin, Germer Christoph-Thomas, Lock Johan F, Flemming Sven
Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital Würzburg, Oberdürrbacherstrasse 6, 97080, Würzburg, Germany.
Langenbecks Arch Surg. 2025 Mar 27;410(1):107. doi: 10.1007/s00423-025-03672-1.
Rectal resection has remained the cornerstone in curative treatment of rectal cancer. This however, implies the risk of anastomotic leakage leading to morbidity, mortality and potentially disease progression. Endoscopic vacuum therapy (EVT) has emerged as a promising tool in leakage therapy in order to avoid reoperation and Hartman resection. However, its clinical efficacy and its potential effect on oncological outcomes still requires further research.
In this retrospective single-centre cohort study, we analysed all consecutive patients undergoing rectal resection for rectal cancer during 2012-2021. The incidence and management of anastomotic leakage and its effects on long-term oncological outcomes were analysed.
A total of 334 patients underwent rectal resection of whom 47 patients (14.1%) developed postoperative anastomotic leakage. Non-operative leakage treatment (NOLT) was successful in in 76.9% of which EVT was the most efficient (90.0% success) while reoperation was successful in 52.4% (p = 0.073). The more frequent application of EVT increased the NOLT rate from 48.3 to 66.7% during the observation period (p = 0.176). Concerning long-term outcomes, no differences in disease-free survival (p = 0.657) nor patient survival (p = 0.295) could be determined.
EVT is an effective treatment option for anastomotic leakage after rectal resection. EVT enables NOLT in the majority of cases. However, there might be no impact on oncological outcomes.
直肠切除术一直是直肠癌根治性治疗的基石。然而，这意味着存在吻合口漏的风险，可能导致发病、死亡，并有可能引发疾病进展。内镜下真空治疗（EVT）已成为一种有前景的漏口治疗工具，以避免再次手术和哈特曼切除术。然而，其临床疗效及其对肿瘤学结局的潜在影响仍需进一步研究。
在这项回顾性单中心队列研究中，我们分析了2012年至2021年期间所有因直肠癌接受直肠切除术的连续患者。分析了吻合口漏的发生率、处理方法及其对长期肿瘤学结局的影响。
共有334例患者接受了直肠切除术，其中47例（14.1%）发生了术后吻合口漏。非手术漏口治疗（NOLT）成功率为76.9%，其中EVT最为有效（成功率90.0%），而再次手术成功率为52.4%（p = 0.073）。在观察期内，EVT应用频率的增加使NOLT率从48.3%提高到66.7%（p = 0.176）。关于长期结局，在无病生存率（p = 0.657）和患者生存率（p = 0.295）方面均未发现差异。
EVT是直肠切除术后吻合口漏的一种有效治疗选择。EVT在大多数情况下能够实现非手术漏口治疗。然而，其对肿瘤学结局可能没有影响。
