Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients
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Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients. / Greijdanus, Nynke G; Wienholts, Kiedo; Ubels, Sander; Talboom, Kevin; Hannink, Gerjon; Wolthuis, Albert; de Lacy, F Borja; Lefevre, Jérémie H; Solomon, Michael; Frasson, Matteo; Rotholtz, Nicolas; Denost, Quentin; Perez, Rodrigo O; Konishi, Tsuyoshi; Panis, Yves; Rutegård, Martin; Hompes, Roel; Rosman, Camiel; van Workum, Frans; Tanis, Pieter J; de Wilt, Johannes H W; TENTACLE-Rectum Collaborative Group.
In: BRIT J SURG, Vol. 110, No. 12, 09.11.2023, p. 1863-1876.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients
AU - Greijdanus, Nynke G
AU - Wienholts, Kiedo
AU - Ubels, Sander
AU - Talboom, Kevin
AU - Hannink, Gerjon
AU - Wolthuis, Albert
AU - de Lacy, F Borja
AU - Lefevre, Jérémie H
AU - Solomon, Michael
AU - Frasson, Matteo
AU - Rotholtz, Nicolas
AU - Denost, Quentin
AU - Perez, Rodrigo O
AU - Konishi, Tsuyoshi
AU - Panis, Yves
AU - Rutegård, Martin
AU - Hompes, Roel
AU - Rosman, Camiel
AU - van Workum, Frans
AU - Tanis, Pieter J
AU - de Wilt, Johannes H W
AU - TENTACLE-Rectum Collaborative Group
AU - Graß, Julia-Kristin
AU - Melling, Nathaniel Timon
AU - Schewe, Simone
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.
PY - 2023/11/9
Y1 - 2023/11/9
N2 - BACKGROUND: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied.METHODS: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1).RESULTS: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days).CONCLUSION: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.
AB - BACKGROUND: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied.METHODS: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1).RESULTS: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days).CONCLUSION: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.
KW - Humans
KW - Anastomotic Leak/etiology
KW - Cohort Studies
KW - Anastomosis, Surgical/methods
KW - Rectum/surgery
KW - Rectal Neoplasms/surgery
KW - Retrospective Studies
U2 - 10.1093/bjs/znad311
DO - 10.1093/bjs/znad311
M3 - SCORING: Journal article
C2 - 37819790
VL - 110
SP - 1863
EP - 1876
JO - BRIT J SURG
JF - BRIT J SURG
SN - 0007-1323
IS - 12
ER -
