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.
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; Bremers, Andreas J A; Ferenschild, Floris T; de Vriendt, Stefanie; D’Hoore, André; Bislenghi, Gabriele; Farguell, Jordi; Lacy, Antonio M; Atienza, Paula González; van Kessel, Charlotte S; Parc, Yann; Voron, Thibault; Collard, Maxime K; Muriel, Jorge Sancho; Cholewa, Hannia; Mattioni, Laura A; Frontali, Alice; Polle, Sebastiaan W; Polat, Fatih; Obihara, Ndidi J; Vailati, Bruna B; Kusters, Miranda; Tuynmann, Jurriaan B; Hazen, Sanne J A; Grüter, Alexander A J; Amano, Takahiro; Fujiwara, Hajime; Salomon, Mario; Ruiz, Hernán; Gonzalez, Ricardo; Estefanía, Diego; Avellaneda, Nicolas; Carrie, Augusto; Santillan, Mateo; Pachajoa, Diana A Pantoja; Parodi, Matias; Gielis, Manuel; Binder, Alf-Dorian; Gürtler, Thomas; Riedl, Peter; Badiani, Sarit; Berney, Christophe; Morgan, Matthew; Hollington, Paul; da Silva, Nigel; Nair, Gavin; Ho, Yiu M; Lamparelli, Michael; Kapadia, Raj; Kroon, Hidde M; Dudi-Venkata, Nagendra N; Liu, Jianliang; Sammour, Tarik; Flamey, Nicolas; Pattyn, Paul; Chaoui, Ahmed; Vansteenbrugge, Louis; van den Broek, Nathalie E J; Vanclooster, Patrick; de Gheldere, Charles; Pletinckx, Pieter; Defoort, Barbara; Dewulf, Maxime; Slavchev, Mihail; Belev, Nikolay; Atanasov, Boyko; Krastev, Panche; Sokolov, Manol; Maslyankov, Svilen; Gribnev, Petar; Pavlov, Vasil; Ivanov, Tsvetomir; Karamanliev, Martin; Filipov, Emil; Tonchev, Pencho; Aigner, Felix; Mitteregger, Martin; Allmer, Caterina; Seitinger, Gerald; Colucci, Nicola; Buchs, Nicolas; Ris, Frédéric; Toso, Christian; Gialamas, Eleftherios; Vuagniaux, Aurélie; Chautems, Roland; Sauvain, Marc-Olivier; Daester, Silvio; von Flüe, Markus; Guenin, Marc-Olivier; Taha-Mehlitz, Stephanie; Hess, Gabriel F; Martínek, Lubomír; Skrovina, Matej; Machackova, Maria; Benčurik, Vladimir; Uluk, Deniz; Pratschke, Johann; Dittrich, Luca S; Guel-Klein, Safak; Perez, Daniel; Grass, Julia-Kristin; Melling, Nathaniel; Mueller, Simone; Iversen, Lene H; Eriksen, Jacob D; Baatrup, Gunnar; Al-Najami, Issam; Bjørsum-Meyer, Thomas; Teras, Jüri; Teras, Roland M; Monib, Fatma A; Ahmed, Nagm Eldin Abu Elnga; Alkady, Eithar; Ali, Ahmed K; Khedr, Gehan Abd Elatti; Abdelaal, Ahmed Samir; Ashoush, Fouad M Bassyouni; Ewedah, Moataz; Elshennawy, Eslam M; Hussein, Mohamed; Fernández-Martínez, Daniel; García-Flórez, Luis J; Fernández-Hevia, María; Suárez-Sánchez, Aida; del Hoyo Aretxabala, Izaskun; Docampo, Iria Losada; Zabala, Jesús Gómez; Tejedor, Patricia; de Quirós, Javier T Morales Bernaldo; Quiroga, Ignacio Bodega; Navarro-Sánchez, Antonio; Darias, Iván Soto; Fernández, Cristina López; de La Cruz Cuadrado, Cristina; Sánchez-Guillén, Luis; López-Rodríguez-Arias, Francisco; Soler-Silva, Álvaro; Arroyo, Antonio; Bernal-Sprekelsen, Juan C; Gómez-Abril, Segundo Á; Gonzálvez, Paula; Torres, María T; Sánchez, Teresa Rubio; Antona, Francisco Blanco; Lara, Juan E Sánchez; Montero, José A Alcázar; Mendoza-Moreno, Fernando; Díez-Alonso, Manuel; Matías-García, Belén; Quiroga-Valcárcel, Ana; Colás-Ruiz, Enrique; Tasende-Presedo, Marta M; Fernández-Hurtado, Ignacio; Cifuentes-Ródenas, José A; Suárez, Marta Castro; Losada, Manuel; Hernández, Miguel; Alonso, Alfredo; Diéguez, Beatriz; Serralta, Daniel; Quintana, Rita E Medina; Lopez, Jose M Gil; Pinto, Francisca Lima; Nieto-Moreno, Elena; Bonito, Alba Correa; Santacruz, Carlos Cerdán; Marcos, Elena Bermejo; Septiem, Javier García; Calero-Lillo, Aránzazu; Alanez-Saavedra, Javier; Muñoz-Collado, Salvador; López-Lara, Manuel; Martínez, María Labalde; Herrero, Eduardo Ferrero; Borda, Francisco Javier García; Villar, Óscar García; Escartín, Jorge; Blas, Juan L; Ferrer, Rocío; Egea, Jorge García; Rodríguez-Infante, Antonio; Mínguez-Ruiz, Germán; Carreño-Villarreal, Guillermo; Pire-Abaitua, Gerardo; Dziakova, Jana; Rodríguez, Carlos Sáez-Cazallas; Aranda, María J Pizarro; Huguet, José M Muguerza; Borda-Arrizabalaga, Nerea; Enriquez-Navascués, José M; Echaniz, Garazi Elorza; Ansorena, Yolanda Saralegui; Estaire-Gómez, Mercedes; Martínez-Pinedo, Carlos; Barbero-Valenzuela, Alejandro; Ruíz-García, Pablo; Kraft, Miquel; Gómez-Jurado, María J; Pellino, Gianluca; Espín-Basany, Eloy; Cotte, Eddy; Panel, Nathalie; Goutard, Claire-Angéline; Deángelis, Nicola; Lauka, Lelde; Shaikh, Shafaque; Osborne, Laura; Ramsay, George; Nichita, Vladimir-Ion; Bhandari, Santosh; Sarmah, Panchali; Bethune, Rob M; Pringle, Heather C M; Massey, Lisa; Fowler, George E; Hamid, Hytham K S; de Simone, Belinda D; Kynaston, James; Bradley, Nicholas; Stienstra, Roxane M; Gurjar, Shashank; Mukherjee, Tanmoy; Chandio, Ashfaq; Ahmed, Safia; Singh, Baljit; Runau, Francois; Chaudhri, Sanjay; Siaw, Oliver; Sarveswaran, Janahan; Miu, Victor; Ashmore, Daniel; Darwich, Haitham; Singh-Ranger, Deepak; Singh, Nirbhaibir; Shaban, Mohamed; Gareb, Fahed; Petropolou, Thalia; Polydorou, Adreas; Dattani, Mit; Afzal, Asma; Bavikatte, Akshay; Sebastian, Boby; Ward, Nicholas; Mishra, Amitabh; Manatakis, Dimitrios; Tasis, ; Christos, Agalianos; Nikolaos, ; Antonopoulou, Maria-Ioanna; Karavokyros, Ioannis; Charalabopoulos, Alexandros; Schizas, Dimitrios; Baili, Efstratia; Syllaios, Athanasios; Karydakis, Lysandros; Vailas, Michail; Balalis, Dimitrios; Korkolis, Dimitrios; Plastiras, Aris; Rompou, Aliki; Xenaki, Sofia; Xynos, Evangelos; Chrysos, Emmanuel; Venianaki, Maria; Christodoulidis, Grigorios; Perivoliotis, Konstantinos; Tzovaras, George; Baloyiannis, Ioannis; Ho, Man-Fung; Ng, Simon Siu-man; Mak, Tony Wing-chung; Futaba, Kaori; Šantak, Goran; Šimleša, Damir; Ćosić, Jurica; Zukanović, Goran; Kelly, Michael E; Larkin, John O; Mccormick, Paul H; Mehigan, Brian J; Connelly, Tara M; Neary, Peter; Ryan, Jessica; Mccullough, Peter; Al-Juaifari, Maytham A; Hammoodi, Hayder; Abbood, Ali Hashim; Calabrò, Marcello; Muratore, Andrea; Terra, Antonio La; Farnesi, Francesca; Feo, Carlo V; Fabbri, Nicolò; Pesce, Antonio; Fazzin, Marta; Roscio, Francesco; Clerici, Federico; Lucchi, Andrea; Vittori, Laura; Agostinelli, Laura; Ripoli, Maria Cristina; Sambucci, Daniele; Porta, Andrea; Sinibaldi, Giovanni; Crescentini, Giacomo; Larcinese, Antonella; Picone, Emanuele; Persiani, Roberto; Biondi, Alberto; Pezzuto, Roberto; Lorenzon, Laura; Rizzo, Gianluca; Coco, Claudio; D’Agostino, Luca; Spinelli, Antonino; Sacchi, Matteo M; Carvello, Michele; Foppa, Caterina; Spinelli, Antonino; Sacchi, Matteo M; Carvello, Michele; Foppa, Caterina; Maroli, Annalisa; Palini, Gian M; Garulli, Gianluca; Zanini, Nicola; Delrio, Paolo; Rega, Daniela; Carbone, Fabio; Aversano, Alessia; Pirozzolo, Giovanni; Recordare, Alfonso; D’Alimonte, Lucrezia; Vignotto, Chiara; Corbellini, Carlo; Sampietro, Gianluca M; Lorusso, Leonardo; Manzo, Carlo A; Ghignone, Federico; Ugolini, Giampaolo; Montroni, Isacco; Pasini, Franceso; Pasini, Francesco; Ballabio, Michele; Bisagni, Pietro; Armao, Francesca T; Longhi, Marco; Ghazouani, Omar; Galleano, Raffaele; Tamini, Nicolò; Oldani, Massimo; Nespoli, Luca; Picciariello, Arcangelo; Altomare, Donato F; Tomasicchio, Giovanni; Lantone, Giuliano; Catena, Fausto; Giuffrida, Mario; Annicchiarico, Alfredo; Perrone, Gennaro; Grossi, Ugo; Santoro, Giulio A; Iacomino, ; Giacomo, Zanus; Alessandro, ; Novello, Simone; Passuello, Nicola; Zucchella, Martino; Puca, Lucia; Degiuli, Maurizio; Reddavid, Rossella; Scabini, Stefano; Aprile, Alessandra; Soriero, Domenico; Fioravanti, Emanuela; Rottoli, Matteo; Romano, Angela; Tanzanu, Marta; Belvedere, Angela; Mariani, Nicolò M; Ceretti, Andrea P; Opocher, Enrico; Gallo, Gaetano; Sammarco, Giuseppe; de Paola, Gilda; Pucciarelli, Salvatore; Marchegiani, Francesco; Spolverato, Gaya; Buzzi, Gianluca; Di Saverio, Salomone; Meroni, Paola; Parise, Cristiano; Bottazzoli, Elisa I; Lapolla, Pierfrancesco; Brachini, Gioia; Cirillo, Bruno; Mingoli, Andrea; Sica, Giuseppe; Siragusa, Leandro; Bellato, Vittoria; Cerbo, Daniele; de Pasqual, Carlo A; de Manzoni, Giovanni; di Cosmo, Maria A; Alrayes, Bourhan M H; Qandeel, Mahmoud W M; Hani, Mohammad Bani; Rabadi, Alexander; el Muhtaseb, Mohammad S; Abdeen, Basel; Karmi, Fahed; Žilinskas, Justas; Latkauskas, Tadas; Tamelis, Algimantas; Pikūnienė, Ingrida; Šlenfuktas, Vygintas; Poskus, Tomas; Kryzauskas, Marius; Jakubauskas, Matas; Mikalauskas, Saulius; Jakubauskiene, Lina; Hassan, Soha Y; Altrabulsi, Amani; Abdulwahed, Eman; Ghmagh, Reem; Deeknah, Abdulqudus; Alshareea, Entisar; Elhadi, Muhammed; Abujamra, Saleh; Msherghi, Ahmed A; Tababa, Osama W E; Majbar, Mohammed A; Souadka, Amine; Benkabbou, Amine; Mohsine, Raouf; Echiguer, Sabrillah; Moctezuma-Velázquez, Paulina; Salgado-Nesme, Noel; Vergara-Fernández, Omar; Sainz-Hernández, Juan C; Alvarez-Bautista, Francisco E; Zakaria, Andee D; Zakaria, Zaidi; Wong, Michael P K; Ismail, Razif; Ibrahim, Aini F; Abdullah, Nik A N; Julaihi, Rokayah; Bhat, Sameer; O’Grady, Greg; Bissett, Ian; Lamme, Bas; Musters, Gijsbert D; Dinaux, Anne M; Grotenhuis, Brechtje A; Aalbers, Ernst J Steller Arend G J; Leeuwenburgh, Marjolein M; Rutten, Harm J T; Burger, Jacobus W A; Bloemen, Johanne G; Ketelaers, Stijn H J; Waqar, Usama; Chawla, Tabish; Rauf, Hareem; Rani, Pallavi; Talsma, Aaldert K; Scheurink, Lieke; van Praagh, Jasper B; Segelman, Josefin; Nygren, Jonas; Anderin, Kajsa; Tiefenthal, Marit; de Andrés, Beatriz; de Heredia, Juan P Beltrán; Vázquez, Andrea; Gómez, Tania; Golshani, Parisa; Kader, Rawaz; Mohamed, Abudi; Westerterp, Marinke; Marinelli, Andreas; Niemer, Quirine; Doornebosch, Pascal G; Shapiro, Joël; Vermaas, Maarten; de Graaf, Eelco J R; van Westreenen, Hendrik L; Zwakman, Marije; van Dalsen, Annette D; Vles, Wouter J; Nonner, Joost; Toorenvliet, Boudewijn R; Janssen, Paul T J; Verdaasdonk, Emiel G G; Amelung, Femke J; Bahadoer, Koen C M J Peeters Renu R; Holman, Fabian A; Heemskerk, Jeroen; Vosbeek, Noortje; Leijtens, Jeroen W A; Taverne, Sophie B M; Heijnen, Bob H M; El-Massoudi, Youssef; de Groot-van Veen, Irene; Hoff, Christiaan; Jou-Valencia, Daniela; Burghgraef, Esther C J Consten Thijs A; Geitenbeek, Ritch; Hulshof, Lorenzo G W L; Slooter, Gerrit D; Reudink, Muriël; Bouvy, Nicole D; Wildeboer, Aurelia C L; Verstappen, Sonja; Pennings, Alexander J; van den Hengel, Berber; Wijma, Allard G; de Haan, Jael; de Nes, Lindsey C F; Heesink, Vera; Karsten, Tom; Heidsma, Charlotte M; Koemans, Willem J; Dekker, Jan-Willem T; van der Zijden, Charlène J; Roos, Daphne; Demirkiran, Ahmet; van der Burg, Sjirk; Oosterling, Steven J; Hoogteijling, Tijs J; Wiering, Bastiaan; Smeeing, Diederik P J; Havenga, Klaas; Lutfi, Hamid; Consten, Esther C J; Tsimogiannis, Konstantinos; Sköldberg, Filip; Folkesson, Joakim; den Boer, Frank; van Schaik, Ted G; van Gerven, Pieter; Sietses, Colin; Hol, Jeroen C; Boerma, Evert-Jan G; Creemers, Davy M J; Schultz, Johannes K; Frivold, Tone; Riis, Rolf; Gregussen, Hilde; Busund, Sondre; Sjo, Ole H; Gaard, Maria; Krohn, Nina; Ersryd, Amanda L; Leung, Edmund; Waqar, Usama; Chawla, Tabish; Rauf, Hareem; Rani, Pallavi; Sultan, Hytham; Hajjaj, Baraa Nabil; Alhisi, Ahmed Jehad; Khader, Ahmed A E; Mendes, Ana Filipa Dias; Semião, Miguel; Faria, Luis Queiroz; Azevedo, Constança; da Costa Devesa, Helena M; Martins, Sónia Fortuna; Jarimba, Aldo M Rodrigues; Marques, Sónia M Ribeiro; Ferreira, Rita Marques; Oliveira, António; Ferreira, Cátia; Pereira, Ricardo; Surlin, Valeriu M; Graure, Giorgiana M; Ramboiu, Stefan Patrascu Sandu D; Negoi, Ionut; Ciubotaru, Cezar; Stoica, Bogdan; Tanase, Ioan; Stoica, Bogdan; Ciubotaru, Cezar; Negoita, Valentina M; Florea, Sabrina; Macau, Florin; Vasile, Mihai; Stefanescu, Victor; Dimofte, Gabriel-Mihail; Luncă, Sorinel; Roată, Cristian-Ene; Mușină, Ana-Maria; Garmanova, Tatiana; Agapov, Mikhail N; Markaryan, Daniil G; Eduard, Galliamov; Yanishev, Alexey; Abelevich, Alexander; Bazaev, Andrey; 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Kozan, Ramazan; Göbüt, Hüseyin; Cengiz, Fevzi; Erdinc, Kemal; Acar, Nihan Coşgun; Kamer, Erdinc; Özgür, İlker; Aydın, Oguzhan; Keskin, Metin; Bulut, Mehmet Türker; Kulle, Cemil B; Kara, Yasin; Sıbıç, Osman; Özata, İbrahim H; Buğra, Dursun; Balık, Emre; Kulle, Cemil B; Çakır, Murat; Alhardan, Anas; Colak, Elif; Aybar, Ahmet B CiftciEngin; Sari, Ahmet Can; Atici, Semra Demirli; Kaya, Tayfun; Dursun, Ayberk; Calik, Bulent; Özkan, Ömer Faruk; Ülgür, Hanife Şeyda; Düzgün, Özgül; Monson, John; George, Sarah; Woods, Kayla; Al-Eryani, Fatima; Albakry, Rudaina; Coetzee, Emile; Boutall, Adam; Herman, Ayesiga; Warden, Claire; Mugla, Naser; Forgan, Tim; Mia, Imraan; Lambrechts, Anton; Null, Null. - In: BRITISH JOURNAL OF SURGERY. - ISSN 0007-1323. - 110:12(2023), pp. 1863-1876. [10.1093/bjs/znad311]
Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients
Gallo, GaetanoMembro del Collaboration Group
;
2023
Abstract
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.