Vacuum-assisted early transanal closure of leaking low colorectal anastomoses: the CLEAN study.
Surg Endosc
; 32(1): 315-327, 2018 01.
Article
de En
| MEDLINE
| ID: mdl-28664443
ABSTRACT
INTRODUCTION:
Non-healing of anastomotic leakage can be observed in up to 50% after total mesorectal excision for rectal cancer. This study investigates the efficacy of early transanal closure of anastomotic leakage after pre-treatment with the Endosponge® therapy.METHODS:
In this prospective, multicentre, feasibility study, transanal suturing of the anastomotic defect was performed after vacuum-assisted cleaning of the presacral cavity. Primary outcome was the proportion of patients with a healed anastomosis at 6 months after transanal closure. Secondary, healing at last follow-up, continuity, direct medical costs, functionality and quality of life were analysed.RESULTS:
Between July 2013 and July 2015, 30 rectal cancer patients with a leaking low colorectal anastomosis were included, of whom 22 underwent neoadjuvant radiotherapy. Median follow-up was 14 (7-29) months. At 6 months, the anastomosis had healed in 16 (53%) patients. At last follow-up, anastomotic integrity was found in 21 (70%) and continuity was restored in 20 (67%) patients. Non-healing at 12 months was observed in 10/29 (34%) patients overall, and in 3/14 (21%) when therapy started within three weeks following the index operation. Major LARS was reported in 12/15 (80%) patients. The direct medical costs were 8933 (95% CI 7268-10,707) per patient.CONCLUSION:
Vacuum-assisted early transanal closure of a leaking anastomosis after total mesorectal excision with 73% preoperative radiotherapy showed that acceptable anastomotic healing rates and stoma reversal rates can be achieved. Early diagnosis and start of treatment seems crucial.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Tumeurs du rectum
/
Rectum
/
Techniques de suture
/
Côlon
/
Traitement des plaies par pression négative
/
Désunion anastomotique
Type d'étude:
Clinical_trials
/
Observational_studies
/
Screening_studies
Aspects:
Patient_preference
Limites:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Langue:
En
Journal:
Surg Endosc
Sujet du journal:
DIAGNOSTICO POR IMAGEM
/
GASTROENTEROLOGIA
Année:
2018
Type de document:
Article
Pays d'affiliation:
Pays-Bas