<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec id="j_raon-2019-0008_s_006">
<h3>Background</h3>
<p>Anterior resection with total mesorectal excision (TME) of ultralow rectal cancer may result in the increased risk of the anastomotic leakage (AL). The aim of this study was to evaluate the usefulness of the gentamicin-collagen sponge (GCS) for the protection against symptomatic AL and investigate association between AL and local relapse (LR).</p>
</sec>
<sec id="j_raon-2019-0008_s_007">
<h3>Patients and methods</h3>
<p>A series of 158 patients with ultralow rectal cancer was studied. All the patients underwent R0 sphincter-saving TME with anastomosis wrapping using GCS. In none of the cases a temporary protective stoma was constructed.</p></sec>
<sec id="j_raon-2019-0008_s_008">
<h3>Results</h3>
<p>AL rate was 3.2% (5/158) while median time to AL diagnosis was 5 days following surgery (range 3-15). There was no postoperative and leakage-related mortality. Patient age > 75 years and smoking were independent risk factors related to significantly increased AL rate: 12.5% <italic>vs</italic>. 0.8% (<italic>P</italic> = 0.0004) and 5.7% <italic>vs</italic>. 0% <italic>P</italic> = 0.043), respectively. LR was observed in 12% of cases. It was highly significantly more common and developed earlier in patients who have had AL when compared with non-AL group: 80% <italic>vs</italic>. 9% (<italic>P</italic> = 0.00001) and 8.5 <italic>vs</italic>. 17 months (<italic>P</italic> = 0.014), respectively.</p></sec>
<sec id="j_raon-2019-0008_s_009">
<h3>Conclusions</h3>
<p>Anastomosis wrapping with GCS after anterior resection with TME is a safe procedure resulting in the low incidence of anastomotic leakage which may be also associated with decreased risk of local relapse.</p></sec></abstract>

Background
Anterior resection with total mesorectal excision (TME) of ultralow rectal cancer may result in the increased risk of the anastomotic leakage (AL). The aim of this study was to evaluate the usefulness of the gentamicin-collagen sponge (GCS) for the protection against symptomatic AL and investigate association between AL and local relapse (LR).


Patients and methods
A series of 158 patients with ultralow rectal cancer was studied. All the patients underwent R0 sphincter-saving TME with anastomosis wrapping using GCS. In none of the cases a temporary protective stoma was constructed.

Results
AL rate was 3.2% (5/158) while median time to AL diagnosis was 5 days following surgery (range 3-15). There was no postoperative and leakage-related mortality. Patient age > 75 years and smoking were independent risk factors related to significantly increased AL rate: 12.5% vs. 0.8% (P = 0.0004) and 5.7% vs. 0% P = 0.043), respectively. LR was observed in 12% of cases. It was highly significantly more common and developed earlier in patients who have had AL when compared with non-AL group: 80% vs. 9% (P = 0.00001) and 8.5 vs. 17 months (P = 0.014), respectively.

Conclusions
Anastomosis wrapping with GCS after anterior resection with TME is a safe procedure resulting in the low incidence of anastomotic leakage which may be also associated with decreased risk of local relapse.

Ultralow anterior resection with implantation of gentamicin-collagen sponge and no defunctioning stoma: anastomotic leakage and local cancer relapse

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background
Anterior resection with total mesorectal excision (TME) of ultralow rectal cancer may result in the increased risk of the anastomotic leakage (AL)....

Characteristics	n (%)
Gender
Female / Male	92 (58) / 66 (42)
Age (years)
Mean ± SD / median / range	67.1 ± 9.8 / 68 / 34-85
Comorbidity
Diabetes / Cardiovascular disease	13 (8) / 40 (25)
Smoking
Yes / No	87 (55) / 71 (45)
Obesity
Yes / No	31 (20) / 127 (80)
Preoperative radiotherapy
Yes / No	65 (41) / 93 (59)
Operating time (minutes)
Mean ± SD / median / range	118.9 ± 24.8 / 120 / 45-190
Level of anastomosis (cm)
Mean ± SD / median / range	5.4 ± 1.1 / 5.0 / 3-7
Blood transfusion
Yes / No	24 (15) / 134 (85)
Postoperative fever
Yes / No	9 (6) / 149 (94)
T stage
T1T2 / T3	95 (60) / 63 (40)
N status
N- / N+	91 (58) / 67 (42)

	Patients with	Univariate	Multivariate
Variables	leakage	analysis	analysis
	n (%)	P - value	P - value
Gender
Female	2 (2.2)	0.4010	-
Male	3 (4.5)
Age
≥ 75	4 (12.5)	0.0007	0.0004
< 75 years	1 (0.8)
Diabetes
Yes	1 (7.7)
No	4 (2.8)	0.3303	-
Cardiovascular disease
Yes	1 (2.5)
No	4 (3.4)	0.7811	-
Smoking
Yes	5 (5.7)
No	0 (0)	0.0401	0.043
Obesity
Yes	2 (6.5)
No	3 (2.4)	0.2435	-
Preoperative radiotherapy
yes	3 (4.6)
no	2 (2.2)	0.4053	-
Level of anastomosis
> 5	1 (1.5)
≤ 5 cm	4 (4.3)	0.3289	-
Blood transfusion
yes	1 (4.2)
no	4 (3.0)	0.7607	-
Postoperative fever
yes	0 (0)
no	5 (3.4)	0.5765	-
T stage
T1T2	3 (3.1)
T3	2 (3.2)	0.9953	-
N status
N-	3 (3.3)
N+	2 (3.0)	0.9119	-

Ultralow anterior resection with implantation of gentamicin-collagen sponge and no defunctioning stoma: anastomotic leakage and local cancer relapse

Article Category: Research Article

Publié en ligne: 03 mars 2019

Pages: 77 - 84

Reçu: 07 nov. 2018

Accepté: 10 janv. 2019

DOI: https://doi.org/10.2478/raon-2019-0008

© 2019 Tomasz Michalik, Rafał Matkowski, Przemyslaw Biecek, Jozef Forgacz, Bartlomiej Szynglarewicz, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Baseline characteristics

Uni – and multivariate analysis of anastomotic leakage incidence