Anastomotic leakage following laparoscopic resection of low and mid rectal cancer


COD: 01_2019_09_2744 Categorie: ,

Mostafa Shalaby, Waleed Thabet, Francesco Rulli, Francesco Palmieri, Federica Saraceno, Ilaria Capuano, Oreste Buonomo, Gabriella Giarratano, Giuseppe Petrella, Mosaad Morshed, Mohamed Farid, Pierpaolo Sileri

Ann. Ital. Chir., 2019 90, 1: 57-67

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PURPOSE: Anastomotic leakage is considered the commonest major complication after surgery for rectal cancer.
MATERIALS AND METHODS: Patients who underwent laparoscopic LAR or ULAR for rectal cancer were recruited. The
primary outcome was the incidence of the AL during 30 days postoperative.
RESULTS: Fifty-nine consecutive patients were included in the study. Fifty-three patients underwent LAR with stapled
colorectal anastomoses, while the remaining 6 patients underwent ULAR with hand-sewn coloanal anastomoses. The
median duration of operation was 195 minutes (range; 120-315). The defunctioning ileostomy was created in 24 (7%)
Overall, there was no recorded mortality. Only 10 (17%) patients developed complications. There were only 4 patients
who developed AL. Three patients had a subclinical AL as they had defunctioning ileostomy at the time of the initial
procedure, the diagnosis was made by CT with rectal contrast. They were treated conservatively with transanal anastomotic
drainage under endoscopic guidance. One patient had a clinically significant AL, demonstrated as a peritonitis. This
patient required reoperation during which pelvic abscess was drained, resection of the previous anastomosis, and hartmann’s
colostomy was performed.
CONCLUSION: Standardization of a definition, as well as, criteria for the diagnosis of AL, will help in comparison of
the results and the surgical techniques in order to optimize the required care offered to rectal cancer patients. On expert
hands, it is feasible to perform a laparoscopic sphincter-saving total mesorectal excision, additionally, it provides the
advantages of a clear view of the deep pelvis and facilitates a precise sharp dissection.