Journal of visceral surgery · 2025
Trends in the management and success rate of anastomotic leakage after rectal surgery: Outcome improvements using a proactive diagnosis and treatment strategy at two academic centers.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Labiad Camélia, Bajul Melinda, Parc Yann, Penna Christophe, Benoist Stéphane, Challine Alexandre, Brouquet Antoine, Lefevre Jérémie H
Аннотация
PURPOSE: Management of anastomotic leakage (AL) following rectal surgery is not standardized. The aim was to evaluate the trends of clinical practice management and outcome of AL over time.
METHOD: All patients with grade B symptomatic AL after rectal surgery from January 2012 to January 2022 in two centers were included. Diagnostic and treatment management was compared in 3 time periods: 2012-2014, 2015-2018 and 2019-2021. Success was defined as a completely healed, preserved and functional anastomosis. Univariate and multivariate analyses were used to identify predictive factors of success.
RESULTS: In total, 194 patients with symptomatic AL were included. The overall success rate was 57%. The use of CRP dosage and CT scan for diagnosis increased overtime from 44% and 81% in 2012-2014, 75% and 95% in 2015-2018, 69% and 100% in 2019-2021, respectively. The use of anal examination under general anesthesia also increased over time: 48% in 2012-2014, 35% in 2015-2018, 60% in 2019-2021 (P=0.025). Success rate increased significantly: 51% in 2012-2014, 52% in 2015-2018, 77% in 2019-2021 (P=0.026). In multivariate analysis, absence of preoperative radiotherapy (OR=2.137, IC95%(1.08-4.22), P=0.029) and most recent period of care (OR=0.319, IC95%(0.12-0.82), P=0.017) were independent factors associated to the healing of AL.
CONCLUSION: Across time, relevant diagnostic and therapeutic changes are observed in the management of AL after rectal cancer surgery, translating in improved outcomes with a higher rate of anastomotic preservation.
METHOD: All patients with grade B symptomatic AL after rectal surgery from January 2012 to January 2022 in two centers were included. Diagnostic and treatment management was compared in 3 time periods: 2012-2014, 2015-2018 and 2019-2021. Success was defined as a completely healed, preserved and functional anastomosis. Univariate and multivariate analyses were used to identify predictive factors of success.
RESULTS: In total, 194 patients with symptomatic AL were included. The overall success rate was 57%. The use of CRP dosage and CT scan for diagnosis increased overtime from 44% and 81% in 2012-2014, 75% and 95% in 2015-2018, 69% and 100% in 2019-2021, respectively. The use of anal examination under general anesthesia also increased over time: 48% in 2012-2014, 35% in 2015-2018, 60% in 2019-2021 (P=0.025). Success rate increased significantly: 51% in 2012-2014, 52% in 2015-2018, 77% in 2019-2021 (P=0.026). In multivariate analysis, absence of preoperative radiotherapy (OR=2.137, IC95%(1.08-4.22), P=0.029) and most recent period of care (OR=0.319, IC95%(0.12-0.82), P=0.017) were independent factors associated to the healing of AL.
CONCLUSION: Across time, relevant diagnostic and therapeutic changes are observed in the management of AL after rectal cancer surgery, translating in improved outcomes with a higher rate of anastomotic preservation.