Annals of gastroenterological surgery · 2025
Late anastomotic complication after laparoscopic surgery for clinical stage I low rectal cancers located within 5 cm of the anal verge: Sub-analysis of the ultimate trial.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Shimomura Manabu, Yoshimitsu Masanori, Tsukada Yuichiro, Ohdan Hideki, Watanabe Jun, Fukunaga Yosuke, Hirano Yasumitsu, Sakamoto Kazuhiro, Hamamoto Hiroki, Horie Hisanaga, Matsuhashi Nobuhisa, Kuriu Yoshiaki, Nagai Shuntaro, Hamada Madoka, Yoshioka Shinichi, Ohnuma Shinobu, Hayama Tamuro, Otsuka Koki, Inoue Yusuke, Ueda Kazuki, Toiyama Yuji, Maruyama Satoshi, Yamaguchi Shigeki, Tanaka Keitaro, Suzuki Motoko, Misumi Toshihiro, Naitoh Takeshi, Watanabe Masahiko, Ito Masaaki, Ultimate Trial Group
Аннотация
BACKGROUND: Although extensive research has been conducted on early anastomotic leakage (AL) after sphincter-sparing surgery, the status of late anastomotic complications (post-30 days) has received limited attention. These late complications significantly affect a patient's quality of life and often lead to permanent stoma creation.
METHODS: This study conducted a sub-analysis of a phase II trial assessing the outcomes of laparoscopic surgery for cStage I lower rectal adenocarcinoma (the ultimate trial). This study included 278 patients who underwent intestinal anastomosis and investigated the frequency, timing, and risk factors of late anastomotic complications (stenosis, fistula, and intestinal prolapse).
RESULTS: Anastomotic stenosis occurred in 27 patients (9.7%), and the median time of occurrence was 274 days (range, 70-1226 days). Only early AL (p = 0.004) was identified as an independent risk factor. A late anastomotic fistula was observed in five patients (1.8%), and 18 patients (6.4%) requiring permanent stomas. A short distance from the lower tumor margin to the anal verge (AV) (p = 0.004) and the presence of stenosis or fistula (p < 0.0001) were independent risk factors.Intestinal prolapse occurred in eight cases (3%), with a median occurrence of 221 days (range, 122-725 days). Intersphincteric resection (ISR) (p = 0.02) and splenic flexure takedown (p < 0.0001) were independent risk factors.
CONCLUSION: Anastomotic stenosis and late fistula formation frequently emerge as secondary consequences of early AL and represent significant complications linked to permanent stoma creation, often proving resistant to treatment. Intestinal prolapse is a characteristic anastomotic complication of ISR that can be caused by excessive intestinal mobilization.
METHODS: This study conducted a sub-analysis of a phase II trial assessing the outcomes of laparoscopic surgery for cStage I lower rectal adenocarcinoma (the ultimate trial). This study included 278 patients who underwent intestinal anastomosis and investigated the frequency, timing, and risk factors of late anastomotic complications (stenosis, fistula, and intestinal prolapse).
RESULTS: Anastomotic stenosis occurred in 27 patients (9.7%), and the median time of occurrence was 274 days (range, 70-1226 days). Only early AL (p = 0.004) was identified as an independent risk factor. A late anastomotic fistula was observed in five patients (1.8%), and 18 patients (6.4%) requiring permanent stomas. A short distance from the lower tumor margin to the anal verge (AV) (p = 0.004) and the presence of stenosis or fistula (p < 0.0001) were independent risk factors.Intestinal prolapse occurred in eight cases (3%), with a median occurrence of 221 days (range, 122-725 days). Intersphincteric resection (ISR) (p = 0.02) and splenic flexure takedown (p < 0.0001) were independent risk factors.
CONCLUSION: Anastomotic stenosis and late fistula formation frequently emerge as secondary consequences of early AL and represent significant complications linked to permanent stoma creation, often proving resistant to treatment. Intestinal prolapse is a characteristic anastomotic complication of ISR that can be caused by excessive intestinal mobilization.