Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patients

Negoi, I.; Ciubotaru, C.; Stoica, B.; Tanase, I.; Ciubotaru, C.; Negoita, V.M.; Florea, S.; Macau, F.; Vasile, M.; Stefanescu, V.; Dimofte, G.; Luncă, S.; Roată, C.; Mușină, A.; Garmanova, T.; Agapov, M.N.; Markaryan, D.G.; Eduard, G.; Yanishev, A.; Abelevich, A.; Bazaev, A.; Rodimov, S.V.; Filimonov, V.B.; Melnikov, A.A.; Suchkov, I.A.; Drozdov, E.S.; Kostromitskiy, D.N.; Sjöström, O.; Matthiessen, P.; Baban, B.; Gadan, S.; Jadid, K.D.; Staffan, M.; Park, J.M.; Rydbeck, D.; Lydrup, M.; Buchwald, P.; Jutesten, H.; Darlin, L.; Lindqvist, E.; Nilsson, K.; Larsson, P.; Jangmalm, S.; Košir, J.A.; Tomažič, A.; Grosek, J.

Авторы: Negoi Ionut, Ciubotaru Cezar, Stoica Bogdan, Tanase Ioan, Ciubotaru Cezar, Negoita Valentina M., Florea Sabrina, Macau Florin, Vasile Mihai, Stefanescu Victor, Dimofte Gabriel-Mihail, Luncă Sorinel, Roată Cristian-Ene, Mușină Ana-Maria, Garmanova Tatiana, Agapov Mikhail N., Markaryan Daniil G., Eduard Galliamov, Yanishev Alexey, Abelevich Alexander, Bazaev Andrey, Rodimov Sergey V., Filimonov Victor B., Melnikov Andrey A., Suchkov Igor A., Drozdov Evgeniy S., Kostromitskiy Dmitriy N., Sjöström Olle, Matthiessen Peter, Baban Bayar, Gadan Soran, Jadid Kaveh Dehlaghi, Staffan Maria, Park Jennifer M., Rydbeck Daniel, Lydrup Marie-Louise, Buchwald Pamela, Jutesten Henrik, Darlin Lotten, Lindqvist Ebba, Nilsson Karl, Larsson Per-Anders, Jangmalm Staffan, Košir Jurij A., Tomažič Aleš, Grosek Jan
Журнал: British Journal of Surgery
Том: 110
Номер: 12
Год издания: 2023
Издательство: John Wiley & Sons Inc.
Местоположение издательства: United States
Первая страница: 1863
Последняя страница: 1876
DOI: 10.1093/bjs/znad311
Аннотация: Background: The optimal treatment of anastomotic leak after rectal cancer resection is unclear. This worldwide cohort study aimed to provide an overview of four treatment strategies applied.Methods: Patients from 216 centres and 45 countries with anastomotic leak after rectal cancer resection between 2014 and 2018 were included. Treatment was categorized as salvage surgery, faecal diversion with passive or active (vacuum) drainage, and no primary/secondary faecal diversion. The primary outcome was 1-year stoma-free survival. In addition, passive and active drainage were compared using propensity score matching (2 : 1).Results: Of 2470 evaluable patients, 388 (16.0 per cent) underwent salvage surgery, 1524 (62.0 per cent) passive drainage, 278 (11.0 per cent) active drainage, and 280 (11.0 per cent) had no faecal diversion. One-year stoma-free survival rates were 13.7, 48.3, 48.2, and 65.4 per cent respectively. Propensity score matching resulted in 556 patients with passive and 278 with active drainage. There was no statistically significant difference between these groups in 1-year stoma-free survival (OR 0.95, 95 per cent c.i. 0.66 to 1.33), with a risk difference of -1.1 (95 per cent c.i. -9.0 to 7.0) per cent. After active drainage, more patients required secondary salvage surgery (OR 2.32, 1.49 to 3.59), prolonged hospital admission (an additional 6 (95 per cent c.i. 2 to 10) days), and ICU admission (OR 1.41, 1.02 to 1.94). Mean duration of leak healing did not differ significantly (an additional 12 (-28 to 52) days).Conclusion: Primary salvage surgery or omission of faecal diversion likely correspond to the most severe and least severe leaks respectively. In patients with diverted leaks, stoma-free survival did not differ statistically between passive and active drainage, although the increased risk of secondary salvage surgery and ICU admission suggests residual confounding.
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Stoma-free survival after anastomotic leak following rectal cancer resection: worldwide cohort of 2470 patientsстатья