Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer
Background Anastomotic stricture following colorectal cancer surgery is not a rare complication, but proper management of anastomotic stricture located close to the anal verge is uncertain. This study aimed to investigate risk factors and management strategies for anastomotic stricture after ultralo...
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| Veröffentlicht in: | Surgical endoscopy 2018-02, Vol.32 (2), p.660-666 |
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| creator | Lee, Soo Young Kim, Chang Hyun Kim, Young Jin Kim, Hyeong Rok |
| description | Background
Anastomotic stricture following colorectal cancer surgery is not a rare complication, but proper management of anastomotic stricture located close to the anal verge is uncertain. This study aimed to investigate risk factors and management strategies for anastomotic stricture after ultralow anterior resection (ULAR).
Methods
We retrospectively reviewed a database of patients with rectal cancer who underwent surgery between January 2007 and June 2015, and included patients with an anastomosis within 4 cm from the anal verge. Clinical outcomes and risk factors for anastomotic stricture were investigated.
Results
Among the 586 patients included, 46 (7.8%) were diagnosed as having anastomotic stricture. Multivariable logistic regression analysis revealed that intersphincteric resection (ISR) with hand-sewn anastomosis (odds ratio [OR] = 3.070; 95% confidence interval [CI] 1.247–7.557) and postoperative radiotherapy (OR 6.237; 95% CI 1.961–19.841) were independent risk factors of anastomotic stricture. Forty-one (89.1%) underwent anastomotic dilatation with a Hegar dilator; while three patients (6.5%) underwent endoscopic balloon dilatation and two (4.3%) underwent surgery initially. Among the patients with initial nonoperative management (
n
= 44), 21 (47.7%) were completely cured with nonoperative management alone, 12 (27.3%) experienced complications, such as bowel perforation, anastomotic rupture, and perirectal abscess; and 21 (47.7%) underwent further surgical management. Fifteen patients (32.6%) eventually had permanent stoma.
Conclusion
ISR with a hand-sewn coloanal anastomosis, compared to ULAR with double-stapling anastomosis, and postoperative radiotherapy were independent risk factors of anastomotic stricture after surgery for very low-lying rectal cancer. Nonoperative anastomotic dilatation showed poor clinical outcome, with high complication rates, and subsequent surgical management. Therefore, nonoperative management of such patients should be carefully selected. |
| doi_str_mv | 10.1007/s00464-017-5718-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1921125181</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1993063525</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-8e54251e56d6bc9c045190c2b0216231a0870fc2b627b547048b534971246ed33</originalsourceid><addsrcrecordid>eNp1kUtLxDAUhYMoOo7-ADdScOMmmptH0y5FfIHgRtchzaQa6SRjkirz700ZFRFchZPz3Qf3IHQE5AwIkeeJEF5zTEBiIaHBbAvNgDOKKYVmG81IywimsuV7aD-lV1LwFsQu2qONpDVwPkPvF16nHJYhO1OlHJ3JY7SV7rON1TjkqIfwUWlfpAuxijZZk13wVRFu-k2rF-fNZJtfbl_sdxvXVanGw9r552KarIfKaG9sPEA7vR6SPfx65-jp-urx8hbfP9zcXV7cY8NZk3FjBacCrKgXdWdaQ7iAlhjaEQo1ZaBJI0lfdE1lJ7gkvOkE460Eymu7YGyOTjd9VzG8jTZltXTJ2GHQ3oYxKWgpQJnQQEFP_qCvYYy-bFeocsiaCSoKBRvKxJBStL1aRbfUca2AqCkUtQlFlVDUFIqaljj-6jx2S7v4qfhOoQB0A6Ri-Wcbf43-t-snPMWX6g</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1993063525</pqid></control><display><type>article</type><title>Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Lee, Soo Young ; Kim, Chang Hyun ; Kim, Young Jin ; Kim, Hyeong Rok</creator><creatorcontrib>Lee, Soo Young ; Kim, Chang Hyun ; Kim, Young Jin ; Kim, Hyeong Rok</creatorcontrib><description>Background
Anastomotic stricture following colorectal cancer surgery is not a rare complication, but proper management of anastomotic stricture located close to the anal verge is uncertain. This study aimed to investigate risk factors and management strategies for anastomotic stricture after ultralow anterior resection (ULAR).
Methods
We retrospectively reviewed a database of patients with rectal cancer who underwent surgery between January 2007 and June 2015, and included patients with an anastomosis within 4 cm from the anal verge. Clinical outcomes and risk factors for anastomotic stricture were investigated.
Results
Among the 586 patients included, 46 (7.8%) were diagnosed as having anastomotic stricture. Multivariable logistic regression analysis revealed that intersphincteric resection (ISR) with hand-sewn anastomosis (odds ratio [OR] = 3.070; 95% confidence interval [CI] 1.247–7.557) and postoperative radiotherapy (OR 6.237; 95% CI 1.961–19.841) were independent risk factors of anastomotic stricture. Forty-one (89.1%) underwent anastomotic dilatation with a Hegar dilator; while three patients (6.5%) underwent endoscopic balloon dilatation and two (4.3%) underwent surgery initially. Among the patients with initial nonoperative management (
n
= 44), 21 (47.7%) were completely cured with nonoperative management alone, 12 (27.3%) experienced complications, such as bowel perforation, anastomotic rupture, and perirectal abscess; and 21 (47.7%) underwent further surgical management. Fifteen patients (32.6%) eventually had permanent stoma.
Conclusion
ISR with a hand-sewn coloanal anastomosis, compared to ULAR with double-stapling anastomosis, and postoperative radiotherapy were independent risk factors of anastomotic stricture after surgery for very low-lying rectal cancer. Nonoperative anastomotic dilatation showed poor clinical outcome, with high complication rates, and subsequent surgical management. Therefore, nonoperative management of such patients should be carefully selected.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-017-5718-3</identifier><identifier>PMID: 28726144</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Aged ; Anal Canal - pathology ; Anal Canal - surgery ; Anastomosis, Surgical - adverse effects ; Colon - pathology ; Colon - surgery ; Colorectal cancer ; Constriction, Pathologic - etiology ; Constriction, Pathologic - therapy ; Dilatation ; Female ; Gastroenterology ; Gynecology ; Health risk assessment ; Hepatology ; Humans ; Male ; Medicine ; Medicine & Public Health ; Proctology ; Radiation therapy ; Radiotherapy, Adjuvant - adverse effects ; Rectal Neoplasms - surgery ; Retrospective Studies ; Risk Factors ; Studies ; Surgery ; Surgical Stapling ; Surgical Stomas ; Suture Techniques</subject><ispartof>Surgical endoscopy, 2018-02, Vol.32 (2), p.660-666</ispartof><rights>Springer Science+Business Media, LLC 2017</rights><rights>Surgical Endoscopy is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-8e54251e56d6bc9c045190c2b0216231a0870fc2b627b547048b534971246ed33</citedby><cites>FETCH-LOGICAL-c438t-8e54251e56d6bc9c045190c2b0216231a0870fc2b627b547048b534971246ed33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-017-5718-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-017-5718-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,778,782,27907,27908,41471,42540,51302</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28726144$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Soo Young</creatorcontrib><creatorcontrib>Kim, Chang Hyun</creatorcontrib><creatorcontrib>Kim, Young Jin</creatorcontrib><creatorcontrib>Kim, Hyeong Rok</creatorcontrib><title>Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Anastomotic stricture following colorectal cancer surgery is not a rare complication, but proper management of anastomotic stricture located close to the anal verge is uncertain. This study aimed to investigate risk factors and management strategies for anastomotic stricture after ultralow anterior resection (ULAR).
Methods
We retrospectively reviewed a database of patients with rectal cancer who underwent surgery between January 2007 and June 2015, and included patients with an anastomosis within 4 cm from the anal verge. Clinical outcomes and risk factors for anastomotic stricture were investigated.
Results
Among the 586 patients included, 46 (7.8%) were diagnosed as having anastomotic stricture. Multivariable logistic regression analysis revealed that intersphincteric resection (ISR) with hand-sewn anastomosis (odds ratio [OR] = 3.070; 95% confidence interval [CI] 1.247–7.557) and postoperative radiotherapy (OR 6.237; 95% CI 1.961–19.841) were independent risk factors of anastomotic stricture. Forty-one (89.1%) underwent anastomotic dilatation with a Hegar dilator; while three patients (6.5%) underwent endoscopic balloon dilatation and two (4.3%) underwent surgery initially. Among the patients with initial nonoperative management (
n
= 44), 21 (47.7%) were completely cured with nonoperative management alone, 12 (27.3%) experienced complications, such as bowel perforation, anastomotic rupture, and perirectal abscess; and 21 (47.7%) underwent further surgical management. Fifteen patients (32.6%) eventually had permanent stoma.
Conclusion
ISR with a hand-sewn coloanal anastomosis, compared to ULAR with double-stapling anastomosis, and postoperative radiotherapy were independent risk factors of anastomotic stricture after surgery for very low-lying rectal cancer. Nonoperative anastomotic dilatation showed poor clinical outcome, with high complication rates, and subsequent surgical management. Therefore, nonoperative management of such patients should be carefully selected.</description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Anal Canal - pathology</subject><subject>Anal Canal - surgery</subject><subject>Anastomosis, Surgical - adverse effects</subject><subject>Colon - pathology</subject><subject>Colon - surgery</subject><subject>Colorectal cancer</subject><subject>Constriction, Pathologic - etiology</subject><subject>Constriction, Pathologic - therapy</subject><subject>Dilatation</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Health risk assessment</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Proctology</subject><subject>Radiation therapy</subject><subject>Radiotherapy, Adjuvant - adverse effects</subject><subject>Rectal Neoplasms - surgery</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Studies</subject><subject>Surgery</subject><subject>Surgical Stapling</subject><subject>Surgical Stomas</subject><subject>Suture Techniques</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kUtLxDAUhYMoOo7-ADdScOMmmptH0y5FfIHgRtchzaQa6SRjkirz700ZFRFchZPz3Qf3IHQE5AwIkeeJEF5zTEBiIaHBbAvNgDOKKYVmG81IywimsuV7aD-lV1LwFsQu2qONpDVwPkPvF16nHJYhO1OlHJ3JY7SV7rON1TjkqIfwUWlfpAuxijZZk13wVRFu-k2rF-fNZJtfbl_sdxvXVanGw9r552KarIfKaG9sPEA7vR6SPfx65-jp-urx8hbfP9zcXV7cY8NZk3FjBacCrKgXdWdaQ7iAlhjaEQo1ZaBJI0lfdE1lJ7gkvOkE460Eymu7YGyOTjd9VzG8jTZltXTJ2GHQ3oYxKWgpQJnQQEFP_qCvYYy-bFeocsiaCSoKBRvKxJBStL1aRbfUca2AqCkUtQlFlVDUFIqaljj-6jx2S7v4qfhOoQB0A6Ri-Wcbf43-t-snPMWX6g</recordid><startdate>20180201</startdate><enddate>20180201</enddate><creator>Lee, Soo Young</creator><creator>Kim, Chang Hyun</creator><creator>Kim, Young Jin</creator><creator>Kim, Hyeong Rok</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20180201</creationdate><title>Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer</title><author>Lee, Soo Young ; Kim, Chang Hyun ; Kim, Young Jin ; Kim, Hyeong Rok</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-8e54251e56d6bc9c045190c2b0216231a0870fc2b627b547048b534971246ed33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Anal Canal - pathology</topic><topic>Anal Canal - surgery</topic><topic>Anastomosis, Surgical - adverse effects</topic><topic>Colon - pathology</topic><topic>Colon - surgery</topic><topic>Colorectal cancer</topic><topic>Constriction, Pathologic - etiology</topic><topic>Constriction, Pathologic - therapy</topic><topic>Dilatation</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Health risk assessment</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Proctology</topic><topic>Radiation therapy</topic><topic>Radiotherapy, Adjuvant - adverse effects</topic><topic>Rectal Neoplasms - surgery</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Studies</topic><topic>Surgery</topic><topic>Surgical Stapling</topic><topic>Surgical Stomas</topic><topic>Suture Techniques</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Soo Young</creatorcontrib><creatorcontrib>Kim, Chang Hyun</creatorcontrib><creatorcontrib>Kim, Young Jin</creatorcontrib><creatorcontrib>Kim, Hyeong Rok</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Soo Young</au><au>Kim, Chang Hyun</au><au>Kim, Young Jin</au><au>Kim, Hyeong Rok</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2018-02-01</date><risdate>2018</risdate><volume>32</volume><issue>2</issue><spage>660</spage><epage>666</epage><pages>660-666</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Anastomotic stricture following colorectal cancer surgery is not a rare complication, but proper management of anastomotic stricture located close to the anal verge is uncertain. This study aimed to investigate risk factors and management strategies for anastomotic stricture after ultralow anterior resection (ULAR).
Methods
We retrospectively reviewed a database of patients with rectal cancer who underwent surgery between January 2007 and June 2015, and included patients with an anastomosis within 4 cm from the anal verge. Clinical outcomes and risk factors for anastomotic stricture were investigated.
Results
Among the 586 patients included, 46 (7.8%) were diagnosed as having anastomotic stricture. Multivariable logistic regression analysis revealed that intersphincteric resection (ISR) with hand-sewn anastomosis (odds ratio [OR] = 3.070; 95% confidence interval [CI] 1.247–7.557) and postoperative radiotherapy (OR 6.237; 95% CI 1.961–19.841) were independent risk factors of anastomotic stricture. Forty-one (89.1%) underwent anastomotic dilatation with a Hegar dilator; while three patients (6.5%) underwent endoscopic balloon dilatation and two (4.3%) underwent surgery initially. Among the patients with initial nonoperative management (
n
= 44), 21 (47.7%) were completely cured with nonoperative management alone, 12 (27.3%) experienced complications, such as bowel perforation, anastomotic rupture, and perirectal abscess; and 21 (47.7%) underwent further surgical management. Fifteen patients (32.6%) eventually had permanent stoma.
Conclusion
ISR with a hand-sewn coloanal anastomosis, compared to ULAR with double-stapling anastomosis, and postoperative radiotherapy were independent risk factors of anastomotic stricture after surgery for very low-lying rectal cancer. Nonoperative anastomotic dilatation showed poor clinical outcome, with high complication rates, and subsequent surgical management. Therefore, nonoperative management of such patients should be carefully selected.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>28726144</pmid><doi>10.1007/s00464-017-5718-3</doi><tpages>7</tpages></addata></record> |
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| subjects | Abdominal Surgery Aged Anal Canal - pathology Anal Canal - surgery Anastomosis, Surgical - adverse effects Colon - pathology Colon - surgery Colorectal cancer Constriction, Pathologic - etiology Constriction, Pathologic - therapy Dilatation Female Gastroenterology Gynecology Health risk assessment Hepatology Humans Male Medicine Medicine & Public Health Proctology Radiation therapy Radiotherapy, Adjuvant - adverse effects Rectal Neoplasms - surgery Retrospective Studies Risk Factors Studies Surgery Surgical Stapling Surgical Stomas Suture Techniques |
| title | Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer |
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