Abstract
PurposeAnterior resection is the procedure of choice for tumours in the mid and upper rectum. Depending on tumour height, a total mesorectal excision (TME) or partial mesorectal excision (PME) can be performed. Low anastomoses in particular have a high risk of developing anastomotic leakage, which might be explained by blood perfusion compromise. A pilot study indicated a worse blood flow in TME patients in an open setting. The aim of this study was to further evaluate perianastomotic blood perfusion changes in relation to TME and PME in a predominantly laparoscopic context.MethodIn this prospective cohort study, laser Doppler flowmetry was used to evaluate the perianastomotic colonic and rectal perfusion before and after surgery. The two surgical techniques were compared in terms of mean differences of perfusion units using a repeated measures ANOVA design, which also enabled interaction analyses between type of mesorectal excision and location of measurement. Anastomotic leakage until 90 days after surgery was reported for descriptive purposes.ResultsSome 28 patients were available for analysis: 17 TME and 11 PME patients. TME patients had a reduced blood perfusion postoperatively compared to PME patients in the aboral posterior area (mean difference: −57 vs 18 perfusion units; p = 0.010). An interaction between mesorectal excision type and anterior/posterior location was detected at the aboral level (p = 0.007). Two patients developed a minor leakage, diagnosed after discharge.ConclusionPatients operated on using TME have a decreased blood flow in the aboral posterior quadrant of the rectum postoperatively compared to patients operated on using PME. This might explain differing rates of anastomotic leakage.Trial registrationClinicalTrials.gov Identifier: NCT02401100
Highlights
Statistics, Umeå University, Umeå, Sweden 4 Faculty of Medicine and Health, School of Health and MedicalSciences, Örebro University, Örebro, Sweden 5 Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, SwedenAnterior resection is the surgery of choice for rectal cancer in the mid and upper rectum [1]
The current study aims to reproduce the results of the previous study in a predominantly laparoscopic/robotic setting, while further investigating microcirculation differences at both ends of the anastomosis after total mesorectal excision (TME) compared to partial mesorectal excision (PME)
Our primary hypothesis was that the postoperative aboral blood perfusion reduction would be more pronounced after TME compared to PME
Summary
Statistics, Umeå University, Umeå, Sweden 4 Faculty of Medicine and Health, School of Health and MedicalSciences, Örebro University, Örebro, Sweden 5 Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, SwedenAnterior resection is the surgery of choice for rectal cancer in the mid and upper rectum [1]. Studies imply that a disturbed rectal microcirculation is related to leakage [8], while angiography data suggest that the collateral blood flow of the mid and lower part of the rectum is less pronounced than in the upper rectum [9]. Differences in blood flow after PME compared to TME using LDF have been investigated in a previous pilot study. In comparison to PME patients, a trend of generally decreased blood flow among patients who had undergone TME was found, as well as a significantly worsened perfusion in the posterior rectal quadrant [18]. The current study aims to reproduce the results of the previous study in a predominantly laparoscopic/robotic setting, while further investigating microcirculation differences at both ends of the anastomosis after TME compared to PME.
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