Rectal washout does not increase the complication risk after anterior resection for rectal cancer

Karl Teurneau-Hermansson,Rebecca Svensson Neufert,Pamela Buchwald,Fredrik Jörgren

doi:10.1186/s12957-021-02193-7

Karl Teurneau-Hermansson, Rebecca Svensson Neufert + Show 2 more

Open Access

https://doi.org/10.1186/s12957-021-02193-7

Copy DOI

Abstract

BackgroundTo reduce local recurrence risk, rectal washout (RW) is integrated in the total mesorectal excision (TME) technique when performing anterior resection (AR) for rectal cancer. Although RW is considered a safe practice, data on the complication risk are scarce. Our aim was to examine the association between RW and 30-day postoperative complications after AR for rectal cancer.MethodsPatients from the Swedish Colorectal Cancer Registry who underwent AR between 2007 and 2013 were analysed using multivariable methods.ResultsA total of 4821 patients were included (4317 RW, 504 no RW). The RW group had lower rates of overall complications (1578/4317 (37%) vs. 208/504 (41%), p = 0.039), surgical complications (879/4317 (20%) vs. 140/504 (28%), p < 0.001) and 30-day mortality (50/4317 (1.2%) vs. 12/504 (2.4%), p = 0.020). In multivariable analysis, RW was a risk factor neither for overall complications (OR 0.73, 95% CI 0.60–0.90, p = 0.002) nor for surgical complications (OR 0.62, 95% CI 0.50–0.78, p < 0.001).ConclusionsRW is a safe technique that does not increase the 30-day postoperative complication risk after AR with TME technique for rectal cancer.

Highlights

To reduce local recurrence risk, rectal washout (RW) is integrated in the total mesorectal excision (TME) technique when performing anterior resection (AR) for rectal cancer
We aimed to evaluate the safety of RW, using population-based data from the Swedish Colorectal Cancer Registry (SCRCR), and explore the hypothesis that RW does not increase the 30day postoperative complication risk with a focus on surgical complications
Between 2007 and 2013, 11,617 patients with rectal cancer were registered in the SCRCR

Summary

Introduction

To reduce local recurrence risk, rectal washout (RW) is integrated in the total mesorectal excision (TME) technique when performing anterior resection (AR) for rectal cancer. Due to advances in management of rectal cancer during the last decades, oncological outcome has improved in terms of decreased local recurrence (LR) rate and improved survival [1,2,3,4,5,6,7,8] These improvements are due to the introduction of the total mesorectal excision (TME) technique and preoperative radiotherapy (RT) or chemoradiotherapy in selected cases [4, 6, 8]. A potential source for LR in rectal cancer is implantation of intraluminal, viable malignant cells shed from the tumour [10,11,12,13,14] To eliminate those cells and thereby reduce the LR risk, rectal washout (RW) has been an integrated part of the TME technique when performing anterior resection (AR) for rectal cancer.

Objectives

Methods

Results

Discussion

Conclusion