Abstract
IntroductionNon-healing of anastomotic leakage can be observed in up to 50% after total mesorectal excision for rectal cancer. This study investigates the efficacy of early transanal closure of anastomotic leakage after pre-treatment with the Endosponge® therapy.MethodsIn this prospective, multicentre, feasibility study, transanal suturing of the anastomotic defect was performed after vacuum-assisted cleaning of the presacral cavity. Primary outcome was the proportion of patients with a healed anastomosis at 6 months after transanal closure. Secondary, healing at last follow-up, continuity, direct medical costs, functionality and quality of life were analysed.ResultsBetween July 2013 and July 2015, 30 rectal cancer patients with a leaking low colorectal anastomosis were included, of whom 22 underwent neoadjuvant radiotherapy. Median follow-up was 14 (7–29) months. At 6 months, the anastomosis had healed in 16 (53%) patients. At last follow-up, anastomotic integrity was found in 21 (70%) and continuity was restored in 20 (67%) patients. Non-healing at 12 months was observed in 10/29 (34%) patients overall, and in 3/14 (21%) when therapy started within three weeks following the index operation. Major LARS was reported in 12/15 (80%) patients. The direct medical costs were €8933 (95% CI 7268–10,707) per patient.ConclusionVacuum-assisted early transanal closure of a leaking anastomosis after total mesorectal excision with 73% preoperative radiotherapy showed that acceptable anastomotic healing rates and stoma reversal rates can be achieved. Early diagnosis and start of treatment seems crucial.
Highlights
This study investigates the efficacy of early transanal closure of anastomotic leakage after pre-treatment with the EndospongeÒ therapy
A minimal invasive treatment strategy with vacuum-assisted drainage (EVAC) combined with early transanal closure of the anastomotic defect (‘vacuum-assisted early transanal closure’) has been very successful in the early management of leaking ileoanal anastomoses for ulcerative colitis (UC) or familial polyposis (FAP) [14]. These patients have a neorectum made of small bowel instead of colon, and did not receive neoadjuvant radiotherapy. For this reason we aimed to study the efficacy of vacuum-assisted early transanal closure for rectal cancer patients in terms of anastomotic healing, stoma closure, functionality of the neorectum, quality of life (QoL) and treatment-related costs
Half of the leaking anastomosis treated with vacuumassisted early transanal closure had healed at 6 months of follow-up
Summary
Non-healing of anastomotic leakage can be observed in up to 50% after total mesorectal excision for rectal cancer. This study investigates the efficacy of early transanal closure of anastomotic leakage after pre-treatment with the EndospongeÒ therapy. Methods In this prospective, multicentre, feasibility study, transanal suturing of the anastomotic defect was performed after vacuum-assisted cleaning of the presacral cavity. Primary outcome was the proportion of patients with a healed anastomosis at 6 months after transanal closure. Secondary, healing at last follow-up, continuity, direct medical costs, functionality and quality of life were analysed. Results Between July 2013 and July 2015, 30 rectal cancer patients with a leaking low colorectal anastomosis were included, of whom 22 underwent neoadjuvant radiotherapy.
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