Diagnosis Of Anastomotic Leakage Research Articles

LABORATORY PREDICTORS FOR DIAGNOSING COLORECTAL ANASTOMOTIC LEAKAGE.

An important concern in oncological coloproctology is colorectal anastomotic leakage (AL), which occurs in 3.5%-21% of patients. Predicting the occurrence of failure based on the results of laboratory markers can be decisive for the treatment of this complication. To improve the early diagnosis of AL by establishing combinations and threshold values of laboratory markers - predictors of the inflammatory process. The prospective study, conducted from 2020 to 2023, included 213 rectal cancer patients who underwent low anterior resection after neoadjuvant chemoradiotherapy. The inflammatory biomarkers were assessed before surgery and on the 3rd, 5th, and 7th days of the postoperative period. AL diagnosed in 25 (11.74%) patients by the grade of severity was as follows: A (radiological) in 7 (3.29%) patients; B (clinical) - 4 (1.88%); C (clinically expressed, peritonitis) - 11 (5.16%), and P (late) - 3 (1.41%) patients. The changes in the laboratory indicators of the inflammatory response such as С-reactive protein (CRP), procalcitonin (PCT), the counts of neutrophils (NEU), lymphocytes (LYM), platelets (PLT), and neutrophil/lymphocyte ratio (NLR) were significant only in B or C AL grades. Among them, only three indicators were identified as significant for predicting AL when assessed 24 h before the onset of this complication, namely LYM (threshold value ≤ 0.97 × 103/mm3, sensitivity 66.7% and specificity 81.3%, p < 0.001); PLT (threshold value > > 257 103/mm3, sensitivity 58.6%, and specificity 86.7%, p < 0.001); and NLR (threshold value > 4.42, sensitivity 58.1%, and specificity 86.7%, p < 0.001). The three-factor model based on these selected indicators was set up, and the prognosis index (Prog) was proposed with the decision threshold Progcrit = 2.23. The sensitivity of the model was 80% (95% CI 51.9%-95.7%), and the specificity - 74.2% (67.6%-80.2%). Based on the routine laboratory predictors used in the complex diagnosis of AL, B or C AL grades may be predicted allowing for the timely effective early diagnosis, medication, and surgical intervention..

517. INTERNATIONAL CONSENSUS AND CLINICAL CARE ALGORITHM FOR THE DIAGNOSIS AND TREATMENT OF ANASTOMOTIC LEAK AFTER ESOPHAGECTOMY

Abstract Background Anastomotic leak (AL) is a common and severe complication after esophagectomy. Guidelines for the management of AL are lacking due to limited evidence, in which case consensus can provide a sound base for guiding clinical practice. This study aimed to develop a consensus-based guideline and clinical algorithm on the diagnosis and treatment of AL after esophagectomy. Methods A three-stage modified Delphi study was performed. Stage 1 comprised a scoping systematic review to find available evidence and formulate statements. Methodological quality was assessed using the Newcastle-Ottawa scale. Stage 2 comprised a two-round Delphi survey, globally distributed to surgeons and gastro-enterologists experienced in diagnosing and treating AL. During stage 3, clinical recommendations were formulated by an international expert panel, based on the Delphi consensus and a strength was assigned following GRADE principals. A clinical care algorithm was developed based on these recommendations. This study was performed in collaboration with the ISDE Guidelines Committee. Results A total of 5.843 articles were screened, and 118 included to formulate Delphi statements. The Delphi survey was completed by 106 participants in the first round and 136 in the second. Consensus was achieved on 13 statements on diagnosis and 21 statements on treatment of AL. During the guideline development stage, 12 diagnostic recommendations were formulated covering screening, clinical signs, biochemical tests, and imaging for the diagnosis of AL. 15 recommendations were formulated regarding treatment strategies of AL and indications and techniques for supportive care, drainage and defect closure. A clinical care algorithm on diagnosis and treatment of AL was designed. Conclusion This study developed clinical recommendations based on consensus and available evidence, and designed a clinical care algorithm for the diagnosis and treatment of AL after esophagectomy. The developed recommendations and clinical care algorithm, may provide clinical support and aid standardized decision-making in clinical practice and potentially improve patient outcomes.

Peritoneal fluid indocyanine green test for diagnosis of gut leakage in anastomotic leakage rats and colorectal surgery patients.

Application of indocyanine green (ICG) fluorescence has led to new developments in gastrointestinal surgery. However, little is known about the use of ICG for the diagnosis of postoperative gut leakage (GL). In addition, there is a lack of rapid and intuitive methods to definitively diagnose postoperative GL. To investigate the effect of ICG in the diagnosis of anastomotic leakage in a surgical rat GL model and evaluate its diagnostic value in colorectal surgery patients. Sixteen rats were divided into two groups: GL group (n = 8) and sham group (n = 8). Approximately 0.5 mL of ICG (2.5 mg/mL) was intravenously injected postoperatively. The peritoneal fluid was collected for the fluorescence test at 24 and 48 h. Six patients with rectal cancer who had undergone laparoscopic rectal cancer resection plus enterostomies were injected with 10 mL of ICG (2.5 mg/mL) on postoperative day 1. Their ostomy fluids were collected 24 h after ICG injection to identify the possibility of the ICG excreting from the peripheral veins to the enterostomy stoma. Participants who had undergone colectomy or rectal cancer resection were enrolled in the diagnostic test. The peritoneal fluids from drainage were collected 24 h after ICG injection. The ICG fluorescence test was conducted using OptoMedic endoscopy along with a near-infrared fluorescent imaging system. The peritoneal fluids from the GL group showed ICG-dependent green fluorescence in contrast to the sham group. Six samples of ostomy fluids showed green fluorescence, indicating the possibility of ICG excreting from the peripheral veins to the enterostomy stoma in patients. The peritoneal fluid ICG test exhibited a sensitivity of 100% and a specificity of 83.3% for the diagnosis of GL. The positive predictive value was 71.4%, while the negative predictive value was 100%. The likelihood ratios were 6.0 for a positive test result and 0 for a negative result. The postoperative ICG test in a drainage tube is a valuable and simple technique for the diagnosis of GL. Hence, it should be employed in clinical settings in patients with suspected GL.

Role of Biomarkers in the Diagnosis of Anastomotic Leakage After Colorectal Surgery: A Systematic Review and Meta-Analysis.

Due to its diverse presentation, anastomotic leakage (AL) following colorectal surgery is challenging to detect and frequently discovered when the patient becomes critically ill. When diagnosing AL in its early stages, biomarkers play a large role. This review was conducted to evaluate the diagnostic value of biomarkers in AL after colorectal surgeries. A literature search was undertaken electronically in major search engines such as Medline (PubMed), Google Scholar, ScienceDirect, EMBASE, and CENTRAL (Cochrane Library) databases. Observational studies of both retrospective and prospective nature were included. Origin Pro 2022 (Origin Labs) software was used to assess the prevalence of AL and generate the forest plot.A total of 13 articles fulfilled the eligibility criteria. A pooled prevalence of 9.19% was noted for AL in colorectal surgeries. In the present review, the observed sensitivity for C-reactive protein (CRP) was 80.5% and the specificity was 84% (postoperative day three). In contrast, these were 100% and 83.9% for procalcitonin on postoperative day five.CRP showed the highest diagnostic accuracy and excels at eliminating AL, but combining biomarkers can increase the diagnostic precision of early detection of AL.

A real-world study was conducted to develop a nomogram that predicts the occurrence of anastomotic leakage in patients with esophageal cancer following esophagectomy.

The incidence of anastomotic leakage (AL) following esophagectomy is regarded as a noteworthy complication. There is a need for biomarkers to facilitate early diagnosis of AL in high-risk esophageal cancer (EC) patients, thereby minimizing its morbidity and mortality. We assessed the predictive abilities of inflammatory biomarkers for AL in patients after esophagectomy. In order to ascertain the predictive efficacy of biomarkers for AL, Receiver Operating Characteristic (ROC) curves were generated. Furthermore, univariate, LASSO, and multivariate logistic regression analyses were conducted to discern the risk factors associated with AL. Based on these identified risk factors, a diagnostic nomogram model was formulated and subsequently assessed for its predictive performance. Among the 438 patients diagnosed with EC, a total of 25 patients encountered AL. Notably, elevated levels of interleukin-6 (IL-6), IL-10, C-reactive protein (CRP), and procalcitonin (PCT) were observed in the AL group as compared to the non-AL group, demonstrating statistical significance. Particularly, IL-6 exhibited the highest predictive capacity for early postoperative AL, exhibiting a sensitivity of 92.00% and specificity of 61.02% at a cut-off value of 132.13 pg/ml. Univariate, LASSO, and multivariate logistic regression analyses revealed that fasting blood glucose ≥7.0mmol/L and heightened levels of IL-10, IL-6, CRP, and PCT were associated with an augmented risk of AL. Consequently, a nomogram model was formulated based on the results of multivariate logistic analyses. The diagnostic nomogram model displayed a robust discriminatory ability in predicting AL, as indicated by a C-Index value of 0.940. Moreover, the decision curve analysis provided further evidence supporting the clinical utility of this diagnostic nomogram model. This predictive instrument can serve as a valuable resource for clinicians, empowering them to make informed clinical judgments aimed at averting the onset of AL.

Role of Biomarkers in the Diagnosis of Anastomotic Leakage After Colorectal Surgery: A Systematic Review and Meta-Analysis

Introduction: Anastomotic leakage (AL) after colorectal surgery is difficult to diagnose because of its varied presentation and is often identified when the patient becomes critically ill. Biomarkers contribute a significant weightage in identifying AL at earlier stages. Hence, this review assessed the diagnostic role of biomarkers in AL following colorectal surgery. Methodology: A literature search was electronically conducted in 3 search engines: Pubmed, Google search, and journal on the web till February 2022. Observational studies of both retrospective and prospective nature were included. Open meta-analyst software was used to assess the prevalence of AL. Results: 13 articles fulfilled the eligibility criteria. A pooled prevalence of 8% was noted for AL in colorectal surgeries (95%CI; 6.3:10.1). In the present review, sensitivity ranged from 53.8% to 90% and specificity from 69.6% to 100%. Conclusion: Biomarkers proved to be a reliable predictor of AL in patients who have undergone colorectal surgery.

Efficacy of Biomarkers in Predicting Anastomotic Leakage After Gastrointestinal Resection: A Systematic Review and Meta-Analysis.

Our systematic review and meta-analysis were designed to evaluate the published literature from 2016 to 2019 on which the role of biomarkers in predicting the anastomotic leakage (AL) in gastroesophageal cancer surgerywas investigated. This extensive literature search was conducted on the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Excerpta Medica dataBASE (EMBASE) were used to gather the relevant information.No restrictions were made on the type of biomarkers. Wald or likelihood ratio (LRT) fixed effect tests were used to estimate the pooled prevalence to generate the proportions with 95% confidence intervals (CI) and model-fitted weights. For analyzing heterogeneity, the Cochran Q test and I square test were used. The Egger regression asymmetry test and funnel plot were used for publication. In this meta-analysis, a total of 15 studies were recruited with 1892 patients undergoing the resection. The pooled elevated C-reactive protein (CRP) was observed as 13.9% ranging from 11.6% to 16.1%. The pooled prevalence of other biomarkers with AL was observed as 4.4%. Significant heterogeneity was observed between studies that reported CRP and other biomarkers (92% each with chi-squared values of 78.80 and 122.78, respectively). However, no significant publication was observed between studies (p=0.61 and p=0.11, respectively). We concluded our study on this note that different biomarkers are involved in the diagnosis of AL. However, all these biomarkers are poor predictors with insufficient predictive value and sensitivity.

EARLY DIAGNOSIS OF ANASTOMOTIC LEAKAGE AFTER ELECTIVE COLO-RECTAL SURGERY USING DUTCH LEAKAGE SCORE – A PROSPECTIVE OBSERVATIONAL STUDY

Introduction: Anastomotic leakage is a major complication after colorectal surgery, with reported incidence of 2–7%. To limit the clinical consequences, it should be detected and treated as soon as possible. Leak usually becomes apparent between 5 and 7 days postoperatively. A standardized post-operative score, Dutch Leakage Score (DLS) can be a useful clinical tool to reduce delay in diagnosis of anastomotic leak (AL) and reduce mortality. A score of &lt;4 was considered negative while a score of 4 or more was considered positive. Methods: Total 110 patients were enrolled after written informed consent during March 2021–October 2022 at a tertiary care hospital in Odisha. DLS was measured before surgery and on POD2, POD3, and POD6. Results: Among the 110 patients, the AL rate was 16.4%. With respect to AL, DLS cutoff of 2.5 on POD2 had positive predictive value (PPV) of 53.10% and a negative predictive value (NPV) of 98.70%. DLS cutoff of 4.0 on POD3 had a PPV of 80.90% and a NPV 98.90%. DLS cutoff of 3.0 on POD6 had a PPV of 84.20% and a NPV of 96.70%.The most common day of AL was the fifth P.O.D (in seven patients) followed by sixth P.O.D (in five patients). Conclusion: DLS is a good positive and excellent negative predictor of AL. DLS is an easy bedside assessment to gauge the likelihood of AL in the early post-operative period.

Is early CT in cases of elevated postoperative CRP the best option for the diagnosis of colorectal anastomotic leakage?

After colorectal surgery (CRS), the early detection and treatment of anastomotic leakage (AL) is critical. We aimed to evaluate the efficacy of early contrast-enhanced computed tomography (CT) (postoperative day [POD] 2-3) after elective colorectal surgery for the diagnosis of AL for patients with elevated CRP levels at POD 2-3. From 2017 to 2022, all patients who underwent elective CRS with an anastomosis and CRP > 150mg/ml on POD 2-3 underwent enhanced CT during the 24h following the CRP evaluation and were included in this retrospective, single-center study. The primary endpoint was the diagnostic value of the early CT scan for the detection of AL. The secondary endpoints were the diagnostic value of the early CT scan for the detection of grade C AL according to the type of resection and anastomosis and the quality of the opacification. A total of 661 patients underwent elective CRS with anastomosis with an overall AL rate of 7.4%. Among the 661 patients, 141 were finally included in the study. The accuracy of early CT for the diagnosis of AL was 83.7%. For grade C AL, the accuracy was 81.6%. Among patients who had an ileocolic anastomosis, the accuracy was 88.2%, among those who had colorectal or ileorectal anastomosis, the accuracy was 83.0%, and among those who had a coloanal, the accuracy was 66.7%. In cases of good opacification by CT, the accuracy was 84.0%. Early CT does not show perfect accuracy for an early diagnosis of AL.

Procalcitonin and C-reactive protein: markers in the early diagnosis of anastomotic leak.

To determine the efficacy of serum procalcitonin (PCT) and C-reactive protein (CRP) in the early diagnosis of anastomotic leak (AL) in patients undergoing colorectal surgery. Diagnostic test in a tertiary care hospital. Patients who did not have preoperative measurements of PCT and CRP were excluded. Those with postoperative infection not related to AL were eliminated. The diagnostic efficacy measures were sensitivity (Sn), specificity (Sp), positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratios, and area under the receiver operating characteristic curve (AUROC). Thirty-nine patients were analyzed; six had AL (15.4%). PCT and CRP increased on the second postoperative day, only in patients with AL. The cut-off points at the second postoperative day were 1.55 ng/mL for PCT and 11.25 mg/L for CRP. The most efficacious test was PCR at second postoperative day (AUROC: 1.00; Sn: 100%; Sp: 96.7%; PPV: 85.7%; NPV: 100%; LR+: 33.0). CRP at second postoperative day was the most effective test in the early diagnosis of AL in patients undergoing colorectal surgery, with a cut-off point lower than that reported in the international literature.

Tandem Mass Tag-Based Proteomic Profiling Identifies Biomarkers in Drainage Fluid for Early Detection of Anastomotic Leakage after Rectal Cancer Resection.

Anastomotic leakage (AL), one of the most severe complications in rectal surgery, is often diagnosed late because of the low specificity of the clinical symptoms and limitations of current clinical investigations. Identification of patients with early AL remains challenging. Here, we explored the protein expression profiles of AL patients to provide potential biomarkers to identify AL in patients who undergo surgery for rectal cancer. We screened differentially expressed proteins (DEPs) in drainage fluid from AL and non-AL patients using a tandem mass tag method. A total of 248 DEPs, including 98 upregulated and 150 downregulated proteins, were identified between AL and non-AL groups. Gene ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses suggested that DEPs were enriched in neutrophil degranulation, bacterial infection, proteolysis, hemostasis, and complement and coagulation cascades. The results of enzyme-linked immunosorbent assay validated that the expression of the top three upregulated DEPs, AMY2A, RETN, and CELA3A, was significantly increased in the drainage fluid of AL patients, compared with that of non-AL patients (AMY2A, P = 0.001; RETN, P < 0.0001; and CELA3A, P = 0.023). Thus, our findings provide several potential biomarkers for the early diagnosis of AL after rectal cancer resection.

225. PREDICTORS OF ANASTOMOTIC LEAK AMONG PATIENTS UNDERGOING ESOPHAGECTOMY: A RETROSPECTIVE COHORT OF 6669 PATIENTS

Abstract Background Despite advances in operative techniques, anastomotic leak (AL) after esophagectomy remains a dreaded complication associated with a relatively high morbidity and mortality. Identification of patient and surgical factors associated with AL are useful for risk stratification to improve patient and procedure selection. Furthermore, an adequately powered analysis for the incidence of AL after minimally invasive esophagectomy is lacking. Methods The ACS-NSQIP database was used to extract patients who underwent esophagectomy between 2016 and 2021. Categorical variables were analyzed using chi-squared tests and continuous variables were evaluated using ANOVA tests. Using a hypothesis driven purposeful selection methodology, a multivariable logistic regression model was created with the primary outcome of interest being the odds of AL. Statistical analysis was completed with StataSE 17 (STATACorp, LP, College Station, TX). The primary outcome of interest was the effect of minimally invasive surgery on AL. Secondary outcomes were the effect of patient characteristics and surgeon specialty on AL. Results Of the 6669 esophagectomies, the leak rates were 14.6% (open; 360/2451), 13.4% (MIS-abdominal; 64/478), 21.1% (MIS-chest; 69/326), 14.3% (MIS-total; 369/2590), and 20.1% (Robotic; 166/824), respectively. On multivariate analysis, positive margin (OR 1.37, 95% CI 1.01–1.85, p = 0.043), MIS-chest (OR 1.40, 95% CI 1.01–1.96, p = 0.047), MIS-total (OR 0.95, 95% CI 0.78–1.15, p = 0.595), MIS-robotic (OR 1.37, 95% CI 1.07–1.77, p = 0.014), transhiatal esophagectomy (OR 1.28, 95% CI 1.01–1.62, p = 0.040), and three-hole esophagectomy (OR 1.38, 95% CI 1.12–1.77, p = 0.014) were surgical factors associated with increased odds of AL (Table 1). Conclusion Anastomoses that were performed by certain types of minimally invasive surgery and those performed in the cervical region were associated with increased odds of AL. Consideration of this increased risk needs to be weighed against the established benefits of minimally invasive surgery when selecting the appropriate procedure for each patient. Identifying patients who are high-risk for an AL pre-operatively may prevent delay in the diagnosis and treatment of ALs in this patient population.

Stoma-free Survival After Rectal Cancer Resection With Anastomotic Leakage: Development and Validation of a Prediction Model in a Large International Cohort.

To develop and validate a prediction model (STOMA score) for 1-year stoma-free survival in patients with rectal cancer (RC) with anastomotic leakage (AL). AL after RC resection often results in a permanent stoma. This international retrospective cohort study (TENTACLE-Rectum) encompassed 216 participating centres and included patients who developed AL after RC surgery between 2014 and 2018. Clinically relevant predictors for 1-year stoma-free survival were included in uni and multivariable logistic regression models. The STOMA score was developed and internally validated in a cohort of patients operated between 2014 and 2017, with subsequent temporal validation in a 2018 cohort. The discriminative power and calibration of the models' performance were evaluated. This study included 2499 patients with AL, 1954 in the development cohort and 545 in the validation cohort. Baseline characteristics were comparable. One-year stoma-free survival was 45.0% in the development cohort and 43.7% in the validation cohort. The following predictors were included in the STOMA score: sex, age, American Society of Anestesiologist classification, body mass index, clinical M-disease, neoadjuvant therapy, abdominal and transanal approach, primary defunctioning stoma, multivisceral resection, clinical setting in which AL was diagnosed, postoperative day of AL diagnosis, abdominal contamination, anastomotic defect circumference, bowel wall ischemia, anastomotic fistula, retraction, and reactivation leakage. The STOMA score showed good discrimination and calibration (c-index: 0.71, 95% CI: 0.66-0.76). The STOMA score consists of 18 clinically relevant factors and estimates the individual risk for 1-year stoma-free survival in patients with AL after RC surgery, which may improve patient counseling and give guidance when analyzing the efficacy of different treatment strategies in future studies.

Assessing the environmental impact of an anastomotic leak care pathway

BackgroundThe healthcare sector faces increasing pressure to improve environmental sustainability whilst continuing to meet the needs of patients. One strategy is to lower the avoidable demand on healthcare services, by reducing the number of surgical complications, such as anastomotic leak (AL). The aim of this study was to assess the environmental impact associated with the care pathway of AL. MethodsAn environmental impact assessment was performed according to the Sustainable Healthcare Coalition (SHC) guidelines. A care pathway, describing the typical steps involved in the diagnosis and treatment of AL was developed. Activity and emission data for each stage of the care pathway were used to calculate the climate, water and waste impact of the treatment of AL patients. ResultsThe environmental impact assessment shows that AL is associated with an average climate, water and waste impact per patient of 1303 kg CO2-eq, 1803 m3 of water and 123 kg waste, respectively. Grade C leaks are associated with the greatest environmental impact, contributing to 89.3 %, 79.4 % and 97.9 % of each impact, respectively. A breakdown of the environmental impact of each activity shows that stoma home management is the largest contributor to the total climate (46.6 %) and waste (47.3 %) impact of AL patients, whilst in-patient hospital stay contributes greatest to the total water impact (46.7 %). ConclusionsThe treatment of AL is associated with a substantial environmental impact. This study is, to our knowledge, the first to assess the environmental impact associated with the treatment of AL.

A risk scoring system for early diagnosis of anastomotic leakage after subtotal esophagectomy for esophageal cancer.

Anastomotic leakage (AL) is one of the most critical postoperative complications after subtotal esophagectomy in patients with esophageal cancer. This study attempted to develop an optimal scoring system for stratifying the risk for AL. The study included 171 patients who underwent subtotal esophagectomy for esophageal cancer followed by esophagogastrostomy in the cervical region from January 2011 to April 2021 at Nagoya University Hospital. AL was defined by radiologic or endoscopic evidence of anastomotic breakdown using some modalities. A risk scoring system for an early diagnosis of AL was established using factors determined in the multivariate analysis. A score was calculated for each patient, and the patients were classified into three categories according to the risk for AL: low-, intermediate- and high-risk. The trend of the risk for AL among the categories was evaluated. Twenty-nine patients (17%) developed AL. Multivariate analysis demonstrated that sinistrous gross features of drain fluid (P<0.001; odds ratio (OR), 10.2), radiologic air bubble sign (P<0.001; OR, 15.0) and the level of drain amylase ≥280U/L on postoperative Day 7 (P<0.001; OR, 9.0) were significantly associated with AL. According to the matching number of the above three risk factors and categorization into three risk groups, the incidence of AL was 6.1% (8/131) in the low-risk group, 45.5% (15/33) in the intermediate-risk group and 85.7% (6/7) in the high-risk group (area under curve, 0.81; 95% confidence interval, 0.72-0.90). The present AL-risk scoring system may be useful in postoperative patient care after subtotal esophagectomy.

Perioperative Blood Transfusions and Anastomotic Leak After Colorectal Surgery for Cancer in an Australian Hospital

PurposePeri-operative blood transfusion has been identified as a risk factor for anastomotic leak in recent studies, but little is known about which patients are at risk for blood transfusion. This study aims to assess the relationship between blood transfusion and anastomotic leak and factors predisposing to leak in patients undergoing colorectal cancer surgery.MethodsThis retrospective cohort study was conducted in a tertiary hospital in Brisbane, Australia, between 2010 and 2019. A total of 522 patients underwent resection of colorectal cancer with primary anastomosis with no covering stoma and the prevalence of anastomotic leak was compared between those who had had perioperative blood transfusion(s) and those who had not.ResultsA total of 19 of 522 patients undergoing surgery for colorectal cancer had developed an anastomotic leak (3.64%). 11.3% of patients who had had a perioperative blood transfusion developed an anastomotic leak whereas 2.2% of patients who had not had a blood transfusion developed an anastomotic leak (p = 0.0002). Patients undergoing procedure on their right colon had proportionally more blood transfusions and this approached statistical significance (p = 0.06). Patients who received a greater quantity of units of blood transfusion prior to their diagnosis of anastomotic leak were more likely to develop an anastomotic leak (p = 0.001).ConclusionPerioperative blood transfusions are associated with a significantly increased risk of an anastomotic leak following bowel resection with primary anastomosis for colorectal cancer.

Diagnostic accuracy of water-soluble contrast enema, contrast-enema computed tomography and endoscopy in detecting anastomotic leakage after (Colo) proctectomy: A meta-analysis.

Anastomotic leakage (AL) as a result of creation of a colorectal/anal anastomosis still represents a frequent complication of colorectal surgery, with short- and long-term consequences on postoperative morbidity, quality of life and oncological outcomes. However, early diagnosis of AL may result in improved outcomes. The aims of this study were to evaluate the diagnostic accuracy of water-soluble contrast enema (WSCE), contrast enema computed tomography (CECT) and endoscopy in identifying AL and to identify the diagnostic procedure that is most accurate. A systematic review and meta-analysis of 19 studies accounting for a total of 25 tests reporting diagnostic accuracy estimates was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines up to June 2021. For the diagnostic tests we evaluated the pooled estimates and conducted pairwise comparisons. For WSCE, the pooled sensitivity was 0.50, the pooled specificity was 0.99 and the area under the curve (AUC) was 0.91. For endoscopy, the pooled sensitivity was 0.69, specificity was 1.00 and AUC was 0.99. The pooled sensitivity and specificity for CECT were 0.89 and 1.00, respectively; the AUC was 0.99. The comparison between CECT and WSCE highlighted a significantly greater sensitivity (p = 0.04) for CECT, whereas no difference was found for specificity. Compared with CECT, endoscopy was not significantly more accurate in terms of either sensitivity or specificity. Endoscopy was found to be significantly more specific than WSCE (p = 0.031) but no difference was found for sensitivity. Water-soluble contrast enema, endoscopy and CECT have an elevated diagnostic accuracy. However, WSCE is less accurate than either endoscopy or CECT. Although greater sensitivity was demonstrated for CECT compared with endoscopy, this was not significant.

Risk factors and conservative therapy outcomes of anastomotic leakage after gastrectomy: Experience of 3,926 patients from a single gastric surgical unit.

Anastomotic leakage (AL) after gastrectomy is one of the severest postoperative complications and is related to increasing mortality. In addition, no consensus guidelines about strategies of AL treatment have been established. This large cohort study aimed to inspect the risk factors and efficacy of the conservative treatment for AL in patients with gastric cancer. We reviewed the clinicopathological data of 3,926 gastric cancer patients undergoing gastrectomy between 2014 and 2021. Results contained the rate, risk factors, and conservative therapy outcomes of AL. In total, 80 patients (2.03%, 80/3,926) were diagnosed with AL, and esophagojejunostomy was the most frequent AL site (73.8%, 59/80). Among them, one patient (2.5%, 1/80) died. Multivariate analysis indicated that low albumin concentration (P = 0.001), presence of diabetes (P = 0.025), laparoscopic method (P < 0.001), total gastrectomy (P = 0.003), and proximal gastrectomy (P = 0.002) were predicting factors for AL. The closure rate for the conservative treatment of AL in the first month after AL diagnosis was 83.54% (66/79), and the median time from leakage diagnosis to the closure of leakage was 17 days (interquartile range 11-26 days). Low level of plasma albumin (P = 0.004) was associated with late leakage closures. In terms of 5-year overall survival, no significant difference was observed between patients with and without AL. The incidence of AL after gastrectomy is associated with low albumin concentration, diabetes, the laparoscopic method, and extent of resection. The conservative treatment is relatively safe and effective for the AL management in patients after gastric cancer surgery.

Curable leakage in stapled IPAA has little effect on the long-term pouch function.

This study aimed to evaluate the frequency and grade of anastomotic leakage (AL) in stapled ileal pouch-anal anastomosis (IPAA) and its long-term impact on the pouch functions. A longitudinal cohort study was conducted on UC patients who underwent stapled IPAA at Yokohama City University Medical Center between 2007 and 2018. The diagnosis and grading of AL were performed in accordance with the recommendations of the International Study Group of Rectal Cancer. We assessed the functional pouch rate, late complication, pouch survival rate, bowel function (bowel movements per day, soiling, spotting, difficulty in distinguishing feces from flatus) and pouch inflammation (pouchitis disease activity index; PDAI) in the long-term period. Two hundred seventy-six patients were analyzed. Twenty-three (8.3%; grade B/C; 13/10) patients were diagnosed with AL, but a functional pouch was achieved in all the twenty-three patients. Anastomotic stricture was significantly more common in patients with AL (AL group) than in patients without AL (non-AL group; AL/non-AL: 13.0/3.2%, p = 0.020). There were no differences in other late complications. Furthermore, the pouch survival rate did not differ between the AL and non-AL groups (100.0/97.9%/10years, p = 0.494). There were no differences between the groups in bowel movements per day, spotting, soling, difficulty in distinguishing feces from flatus, or PDAI postoperatively. Curable AL may not affect late complications (except anastomotic stricture), pouch survival, the bowel function, or pouch inflammation over the long term. Perioperative management to prevent the severity of AL is as important as preventing its occurrence.

Percutaneous Drainage vs. Surgery as Definitive Treatment for Anastomotic Leak after Intestinal Resection in Patients with Crohn's Disease.

Anastomotic leak (AL) remains one of the most relevant complications after intestinal resection for Crohn's disease (CD). While surgery has always been considered the standard treatment for perianastomotic collection, percutaneous drainage (PD) has been proposed as a potential alternative. Retrospective study in consecutive patients treated with either PD or surgery for AL after intestinal resection for CD between 2004 and 2022. AL was defined as a perianastomotic fluid collection confirmed by radiological findings. Patients with generalized peritonitis or clinical instability were excluded. To compare the success rate of PD vs. surgery. Secondary aims: To compare the outcomes at 90 days after the procedures; to identify the variables associated with the indication for PD. A total of 47 patients were included, of which 25 (53%) underwent PD and 22 (47%) surgery. The success rate was 84% in the PD and 95% in the surgery group (p = 0.20). There were no significant differences between the PD and surgery group in postoperative medical and surgical complications, discharge, readmission or reoperation rates at 90 days. PD was more likely to be performed in patients with later diagnosis of AL (OR 1.25, 95% CI 1.03-1.53, p = 0.027), undergoing ileo-colic anastomosis alone (OR 3.72, 95% CI 2.29-12.45, p = 0.034) and treated after 2016 (OR 6.36, 95% CI 1.04-39.03, p = 0.046). The present study suggests that PD is a safe and effective procedure to treat anastomotic leak and perianastomotic collection in CD patients. PD should be indicated in all eligible patients as an effective alternative to surgery.