Ultralow anterior resection with implantation of gentamicin-collagen sponge and no defunctioning stoma: anastomotic leakage and local cancer relapse

Tomasz Michalik , Rafał Matkowski , Przemysław Biecek , Jozef Forgacz , Bartlomiej Szynglarewicz

Abstract

BackgroundAnterior resection with total mesorectal excision (TME) of ultralow rectal cancer may result in the increased risk of the anastomotic leakage (AL). The aim of this study was to evaluate the usefulness of the gentamicin-collagen sponge (GCS) for the protection against symptomatic AL and investigate association between AL and local relapse (LR).Patients and methodsA series of 158 patients with ultralow rectal cancer was studied. All the patients underwent R0 sphincter-saving TME with anastomosis wrapping using GCS. In none of the cases a temporary protective stoma was constructed.ResultsAL rate was 3.2% (5/158) while median time to AL diagnosis was 5 days following surgery (range 3-15). There was no postoperative and leakage-related mortality. Patient age > 75 years and smoking were independent risk factors related to significantly increased AL rate: 12.5%vs. 0.8% (P= 0.0004) and 5.7%vs. 0%P= 0.043), respectively. LR was observed in 12% of cases. It was highly significantly more common and developed earlier in patients who have had AL when compared with non-AL group: 80%vs. 9% (P= 0.00001) and 8.5vs. 17 months (P= 0.014), respectively.ConclusionsAnastomosis wrapping with GCS after anterior resection with TME is a safe procedure resulting in the low incidence of anastomotic leakage which may be also associated with decreased risk of local relapse.
Author Tomasz Michalik
Tomasz Michalik,,
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, Rafał Matkowski
Rafał Matkowski,,
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, Przemysław Biecek (FMIS / DCSDCAM)
Przemysław Biecek,,
- Department of CAD/CAM Systems Design and Computer-Aided Medicine
, Jozef Forgacz
Jozef Forgacz,,
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, Bartlomiej Szynglarewicz
Bartlomiej Szynglarewicz,,
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Journal seriesRadiology and Oncology, ISSN , e-ISSN 1581-3207, (0 pkt)
Issue year2019
Vol53
No1
Pages77-84
Publication size in sheets0.5
Keywords in Englishanastomotic leakage; anterior resection; gentamicin-collagen sponge; rectal cancer; total mesorectal excision
DOIDOI:10.2478/raon-2019-0008
URL https://www.ncbi.nlm.nih.gov/pubmed/30840588
Languageen angielski
Score (nominal)0
ScoreMinisterial score = 0.0, 13-05-2019, ArticleFromJournal
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