Journal of Gastrointestinal Surgery

, Volume 16, Issue 2, pp 427–434 | Cite as

RETRACTED ARTICLE: Colorectal Infraperitoneal Anastomosis: The Effects of Perioperative Supplemental Oxygen Administration on the Anastomotic Dehiscence

  • Mario SchietromaEmail author
  • Francesco Carlei
  • Emanuela Marina Cecilia
  • Federica Piccione
  • Zuleyka Bianchi
  • Gianfranco Amicucci
Review Article



The role of supplemental oxygen therapy in the healing of colorectal anastomosis is still very much at an experimental stage. The aim of the present study, prospective randomized, was to assess the effect of administration of perioperative supplemental oxygen therapy on infraperitoneal anastomosis, where the risk of leakage is higher.


We enrolled 72 patients between February, 2008 and February, 2011, who underwent elective open infraperitoneal anastomosis for rectal cancer (middle and low). Patients were assigned randomly to an oxygen/air mixture with a fraction of inspired oxygen (FiO2) of 30% (n = 37) or 80% (n = 35). Administration was commenced after induction of anesthesia and maintained for 6 h after surgery.


The overall anastomotic leak rate was 16.6% (12 out of 72); 8 patients (21.6%) had an anastomotic dehiscence in the 30% FiO2 group and 4 (11.4%) in the 80% FiO2 group (p < 0.05). The risk of anastomotic leak was 46% lower in the 80% FiO2 group (RR, 0.63; 95% confidence interval, 0.42–0.98) vs. the 30% FiO2.


Therefore, supplemental 80% FiO2 during and for 6 h after major rectal cancer surgery, reducing postoperative anastomotic dehiscence, should be considered part of ongoing quality improvement activities related to surgical care, with few risks to the patient and little associated cost.


Rectal cancer Colorectal anastomosis Oxygen 


  1. 1.
    Eriksen MT, Wibe A, Norstein J, Haafner J, Wiig JN. Norwegian Rectal Cancer Group. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 2005; 7:51–57.PubMedCrossRefGoogle Scholar
  2. 2.
    Alves A, Panis Y, Trancart D, Reginbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 2002; 26:499–502.PubMedCrossRefGoogle Scholar
  3. 3.
    Yeh CY, Changchien CR, Wang JY, Chen JS, Chen HH, Chiang JM, Tang R. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 2005; 241:9–13.PubMedGoogle Scholar
  4. 4.
    Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998; 85:355–358.PubMedCrossRefGoogle Scholar
  5. 5.
    Platell C, Barwood N, Dorfmann G, Makin G. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis 2007; 9:71–79.PubMedCrossRefGoogle Scholar
  6. 6.
    Köckerling F, Rose J, Schneider C, Scheidbach H, Scheuerlein HR, Reymond MA, Reck T, Konradt J, Bruch HP, Zornig C, Bärlehner E, Kuthe A, Szinicz G, Richter HA, Hohenberger W. Laparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group (LCSSG). Surg Endosc 1999; 13:639–644.PubMedCrossRefGoogle Scholar
  7. 7.
    Kirchhoff P, Clavien PA, Hahnloser D. Complications in colorectal surgery: risk factors and preventive strategies. Patient Safety in Surgery 2010; 4:5.PubMedCrossRefGoogle Scholar
  8. 8.
    Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR. Factors associated with the occurence of leaks in stapled rectal anastomosis: a review of 1014 patients. J Am Coll Surg 1997; 185:105–113.PubMedGoogle Scholar
  9. 9.
    Mäkelä JT, Kiviniemi H, Laitinem S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 2003; 46:653–656.PubMedCrossRefGoogle Scholar
  10. 10.
    Sørensen LT, Jørgenson T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jørgensen P. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 1999; 86:927-931.PubMedCrossRefGoogle Scholar
  11. 11.
    Dworkin MJ, Allen-Mersh TG. Effect of inferior mesenteric artery ligation on blood flow in the marginal artery-dependent sigmoid colon. J Am Coll Surg 1996; 183:357–360.PubMedGoogle Scholar
  12. 12.
    Abele D. Toxyc oxygen: the radical life-giver. Nature 2002; 420:27PubMedCrossRefGoogle Scholar
  13. 13.
    Clarkson AN, Sutherland BA, Appleton I. The biology and pathology of hypoxia-ischemia: an update. Arch Immunol Ther Exp 2005; 53:213–225Google Scholar
  14. 14.
    Mariani E, Polidori MC, Cherubini A, Mecocci P. Oxidative stress in brain aging, neurodegenerative and vascular disease: an overview. J Chromatogr B Anal Technol Biomed Life Sci 2005; 827:65–75CrossRefGoogle Scholar
  15. 15.
    Shannon AM, Bouchier-Hayes DJ, Condrom CM, Toomey D. Tumor hypoxia, chemotherapeutic resistance and hypoxia-related therapies. Cancer Treat Rev 2003; 29:297–307PubMedCrossRefGoogle Scholar
  16. 16.
    Sheridan WG, Lowndes RH, Young HL. Tissue oxygen tension as a predictor of colonic anastomotic healing. Dis Colon Rectum 1987; 30:867–871.PubMedCrossRefGoogle Scholar
  17. 17.
    Hamzaoğlu I, Karahasanoğlu T, Aydin S, Sahin DA, Carkman S, Sariyar M, Alemdaroğlu K. The effects of hyperbaric oxygen on normal and ischemic colon anastomoses. Am J Surg 1998; 176:458–461PubMedCrossRefGoogle Scholar
  18. 18.
    Semenza GL. HIF-1, O2 and the 3 PHDs: how animal cells signal hypoxia to the nucleus. Cell 2001; 107:1–3PubMedCrossRefGoogle Scholar
  19. 19.
    West JB. Respiratory physiology—the essentials. Williams & Willkins; 1999.Google Scholar
  20. 20.
    Hockel M, Vaupel P. tumour hypoxia: definitions and current clinical, biologic and molecular aspects. J Natl Cancer Inst 2001; 93:266–276.PubMedCrossRefGoogle Scholar
  21. 21.
    Hunt TK, Pai MP. The effect of varying oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet 1972; 135:561–567.PubMedGoogle Scholar
  22. 22.
    Belda FJ, Aguilera L, García de la Asunción J, Alberti J, Vicente R, Ferrándiz L, Rodríguez R, Company R, Sessler DI, Aguilar G, Botello SG, Ortí R; Spanish Reduccion de la Tasa de Infeccion Quirurgica Group. Supplemental perioperative oxygen and the risk of surgical wound infection: a randomized controlled trial. JAMA 2005; 294:2035–42.PubMedCrossRefGoogle Scholar
  23. 23.
    García-Botello SA, García-Granero E, Lillo R, López-Mozos F, Millán M, Lledó S. Randomized clinical trial to evaluate the effects of perioperative supplemental oxygen administration on the colorectal anastomosis. Br J Surg 2006; 93:698–706.PubMedCrossRefGoogle Scholar
  24. 24.
    American Society of Anesthesiologists. New classification of physiology statuss. Anesthesiologists 1963;24:111.Google Scholar
  25. 25.
    Franchi M, Ghezzi F, Zanaboni F, Scarabelli C, Beretta P, Donadello N. Nonclosure of peritoneum at radical abdominal hysterectomy and pelvic node dissection: a randomized study. Obstet Gynecol 1997; 90:622.PubMedCrossRefGoogle Scholar
  26. 26.
    Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22:321–336.PubMedCrossRefGoogle Scholar
  27. 27.
    Greif R, Akca O, Horn EP, Kurz A, Sessler DI. Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. Outcomes Research Group. N Eng J Med 2000; 342:161–167.CrossRefGoogle Scholar
  28. 28.
    Brasel K, McRitchie D, Dellinger P; EBRS Group. Canadian Association of General Surgeons and American College of Surgeons Evidence Based Reviews in Surgery. 21: the risk of surgical site infection is reduced with perioperative oxygen. Can J Surg 2007; 50:214–216.PubMedGoogle Scholar
  29. 29.
    Caldwell PRB, Lee Wl Jr, Schildkraut HS, Archibald ER. Changes in lung volume, diffusing capacity, and blood gases in men breathing oxygen. J Appl Physiol 1966; 21:1477–1483.PubMedGoogle Scholar
  30. 30.
    Turan A, Apfel CC, Kumpch M, Danzeisen O, Eberhart LH, Forst H, Heringhaus C, Isselhorst C, Trenkler S, Trick M, Vedder I, Kerger H. Does the efficacy of supplemental oxygen for the prevention of postoperative nausea and vomiting depend on the measured outcome, observational period or site of surgery? Anaesthesia 2006; 61(7):628–633.PubMedCrossRefGoogle Scholar
  31. 31.
    Mayzler O, Weksler N, Domchik S, Klein M, Mizrahi S, Gurman GM. Does supplemental perioperative oxygen administration reduce the incidence of wound infection in elective colorectal surgery? Minerva Anestesiol 2005; 71: 21–25.PubMedGoogle Scholar
  32. 32.
    Pryor KO, Fahey TJ III, Lien CA, Goldstein PA. Surgical site infection and the routine use of perioperative hyperoxia in a general surgical population: a randomized controlled trial. JAMA 2004; 291: 79–87.PubMedCrossRefGoogle Scholar
  33. 33.
    Gardella C, Goltra LB, Laschansky E, Drolette L, Magaret A, Chadwick HS, Eschenbach D. High concentration supplemental perioperative oxygen to reduce the incidence of postcesarean surgical site infection: a randomized controlled trial. Obstet Gynecol 2008; 112: 545–552.PubMedCrossRefGoogle Scholar
  34. 34.
    Qadan M, Akça O, Mahid SS, Hornung CA, Polk HC Jr. Perioperative supplemental oxygen therapy and surgical site infection: a meta-analysis of randomized controlled trials. Arch Surg 2009; 144(4):359–367.PubMedCrossRefGoogle Scholar
  35. 35.
    Meyhoff CS, Wetterslev J, Jorgensen LN, Henneberg SW, Høgdall C, Lundvall L, Svendsen PE, Mollerup H, Lunn TH, Simonsen I, Martinsen KR, Pulawska T, Bundgaard L, Bugge L, Hansen EG, Riber C, Gocht-Jensen P, Walker LR, Bendtsen A, Johansson G, Skovgaard N, Heltø K, Poukinski A, Korshin A, Walli A, Bulut M, Carlsson PS, Rodt SA, Lundbech LB, Rask H, Buch N, Perdawid SK, Reza J, Jensen KV, Carlsen CG, Jensen FS, Rasmussen LS; PROXI Trial. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery. JAMA 2009; 302: 1543–1550.PubMedCrossRefGoogle Scholar
  36. 36.
    Vance Y Sohn, Scott R. Steele. Temperature control and the role of supplemental oxygen. Clin Colon Rectal Surg 2009; 22(1):21–27.PubMedCrossRefGoogle Scholar
  37. 37.
    Shandall A, Lowndes R, Young HL. Colonic anastomotic healing and oxygen tension. Br J Surg 1985; 72:606–609.PubMedCrossRefGoogle Scholar
  38. 38.
    Tornero- Campello G. Br J Surg 2006; 93: 1148.PubMedCrossRefGoogle Scholar
  39. 39.
    Garcia-Botello SA. Br J Surg 2006; 93: 1148.Google Scholar
  40. 40.
    Sala C, García-Granero E, Martí R. Anastomotic pHi monitoring after colorectal surgery. Design and preliminary results. Br J Surg 1994; 81:35.Google Scholar
  41. 41.
    García-Granero E, García J, Sala C. Is intramucosal pH associated with wound anastomotic complications after colorectal surgery? Dis Colon Rectum 1998; 41:A56 (Abstract)Google Scholar
  42. 42.
    Comroe JH Jr, Dripps RD, Dumke PR. Oxygen toxicity. The effect of inhalation of high concentrations of oxygen for twenty-four hours on normal men at sea level and at simulated altitude of 18000 feet. JAMA 1945; 128:710–717.CrossRefGoogle Scholar
  43. 43.
    Dubois AB, Turaids T, Mammen RE, Nobrega FT. Pulmonary atelectasis in subjects breathing oxygen at sea level or at simulated altitude. J Appl Physiol 1966; 21:828–836.PubMedGoogle Scholar
  44. 44.
    Montgomery AB, Luce JM, Murray JF. Retrosternal pain is an early indicator of oxygen toxicity. Am Rev Respir Dis 1989; 139:1548–1550.PubMedCrossRefGoogle Scholar
  45. 45.
    Kabon B, Kurz A. Optimal perioperative oxygen administration. Curr Opin Anaesthesiol 2006; 19:11–18.PubMedCrossRefGoogle Scholar
  46. 46.
    Knighton DR, Halliday B, Hunt TK. Oxygen as an antibiotic: the effect of inspired oxygen on infection. Arch Surg 1984; 119(2):199–204.PubMedCrossRefGoogle Scholar
  47. 47.
    Allen DB, Maguire JJ, Mahdavian M, Wicke C, Marcocci L, Scheuenstuhl H, Chang M, Le AX, Hopf HW, Hunt TK. Wound hypoxia and acidosis limit neutrophil bacterial killing mechanisms. Arch Surg 1997; 132(9):991–996.PubMedCrossRefGoogle Scholar
  48. 48.
    Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, Bokey EL. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 2004; 240:255–259.PubMedCrossRefGoogle Scholar
  49. 49.
    Law WL, Choi HK, Lee YM, Ho JW, Seto CL. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg 2007; 11:8–15.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Mario Schietroma
    • 1
    • 2
    Email author
  • Francesco Carlei
    • 1
  • Emanuela Marina Cecilia
    • 1
  • Federica Piccione
    • 1
  • Zuleyka Bianchi
    • 1
  • Gianfranco Amicucci
    • 1
  1. 1.Department of SurgeryUniversity of L’AquilaCoppitoItaly
  2. 2.Università degli Studi di L’Aquila, Facoltà di Medicina e Chirurgia, Dipartimento di Scienze ChirurgicheCoppitoItaly

Personalised recommendations