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Risk factors for ischemia/necrosis of the colonic stump after proctectomy and delayed coloanal anastomosis

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Abstract

Introduction

Delayed coloanal anastomosis (DCAA) is a two-stage procedure. DCAA has been increasingly reused in recent years in the management of rectal cancer. Such increased use of DCAA has highlighted the complications associated with this procedure. We aimed to evaluate the risk and risk factors of ischemia/necrosis of the colonic stump between the two stages of DCAA.

Patients and methods

All patients who underwent a proctectomy with a DCAA were included in this retrospective single-centre study from November 2012 to June 2022. Two groups of patients were defined: patients with a well vascularized colonic stump (well vascularized group) and those who experienced ischemia or necrosis of the colonic stump (ischemic group). The primary endpoint was the rate of ischemia or necrosis of the colonic stump and an evaluation of the associated risk factors.

Results

During the study period, 43 patients underwent DCAA. Amongst them, 32 (75%) had a well-vascularized colonic stump (well-vascularized group) and 11 (25%) ischemia of the colonic stump (ischemic group). Relative to patients in the well-vascularized group, those in the ischemic group were more often men (81.8% vs 40.6%, p = 0.034), had a higher BMI (29.2 kg/m2 vs 25.7 kg/m2, p = 0.03), were more frequently diabetic (63.6% vs 21.9%, p = 0.01) and more frequently had had preoperative radiotherapy (100% vs 53.1%, p = 0.008). On the preoperative CT scan, the interspinous diameter was shorter in the ischemic group (9.4 ± 1.01 cm vs 10.6 ± 1.01 cm, p = 0.001), the intertuberosity diameter was shorter (9.2 ± 1.18 cm vs 11.9 ± 1.18 cm, p < 0.0001), and the length of the anal canal was longer (31.9 ± 3 mm vs 27.4 ± 3.2 mm, p < 0.0001).

Conclusion

This study highlights clear risk factors for ischemia/necrosis of the colonic stump after proctectomy with DCAA.

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Data archiving is not mandated but data will be made available on reasonable request.

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Authors and Affiliations

  1. Department of Digestive Surgery, CHU d’Amiens Picardie, 1 Rond point du Pr Cabrol, 80054, Amiens Cedex 01, France

    Jules Le Pessot, Alexandra Pellegrin, Jean-Marc Regimbeau & Charles Sabbagh

  2. UR UPJV 7518, SSPC (Simplification of Surgical Patients Care), Université de Picardie Jules Verne, Amiens, France

    Jules Le Pessot, Alexandra Pellegrin, Jean-Marc Regimbeau & Charles Sabbagh

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  1. Jules Le Pessot
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Contributions

Jules Le Pessot, Alexandra Pellegrin, Jean-Marc Regimbeau and Charles Sabbagh state the following: (1) made substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Charles Sabbagh.

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Le Pessot, J., Pellegrin, A., Regimbeau, JM. et al. Risk factors for ischemia/necrosis of the colonic stump after proctectomy and delayed coloanal anastomosis. Langenbecks Arch Surg 408, 424 (2023). https://doi.org/10.1007/s00423-023-03157-z

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