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ETVARD (endoscopic transanal vacuum-assisted rectal drainage) leads to complete but delayed closure of extraperitoneal rectal anastomotic leakage cavities following neoadjuvant radiochemotherapy

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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Abstract

Purpose

The purpose of the study was to prospectively assess the impact of neoadjuvant radiochemotherapy on the formation of major anastomotic rectal leaks and treatment by endoscopic transanal vacuum-assisted rectal drainage (ETVARD).

Materials and methods

Twenty six patients with malignancies with rectal anastomotic leaks were prospectively treated, including 14 of 26 patients following neoadjuvant radiochemotherapy. ETVARD was the first-line treatment.

Results

In 23 of 26 patients, ETVARD was successfully completed. In patients following neoadjuvant radiochemotherapy sizes of leakage cavities, duration of ETVARD, number of sponge exchanges, and endoscopies as well as time to closure of cavities were significantly increased (0.009 < p < 0.035) compared to patients after primary surgery. Increased age showed similar correlations, whereas the level of anastomoses did not influence these parameters. Patients without (ile)ostomies could also be treated by ETVARD. Follow-up endoscopies have not shown any major changes.

Conclusions

Radiochemotherapy has a significant impact on development and treatment of major anastomotic rectal leaks. Most patients can be successfully treated by ETVARD, avoiding additional resective surgery or permanent (col)ostomies.

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Abbreviations

ETVARD:

Endoscopic transanal vacuum-assisted rectal drainage

References

  1. Kruschewski M, Rieger H, Pohlen U, Hotz HG, Buhr HJ (2007) Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis 22:919–927

    Article  PubMed  Google Scholar 

  2. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358

    Article  PubMed  CAS  Google Scholar 

  3. Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469

    Article  PubMed  CAS  Google Scholar 

  4. Eckmann C, Kujath P, Schiedeck TH, Shekarriz H, Bruch HP (2004) Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis 19:128–133

    Article  PubMed  CAS  Google Scholar 

  5. Gendall KA, Raniga S, Kennedy R, Frizelle FA (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50:2223–2237

    Article  PubMed  Google Scholar 

  6. Lee WS, Yun SH, Roh YN, Yun HR, Lee WY, Cho YB, Chun HK (2008) Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg 32:1124–1129

    Article  PubMed  Google Scholar 

  7. Jung SH, Yu CS, Choi PW, Kim DD, Park IJ, Kim HC, Kim JC (2008) Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum 51:902–908

    Article  PubMed  Google Scholar 

  8. Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 23:265–270

    Article  PubMed  Google Scholar 

  9. Glitsch A, von Bernstorff W, Seltrecht U, Partecke I, Paul H, Heidecke CD (2008) Endoscopic transanal vacuum-assisted rectal drainage (ETVARD): an optimized therapy for major leaks from extraperitoneal rectal anastomoses. Endoscopy 40:192–199

    Article  PubMed  CAS  Google Scholar 

  10. Glitsch A, Schreiber A, Seltrecht U, Partecke I, Paul H, Patrzyk M, Heidecke CD, von Bernstorff W (2008) Komplikationsmanagement von Leckagen nach extraperitonealen rektalen Anastomosen. Chir Gastroenterol 24:134–149

    Article  Google Scholar 

  11. Hedrick TL, Sawyer RG, Foley EF, Friel CM (2006) Anastomotic leak and the loop ileostomy: friend or foe? Dis Colon Rectum 49:1167–1176

    Article  PubMed  Google Scholar 

  12. Basilico V, Griffa B, Castiglione N, Giacci F, Zanardo M, Griffa A (2006) Anastomotic fistulas after colorectal resection for carcinoma: incidence and treatment in our recent experience. Minerva Chir 61:373–380

    PubMed  CAS  Google Scholar 

  13. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  PubMed  CAS  Google Scholar 

  14. Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN (2005) Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 7:51–57

    Article  PubMed  CAS  Google Scholar 

  15. Branagan G, Finnis D (2005) Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 48:1021–1026

    Article  PubMed  Google Scholar 

  16. Lim M, Akhtar S, Sasapu K, Harris K, Burke D, Sagar P, Finan P (2006) Clinical and subclinical leaks after low colorectal anastomosis: a clinical and radiologic study. Dis Colon Rectum 49:1611–1619

    Article  PubMed  Google Scholar 

  17. Völzke H, Neuhauser H, Moebus S, Baumert J, Berger K, Stang A, Ellert U, Werner A, Döring A (2006) Rauchen: Regionale Unterschiede in Deutschland (Regional Disparities in Smoking among Adults in Germany). Dtsch Arztebl 103:A-2784-2790/B-2419/C-2327

  18. Völzke H, Alte D, Neuhauser H, Moebus S, Löwel H, Kohlmann T, Hoffmann W, Biffar R, John U (2007) Risikopopulation Vorpommern. Ärzteblatt Mecklenburg-Vorpommern 17:49–53

    Google Scholar 

  19. Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW (2008) Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 22:1818–1825

    Article  PubMed  Google Scholar 

  20. Mees ST, Palmes D, Mennigen R, Senninger N, Haier J, Bruewer M (2008) Endo-vacuum assisted closure treatment for rectal anastomotic insufficiency. Dis Colon Rectum 51:404–410

    Article  PubMed  Google Scholar 

  21. Nagell CF, Holte K (2006) Treatment of anastomotic leakage after rectal resection with transrectal vacuum-assisted drainage (VAC). A method for rapid control of pelvic sepsis and healing. Int J Colorectal Dis 21:657–660

    Article  PubMed  Google Scholar 

  22. Pucciarelli S, Toppan P, Friso ML, Fornasiero A, Vieceli G, Marchiori E, Lise M (1999) Preoperative combined radiotherapy and chemotherapy for rectal cancer does not affect early postoperative morbidity and mortality in low anterior resection. Dis Colon Rectum 42:1276–1283 discussion 1283-1274

    Article  PubMed  CAS  Google Scholar 

  23. Korkolis DP, Plataniotis GD, Gondikakis E, Xinopoulos D, Koulaxouzidis GV, Katsilieris J, Vassilopoulos PP (2006) Short-term preoperative radiotherapy is a safe approach for treatment of locally advanced rectal cancer. Int J Colorectal Dis 21:1–6

    Article  PubMed  CAS  Google Scholar 

  24. Martel G, Al-Suhaibani Y, Moloo H, Haggar F, Friedlich M, Mamazza J, Poulin EC, Stern H, Boushey RP (2008) Neoadjuvant therapy and anastomotic leak after tumor-specific mesorectal excision for rectal cancer. Dis Colon Rectum 51:1195–1201. doi:10.1007/s10350-008-9368-3

    Article  PubMed  Google Scholar 

  25. Huh JW, Park YA, Sohn SK (2007) A diverting stoma is not necessary when performing a handsewn coloanal anastomosis for lower rectal cancer. Dis Colon Rectum 50:1040–1046

    Article  PubMed  Google Scholar 

  26. Jestin P, Pahlman L, Gunnarsson U (2008) Risk factors for anastomotic leakage after rectal cancer surgery: a case-control study. Colorectal Dis 10:715–721. doi:10.1111/j.1463-1318.2007.01466.x

    Article  PubMed  CAS  Google Scholar 

  27. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214

    Article  PubMed  Google Scholar 

  28. Lefebure B, Tuech JJ, Bridoux V, Costaglioli B, Scotte M, Teniere P, Michot F (2008) Evaluation of selective defunctioning stoma after low anterior resection for rectal cancer. Int J Colorectal Dis 23:283–288

    Article  PubMed  CAS  Google Scholar 

  29. Huser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, Friess H (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248:52–60

    Article  PubMed  Google Scholar 

  30. den Dulk M, Smit M, Peeters KC, Kranenbarg EM, Rutten HJ, Wiggers T, Putter H, van de Velde CJ (2007) A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol 8:297–303

    Article  Google Scholar 

  31. Mala T, Nesbakken A (2008) Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis 10:785–788. doi:10.1111/j.1463-1318.2007.01456.x

    Article  PubMed  CAS  Google Scholar 

  32. Ptok H, Marusch F, Meyer F, Schubert D, Gastinger I, Lippert H (2007) Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg 94:1548–1554

    Article  PubMed  CAS  Google Scholar 

  33. Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, Bokey EL (2003) Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 90:1261–1266

    Article  PubMed  CAS  Google Scholar 

  34. Chang SC, Lin JK, Yang SH, Jiang JK, Chen WC, Lin TC (2003) Long-term outcome of anastomosis leakage after curative resection for mid and low rectal cancer. Hepatogastroenterology 50:1898–1902

    PubMed  Google Scholar 

  35. Welsch T, Muller SA, Ulrich A, Kischlat A, Hinz U, Kienle P, Buchler MW, Schmidt J, Schmied BM (2007) C-reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Colorectal Dis 22:1499–1507

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General, Visceral, Thoracic and Vascular Surgery, Universitätsklinikum Greifswald, Ernst-Moritz-Arndt-University, Friedrich-Loeffler-Str. 23b, 17489, Greifswald, Germany

    Wolfram von Bernstorff, Anne Glitsch, André Schreiber, Lars Ivo Partecke & Claus Dieter Heidecke

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  1. Wolfram von Bernstorff
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  2. Anne Glitsch
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  3. André Schreiber
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  4. Lars Ivo Partecke
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  5. Claus Dieter Heidecke
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Corresponding author

Correspondence to Claus Dieter Heidecke.

Additional information

Wolfram von Bernstorff and Anne Glitsch contributed equally to this work and share first authorship.

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von Bernstorff, W., Glitsch, A., Schreiber, A. et al. ETVARD (endoscopic transanal vacuum-assisted rectal drainage) leads to complete but delayed closure of extraperitoneal rectal anastomotic leakage cavities following neoadjuvant radiochemotherapy. Int J Colorectal Dis 24, 819–825 (2009). https://doi.org/10.1007/s00384-009-0673-7

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