Clin Colon Rectal Surg 2021; 34(06): 431-438
DOI: 10.1055/s-0041-1736465
Review Article

Treatment Modalities for Anastomotic Leakage in Rectal Cancer Surgery

Deborah S. Keller
1   Division of Colorectal Surgery, Department of Surgery, University of California at Davis Medical Center, Sacramento, California
,
K. Talboom
2   Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
,
C.P.M van Helsdingen
2   Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
,
Roel Hompes
2   Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
› Author Affiliations
Funding None.

Abstract

Despite advances in rectal cancer surgery, anastomotic leakage (AL) remains a common complication with a significant impact on patient recovery, health care costs, and oncologic outcomes. The spectrum of clinical severity associated with AL is broad, and treatment options are diverse with highly variable practices across the colorectal community. To be effective, the treatment must match not only the patient's current status but also the type of leak, the surgeon's skill, and the resources available. In this chapter, we will review the current and emergent treatment modalities for AL after rectal cancer surgery.



Publication History

Article published online:
23 November 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Lee SW, Gregory D, Cool CL. Clinical and economic burden of colorectal and bariatric anastomotic leaks. Surg Endosc 2020; 34 (10) 4374-4381
  • 2 Kverneng Hultberg D, Svensson J, Jutesten H. et al. The impact of anastomotic leakage on long-term function after anterior resection for rectal cancer. Dis Colon Rectum 2020; 63 (05) 619-628
  • 3 Yang J, Chen Q, Jindou L, Cheng Y. The influence of anastomotic leakage for rectal cancer oncologic outcome: a systematic review and meta-analysis. J Surg Oncol 2020; 121 (08) 1283-1297
  • 4 Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011; 253 (05) 890-899
  • 5 La Regina D, Di Giuseppe M, Lucchelli M. et al. Financial impact of anastomotic leakage in colorectal surgery. J Gastrointest Surg 2019; 23 (03) 580-586
  • 6 Peel AL, Taylor EW. Surgical Infection Study Group. Proposed definitions for the audit of postoperative infection: a discussion paper. Ann R Coll Surg Engl 1991; 73 (06) 385-388
  • 7 Lichthardt S, Wagner J, Löb S. et al. Pathological complete response due to a prolonged time interval between preoperative chemoradiation and surgery in locally advanced rectal cancer: analysis from the German StuDoQ|Rectalcarcinoma registry. BMC Cancer 2020; 20 (01) 49
  • 8 Rutegård M, Kverneng Hultberg D, Angenete E, Lydrup ML. Substantial underreporting of anastomotic leakage after anterior resection for rectal cancer in the Swedish Colorectal Cancer Registry. Acta Oncol 2017; 56 (12) 1741-1745
  • 9 Penna M, Hompes R, Arnold S. et al; International TaTME Registry Collaborative. Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the International TaTME Registry. Ann Surg 2019; 269 (04) 700-711
  • 10 Borstlap WAA, Westerduin E, Aukema TS, Bemelman WA, Tanis PJ. Dutch Snapshot Research Group. Anastomotic leakage and chronic presacral sinus formation after low anterior resection: results from a large cross-sectional study. Ann Surg 2017; 266 (05) 870-877
  • 11 McDermott FD, Arora S, Smith J, Steele RJC, Carlson GL, Winter DC. (on behalf of the joint ASGBI/ACPGBI). Anastomotic leakage working group issues in professional practice. prevention, diagnosis and management of colorectal anastomotic leakage. March 2016. Accessed December 2020 at: https://www.asgbi.org.uk/publications/professional-practice-booklets-members-only
  • 12 van Helsdingen CP, Jongen AC, de Jonge WJ, Bouvy ND, Derikx JP. Consensus on the definition of colorectal anastomotic leakage: a modified Delphi study. World J Gastroenterol 2020; 26 (23) 3293-3303
  • 13 Rahbari NN, Weitz J, Hohenberger W. et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 2010; 147 (03) 339-351
  • 14 Kennedy R, Jenkins I, Finan PJ. Controversial topics in surgery: splenic flexure mobilisation for anterior resection performed for sigmoid and rectal cancer. Ann R Coll Surg Engl 2008; 90 (08) 638-642
  • 15 Vennix S, Bakker OJ, Prins HA, Lips DJ. Re-interventions following laparoscopic surgery for colorectal cancer: data from 818 individuals from the Dutch surgical colorectal audit. J Laparoendosc Adv Surg Tech A 2014; 24 (11) 751-755
  • 16 Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg 2014; 101 (04) 339-346
  • 17 Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D. Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis 2013; 28 (04) 437-445
  • 18 Kauv P, Benadjaoud S, Curis E, Boulay-Coletta I, Loriau J, Zins M. Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT. Eur Radiol 2015; 25 (12) 3543-3551
  • 19 Habib K, Gupta A, White D, Mazari FAK, Wilson TR. Utility of contrast enema to assess anastomotic integrity and the natural history of radiological leaks after low rectal surgery: systematic review and meta-analysis. Int J Colorectal Dis 2015; 30 (08) 1007-1014
  • 20 Solomkin JS, Mazuski JE, Bradley JS. et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis 2010; 50 (02) 133-164
  • 21 Yang G, Kim CW, Lee SH. Patterns of antibiotics and pathogens for anastomotic leakage after colorectal cancer surgery. Korean J Clin Oncol 2019; 15 (02) 79-85
  • 22 Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach D. A review of ten years of the Study for Monitoring Antimicrobial Resistance Trends (SMART) from 2002 to 2011. Pharmaceuticals (Basel) 2013; 6 (11) 1335-1346
  • 23 Creavin B, Ryan EJ, Kelly ME. et al. Minimally invasive approaches to the management of anastomotic leakage following restorative rectal cancer resection. Colorectal Dis 2019; 21 (12) 1364-1371
  • 24 Blumetti J, Chaudhry V, Cintron JR. et al. Management of anastomotic leak: lessons learned from a large colon and rectal surgery training program. World J Surg 2014; 38 (04) 985-991
  • 25 Maggiori L, Bretagnol F, Lefèvre JH, Ferron M, Vicaut E, Panis Y. Conservative management is associated with a decreased risk of definitive stoma after anastomotic leakage complicating sphincter-saving resection for rectal cancer. Colorectal Dis 2011; 13 (06) 632-637
  • 26 Harisinghani MG, Gervais DA, Maher MM. et al. Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology 2003; 228 (03) 701-705
  • 27 Robert B, Chivot C, Rebibo L, Sabbagh C, Regimbeau JM, Yzet T. Percutaneous transgluteal drainage of pelvic abscesses in interventional radiology: a safe alternative to surgery. J Visc Surg 2016; 153 (01) 3-7
  • 28 Challine A, Lefèvre JH, Creavin B. et al. Can a local drainage salvage a failed colorectal or coloanal anastomosis? A prospective cohort of 54 patients. Dis Colon Rectum 2020; 63 (01) 93-100
  • 29 Sirois-Giguère E, Boulanger-Gobeil C, Bouchard A. et al. Transanal drainage to treat anastomotic leaks after low anterior resection for rectal cancer: a valuable option. Dis Colon Rectum 2013; 56 (05) 586-592
  • 30 Shalaby M, Thabet W, Buonomo O. et al. Transanal tube drainage as a conservative treatment for anastomotic leakage following a rectal resection. Ann Coloproctol 2018; 34 (06) 317-321
  • 31 Lamazza A, Sterpetti AV, De Cesare A, Schillaci A, Antoniozzi A, Fiori E. Endoscopic placement of self-expanding stents in patients with symptomatic anastomotic leakage after colorectal resection for cancer: long-term results. Endoscopy 2015; 47 (03) 270-272
  • 32 Pérez Roldán F, González Carro P, Villafáñez García MC. et al. Usefulness of biodegradable polydioxanone stents in the treatment of postsurgical colorectal strictures and fistulas. Endoscopy 2012; 44 (03) 297-300
  • 33 Lamazza A, Sterpetti AV, De Cesare A, Schillaci A, Antoniozzi A, Fiori E. Endoscopic placement of self-expanding stents in patients with symptomatic anastomotic leakage after colorectal resection for cancer: long-term results. Endoscopy 2015; 47 (03) 270-272
  • 34 Abbas MA. Endoscopic management of acute colorectal anastomotic complications with temporary stent. JSLS 2009; 13 (03) 420-424
  • 35 Chorti A, Stavrou G, Stelmach V. et al. Endoscopic repair of anastomotic leakage after low anterior resection for rectal cancer: a systematic review. Asian J Endosc Surg 2020; 13 (02) 141-146
  • 36 Chopra SS, Mrak K, Hünerbein M. The effect of endoscopic treatment on healing of anastomotic leaks after anterior resection of rectal cancer. Surgery 2009; 145 (02) 182-188
  • 37 Lippert E, Klebl FH, Schweller F. et al. Fibrin glue in the endoscopic treatment of fistulae and anastomotic leakages of the gastrointestinal tract. Int J Colorectal Dis 2011; 26 (03) 303-311
  • 38 Weidenhagen R, Gruetzner KU, Wiecken T, Spelsberg F, Jauch KW. Endoscopic vacuum-assisted closure of anastomotic leakage following anterior resection of the rectum: a new method. Surg Endosc 2008; 22 (08) 1818-1825
  • 39 Gardenbroek TJ, Musters GD, Buskens CJ. et al. Early reconstruction of the leaking ileal pouch-anal anastomosis: a novel solution to an old problem. Colorectal Dis 2015; 17 (05) 426-432
  • 40 Borstlap WAA, Musters GD, Stassen LPS. et al. Vacuum-assisted early transanal closure of leaking low colorectal anastomoses: the CLEAN study. Surg Endosc 2018; 32 (01) 315-327
  • 41 Talboom K, van Kesteren J, Sonneveld DJA, Tanis PJ, Bemelman WA, Hompes R. Early transanal closure after vacuum-assisted drainage for anastomotic leakage in rectal cancer surgery—a video vignette. Colorectal Dis 2020; 22 (08) 973-974
  • 42 Shalaby M, Emile S, Elfeki H, Sakr A, Wexner SD, Sileri P. Systematic review of endoluminal vacuum-assisted therapy as salvage treatment for rectal anastomotic leakage. BJS Open 2018; 3 (02) 153-160
  • 43 Abdalla S, Cotte E, Epin A. et al; on behalf the French GRECCAR group. Short-term and long-term outcome of endoluminal vacuum therapy for colorectal or coloanal anastomotic leakage: results of a nationwide multicenter cohort study from the French GRECCAR Group. Dis Colon Rectum 2020; 63 (03) 371-380
  • 44 Huisman JF, van Westreenen HL, van der Wouden EJ. et al. Effectiveness of endosponge therapy for the management of presacral abscesses following rectal surgery. Tech Coloproctol 2019; 23 (06) 551-557
  • 45 Kühn F, Janisch F, Schwandner F. et al. Comparison between endoscopic vacuum therapy and conventional treatment for leakage after rectal resection. World J Surg 2020; 44 (04) 1277-1282
  • 46 Westerduin E, Borstlap WAA, Musters GD. et al. Redo coloanal anastomosis for anastomotic leakage after low anterior resection for rectal cancer: an analysis of 59 cases. Colorectal Dis 2018; 20 (01) 35-43
  • 47 Woo IT, Park JS, Choi GS, Park SY, Kim HJ, Park IK. Clinical outcomes of a redo for a failed colorectal or coloanal anastomosis. Ann Coloproctol 2018; 34 (05) 259-265
  • 48 Boullenois H, Lefevre JH, Creavin B. et al. Long-term functional results and quality of life after redo rectal surgery: delayed versus immediate colo-anal anastomosis. Colorectal Dis 2020; 22 (08) 885-893
  • 49 Westerduin E, Klaver CEL, van Geloven AAW, Westerterp M, Bemelman WA, Tanis PJ. Outcome after redo surgery for complicated colorectal and coloanal anastomosis: a systematic review. Dis Colon Rectum 2018; 61 (08) 988-998
  • 50 Borel Rinkes IH, Wiggers T. Gracilis muscle flap in the treatment of persistent, infected pelvic necrosis. Eur J Surg 1999; 165 (04) 390-391
  • 51 Musters GD, Borstlap WA, Bemelman WA, Buskens CJ, Tanis PJ. Intersphincteric completion proctectomy with omentoplasty for chronic presacral sinus after low anterior resection for rectal cancer. Colorectal Dis 2016; 18 (02) 147-154
  • 52 Goldsmith HS, Griffith AL, Kupferman A, Catsimpoolas N. Lipid angiogenic factor from omentum. JAMA 1984; 252 (15) 2034-2036
  • 53 Meza-Perez S, Randall TD. Immunological functions of the omentum. Trends Immunol 2017; 38 (07) 526-536
  • 54 Swain BT, Ellis CN. Fibrin glue treatment of low rectal and pouch-anal anastomotic sinuses. Dis Colon Rectum 2004; 47 (02) 253-255
  • 55 Alsanea N, Alabbad S. Use of the endostapler for the treatment of non-healing sinus secondary to a dehisced colorectal anastomosis. Tech Coloproctol 2010; 14 (03) 249-251
  • 56 Abild N, Bulut O, Nielsen CB. Endoscopic stapled marsupialisation of chronic presacral sinus following low anterior resection: a simple option in selected cases. Scand J Surg 2012; 101 (04) 307-310