Vacuum-assisted early transanal closure of leaking low colorectal anastomoses: the CLEAN study

W. A. A. Borstlap*, G. D. Musters, L. P. S. Stassen, H. L. van Westreenen, D. Hess, S. van Dieren, S. Festen, E. J. van der Zaag, P. J. Tanis, W. A. Bemelman

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

51 Citations (Web of Science)

Abstract

Non-healing of anastomotic leakage can be observed in up to 50% after total mesorectal excision for rectal cancer. This study investigates the efficacy of early transanal closure of anastomotic leakage after pre-treatment with the Endosponge(A (R)) therapy. In this prospective, multicentre, feasibility study, transanal suturing of the anastomotic defect was performed after vacuum-assisted cleaning of the presacral cavity. Primary outcome was the proportion of patients with a healed anastomosis at 6 months after transanal closure. Secondary, healing at last follow-up, continuity, direct medical costs, functionality and quality of life were analysed. Between July 2013 and July 2015, 30 rectal cancer patients with a leaking low colorectal anastomosis were included, of whom 22 underwent neoadjuvant radiotherapy. Median follow-up was 14 (7-29) months. At 6 months, the anastomosis had healed in 16 (53%) patients. At last follow-up, anastomotic integrity was found in 21 (70%) and continuity was restored in 20 (67%) patients. Non-healing at 12 months was observed in 10/29 (34%) patients overall, and in 3/14 (21%) when therapy started within three weeks following the index operation. Major LARS was reported in 12/15 (80%) patients. The direct medical costs were a,notsign8933 (95% CI 7268-10,707) per patient. Vacuum-assisted early transanal closure of a leaking anastomosis after total mesorectal excision with 73% preoperative radiotherapy showed that acceptable anastomotic healing rates and stoma reversal rates can be achieved. Early diagnosis and start of treatment seems crucial.
Original languageEnglish
Pages (from-to)315-327
Number of pages13
JournalSurgical endoscopy and other interventional techniques
Volume32
Issue number1
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • Anastomotic leakage
  • Rectal cancer
  • Vacuum therapy
  • Transanal closure
  • TOTAL MESORECTAL EXCISION
  • LOW ANTERIOR RESECTION
  • CHRONIC PRESACRAL SINUS
  • RECTAL-CANCER
  • ABDOMINOPERINEAL RESECTION
  • RISK-FACTORS
  • LEAKAGE
  • SURGERY
  • VALIDATION
  • THERAPY

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