Ultralow Anterior Resection With Implantation Of Gentamicin-collagen Sponge And No Defunctioning Stoma: Anastomotic Leakage And Local Cancer Relapse

  • Tomasz Michalik Lower Silesian Oncology Centre – Regional Comprehensive Cancer Centre, Wroclaw, Poland
  • Rafal Matkowski Lower Silesian Oncology Centre – Regional Comprehensive Cancer Centre, Wroclaw, Poland and Wroclaw Medical University, Wroclaw, Poland
  • Przemyslaw Biecek Warsaw University of Technology, Warsaw, Poland
  • Jozef Forgacz Lower Silesian Oncology Centre – Regional Comprehensive Cancer Centre, Wroclaw, Poland
  • Bartlomiej Szynglarewicz Lower Silesian Oncology Centre – Regional Comprehensive Cancer Centre, Wroclaw, Poland and Wroclaw Medical University, Wroclaw, Poland http://orcid.org/0000-0002-1153-5647

Abstract

Abstract (Eng)

Background. Anterior resection with total mesorectal excision (TME) of ultralow rectal cancer may result in the increased risk of the anastomotic leakage (AL). The aim of this study was to evaluate the usefulness of the gentamicin-collagen sponge (GCS) for the protection against symptomatic AL and investigate association between AL and local relapse (LR).

Patients and methods. A series of 158 patients with ultralow rectal cancer was studied prospectively. All the patients underwent R0 sphincter-saving TME with anastomosis wrapping using GCS. In none of the cases a temporary protective stoma was constructed.

Results. AL rate was 3.2% (5/158) while median time to AL diagnosis was 5 days following surgery (range 3-15). There was no postoperative and leakage-related mortality. Patient age >75 years and smoking were independent risk factors related to significantly increased AL rate: 12.5% vs. 0.8% (P=0.0004) and 5.7% vs. 0% (P=0.043), respectively. LR was observed in 12% of cases. It was highly significantly more common and developed earlier in patients who have had AL when compared with non-AL group: 80% vs 9% (P=0.00001) and 8.5 vs 17 months (P=0.014), respectively.

Conclusions. Anastomosis wrapping with GCS after anterior resection with TME is a safe procedure resulting in the low incidence of anastomotic leakage which may be also associated with decreased risk of local relapse.

Key words: rectal cancer, anterior resection, total mesorectal excision, anastomotic leakage, gentamicin-collagen sponge

Author Biographies

Tomasz Michalik, Lower Silesian Oncology Centre – Regional Comprehensive Cancer Centre, Wroclaw, Poland

Department of Surgical Oncology

Senior Assistant

Rafal Matkowski, Lower Silesian Oncology Centre – Regional Comprehensive Cancer Centre, Wroclaw, Poland and Wroclaw Medical University, Wroclaw, Poland

Department of Surgical Oncology and Department of Oncology - Faculty of Postgraduate Medical Training

Professor and Head of Department

Przemyslaw Biecek, Warsaw University of Technology, Warsaw, Poland

Faculty of Mathematics and Information Science

Associate Professor

Jozef Forgacz, Lower Silesian Oncology Centre – Regional Comprehensive Cancer Centre, Wroclaw, Poland

Department of Surgical Oncology

Head of Department

Bartlomiej Szynglarewicz, Lower Silesian Oncology Centre – Regional Comprehensive Cancer Centre, Wroclaw, Poland and Wroclaw Medical University, Wroclaw, Poland

Department of Surgical Oncology and Department of Oncology - Faculty of Postgraduate Medical Training

Associate Professor

Published
2019-02-21
How to Cite
Michalik, T., Matkowski, R., Biecek, P., Forgacz, J., & Szynglarewicz, B. (2019). Ultralow Anterior Resection With Implantation Of Gentamicin-collagen Sponge And No Defunctioning Stoma: Anastomotic Leakage And Local Cancer Relapse. Radiology and Oncology, 53(1). Retrieved from https://radioloncol.com/index.php/ro/article/view/3178
Section
Clinical oncology