Our Summary

This research paper is reviewing different methods for treating a severe complication called anastomotic leakage (AL) that can occur after a surgical procedure for rectal cancer. AL is when the connection made by the surgeon between two parts of the intestine leaks. Instead of another surgery, various less invasive treatments using endoscopy (a procedure where doctors use a small camera on a flexible tube to look at parts of your digestive tract) are being investigated. These include vacuum devices, tissue sealants, and a technique called Over-The-Scope-Clip (OTSC).

The researchers looked at previous studies and found 75 cases where these endoscopic techniques were used to treat AL. The average patient was around 66 years old and they were slightly more likely to be male. The leakage was usually identified about 44 days after the surgery.

The most common treatment was vacuum-assisted closure therapy (used in 52% of cases), followed by fibrin glue (a type of tissue sealant, used in 25.3% of cases) and the OTSC technique (22.7%). Fibrin glue was also the most frequently used additional treatment.

The study concludes that these endoscopic techniques could be a good alternative to more surgery for treating AL after rectal cancer surgery. They show promise but more research is needed to confirm their effectiveness.

FAQs

  1. What is anastomotic leakage after low anterior resection for rectal cancer?
  2. What are the alternative endoscopic treatment options for anastomotic leakage repair?
  3. How effective is the endoscopic management of anastomotic leakage as an alternative to surgical treatment?

Doctor’s Tip

A helpful tip a doctor might tell a patient about proctectomy is to follow post-operative care instructions carefully, including proper wound care, pain management, and activity restrictions. It is important to attend all follow-up appointments and communicate any concerns or changes in symptoms to your healthcare provider promptly. Additionally, maintaining a healthy diet and staying hydrated can aid in the healing process.

Suitable For

Patients who are typically recommended proctectomy include those with severe cases of anastomotic leakage after low anterior resection for rectal cancer. These patients may benefit from alternative endoscopic treatment options such as endoluminal vacuum devices, tissue sealants, and Over-The-Scope-Clip (OTSC) technique. Patients who have a cavity diameter of around 5 cm, a delayed diagnosis of AL, and who are not suitable candidates for re-operation may also be recommended for proctectomy. Additionally, patients who have failed initial endoscopic treatments such as vacuum-assisted closure therapy, fibrin glue, or endoclips may also be considered for proctectomy.

Timeline

  • Before proctectomy:
  1. Patient is diagnosed with rectal cancer and undergoes preoperative evaluation and staging.
  2. Patient undergoes preoperative preparation, which may include bowel preparation and other preoperative instructions.
  3. Patient undergoes proctectomy surgery, which involves removal of part or all of the rectum.
  4. Patient may experience postoperative complications such as anastomotic leakage, which is a severe complication that can occur after low anterior resection.
  5. Diagnosis of anastomotic leakage is made based on clinical symptoms, imaging studies, and endoscopic evaluation.
  • After proctectomy:
  1. Anastomotic leakage is diagnosed, and endoscopic treatment options are considered as an alternative to re-operation.
  2. Endoscopic repair techniques such as endoluminal vacuum devices, tissue sealants, and Over-The-Scope-Clip (OTSC) are used for the treatment of anastomotic leakage.
  3. The cavity diameter and time until diagnosis are assessed to determine the appropriate treatment approach.
  4. Vacuum-assisted closure therapy, fibrin glue, and OTSC are commonly used endoscopic techniques for AL repair.
  5. Additional endoscopic therapies such as OTSC, vacuum-assisted closure, and endoclips may be used as supplementary therapy.
  6. Endoscopic management of AL is considered effective and promising as an alternative to surgical treatment for AL after low anterior resection.

What to Ask Your Doctor

Some questions a patient should ask their doctor about proctectomy include:

  1. What are the risks and benefits of a proctectomy in my specific case?
  2. What alternative treatment options are available for my condition?
  3. What is the success rate of endoscopic repair for anastomotic leakage after a proctectomy?
  4. How long is the recovery time after endoscopic repair compared to re-operation?
  5. What are the potential complications of endoscopic repair for anastomotic leakage?
  6. How experienced are you in performing endoscopic repair procedures?
  7. Will I need additional treatments or follow-up care after endoscopic repair?
  8. What can I expect in terms of pain management and post-operative care after endoscopic repair?
  9. Are there any dietary or lifestyle changes I should make after endoscopic repair?
  10. How will endoscopic repair affect my long-term prognosis and quality of life?

Reference

Authors: Chorti A, Stavrou G, Stelmach V, Tsaousi G, Michalopoulos A, Papavramidis TS, Kotzampassi K. Journal: Asian J Endosc Surg. 2020 Apr;13(2):141-146. doi: 10.1111/ases.12733. Epub 2019 Jul 12. PMID: 31297989