A trinity technique for prevention of low rectal anastomotic leakage in the robotic era |
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| Affiliation: | 1. Colorectal Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, 200032, China;2. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China;3. Shanghai Engineering Research Cancer of Colorectal Cancer Minimally Invasive Technology, Shanghai, 200032, China;4. Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, 20032, China;1. Department of Surgery, Mayo Clinic, Rochester, MN;2. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN;3. Department of Surgery, Ohio State University Medical Center, Columbus, OH;4. Department of Surgery, MetroHealth Medical Center, Cleveland, OH;5. Department of Surgery, H Lee Moffitt Cancer Center, Tampa, FL;6. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY;7. Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, CA;8. Department of Surgery, Duke University School of Medicine, Durham, NC;9. Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI;10. Department of Surgery, Mayo Clinic, Phoenix, AZ;11. Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA;12. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL;13. Department of Surgery, University of Texas Medical Branch, Galveston, TX;1. State Key Laboratory of Oncology in South China, Guangzhou, 510060, China;2. Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China;1. Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, PR China;2. Department of Surgical Oncology, Shenyang Cancer Hospital, Shenyang, 110001, Liaoning, PR China;1. Department of Surgical Oncology, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China;2. Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, 110001, PR China;1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China;2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China;3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China;4. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China |
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| Abstract: | BackgroundAnastomotic leakage (AL) is a severe complication of low anterior resection (LAR) for rectal cancer, and effectiveprevention is urgently needed. In the robotic era, this study aimed to explore the role of innovative techniques in preventing AL in rectal cancer patients undergoing robotic LAR.MethodsFrom May 2012 to May 2017, a total of 601 patients underwent robotic LAR, with 191 patients participated as control subjects (non-PST group) and 410 patients are subjected to a trinity technique (PST group). The AL rate, short-term and long-term outcomes are analyzed and compared.ResultsThe overall rate of AL was 6.8% out of 601 patients, with Grade B at 5.7% and Grade C at 1.1%, using the ISREC grading system. The PST group presented lower incidence of both overall AL (5.1% vs 10.5%, P = 0.015) and major AL (0.2% vs 3.2%, P = 0.005), when compared with the non-PST group, respectively. Furthermore, the PST group had similar surgical complications (17.3% vs 20.9%, P = 0.286), while with lower re-hospitalization rate (2.7% vs 6.3%, P = 0.038) and reoperation rate (0.2% vs 4.2%, P = 0.001), compared with the non-PST group, respectively. Short-term recovery and long-term oncological outcomes were not significant in the two groups. By multivariate logistic regression models, the risk factors of AL of robotic LAR are confirmed as non-PST technique, estimated blood loss ≥100 mL, anastomosis from anal verge <5 cm, and distal resection margin from tumor <2 cm.ConclusionsThe innovative PST technique may shed light on an effective method for preventing occurrence of AL in robotic LAR. |
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| Keywords: | Low anterior resection Robotic rectal surgery Anastomotic leakage Risk factors Prevention Treatment |
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