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Radiol Oncol. 2019 Mar 3;53(1):77-84. doi: 10.2478/raon-2019-0008.

Ultralow anterior resection with implantation of gentamicin-collagen sponge and no defunctioning stoma: anastomotic leakage and local cancer relapse.

Author information

1
Department of Surgical Oncology, Lower Silesian Oncology Centre - Regional Comprehensive Cancer Centre, Wroclaw, Poland.
2
Department of Oncology, Faculty of Postgraduate Medical Training, Wroclaw Medical University, Wroclaw, Poland.
3
Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland.

Abstract

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. 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.

KEYWORDS:

anastomotic leakage; anterior resection; gentamicin-collagen sponge; rectal cancer; total mesorectal excision

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