Incidence and risk factors for anastomotic failure in 1594 Patients treated by transanal total mesorectal excision: results from the international TaTME registry
File(s)
Supporting information
Supporting information
Author(s)
Type
Journal Article
Abstract
To determine the incidence of anastomotic-related morbidity following Transanal Total Mesorectal Excision (TaTME) and identify independent risk factors for failure.Anastomotic leak and its sequelae are dreaded complications following gastrointestinal surgery. TaTME is a recent technique for rectal resection, which includes novel anastomotic techniques.Prospective study of consecutive reconstructed TaTME cases recorded over 30 months in 107 surgical centers across 29 countries. Primary endpoint was "anastomotic failure," defined as a composite endpoint of early or delayed leak, pelvic abscess, anastomotic fistula, chronic sinus, or anastomotic stricture. Multivariate regression analysis performed identifying independent risk factors of anastomotic failure and an observed risk score developed.One thousand five hundred ninety-four cases with anastomotic reconstruction were analyzed; 96.6% performed for cancer. Median anastomotic height from anal verge was 3.0 ± 2.0 cm with stapled techniques accounting for 66.0%. The overall anastomotic failure rate was 15.7%. This included early (7.8%) and delayed leak (2.0%), pelvic abscess (4.7%), anastomotic fistula (0.8%), chronic sinus (0.9%), and anastomotic stricture in 3.6% of cases. Independent risk factors of anastomotic failure were: male sex, obesity, smoking, diabetes mellitus, tumors >25 mm, excessive intraoperative blood loss, manual anastomosis, and prolonged perineal operative time. A scoring system for preoperative risk factors was associated with observed rates of anastomotic failure between 6.3% to 50% based on the cumulative score.Large tumors in obese, diabetic male patients who smoke have the highest risk of anastomotic failure. Acknowledging such risk factors can guide appropriate consent and clinical decision-making that may reduce anastomotic-related morbidity.
Date Issued
2019-04
Date Acceptance
2018-01-01
Citation
Annals of Surgery, 2019, 269 (4), pp.700-711
ISSN
0003-4932
Publisher
Lippincott, Williams & Wilkins
Start Page
700
End Page
711
Journal / Book Title
Annals of Surgery
Volume
269
Issue
4
Copyright Statement
© 2018 Wolters Kluwer Health, Inc. This is a non-final version of an article published in final form in the Annals of Surgery (https://dx.doi.org/10.1097/SLA.0000000000002653)
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/29315090
Subjects
Science & Technology
Life Sciences & Biomedicine
Surgery
anastomotic failure
incidence
rectal surgery
risk factors
total mesorectal excision
transanal
COLORECTAL-CANCER
RECTAL-CANCER
ANTERIOR RESECTION
LEAKAGE
SURGERY
COMPLICATIONS
IMPACT
MANAGEMENT
CONSENSUS
Adult
Aged
Aged, 80 and over
Anal Canal
Anastomosis, Surgical
Anastomotic Leak
Digestive System Surgical Procedures
Female
Humans
Incidence
Internationality
Male
Middle Aged
Prospective Studies
Rectum
Registries
Risk Factors
Young Adult
International TaTME Registry Collaborative
Rectum
Humans
Anastomosis, Surgical
Digestive System Surgical Procedures
Registries
Incidence
Risk Factors
Prospective Studies
Internationality
Adult
Aged
Aged, 80 and over
Middle Aged
Anal Canal
Female
Male
Young Adult
Anastomotic Leak
11 Medical and Health Sciences
Surgery
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2019-04