Article ; Online: Superior rectal artery preservation to reduce anastomotic leak rates in familial adenomatous polyposis patients treated with total colectomy and ileorectal anastomosis.
2023 Volume 27, Issue 12, Page(s) 1327–1334
Abstract: Background: Total colectomy with ileorectal anastomosis (TC/IRA) is one of the prophylactic surgical options in patients with familial adenomatous polyposis (FAP). This study investigated the effectiveness of superior rectal artery (SRA) preservation ... ...
| Abstract | Background: Total colectomy with ileorectal anastomosis (TC/IRA) is one of the prophylactic surgical options in patients with familial adenomatous polyposis (FAP). This study investigated the effectiveness of superior rectal artery (SRA) preservation during TC/IRA in reducing anastomotic leakage (AL). Methods: This retrospective study was based on prospectively collected data (01/2000 - 12/2022) at the National Cancer Institute, Milan, Italy. FAP patients undergoing TC/IRA were enrolled. A 1:1 propensity score matching (PSM) was performed. Associations between SRA preservation and complications were investigated using univariate and multivariate analysis. Results: The study population included 211 patients undergoing TC/IRA (Sex: 106 Male, 105 Female; Age: median 30 yrs, IQR: 20-48 yrs), 82 with SRA preservation (SRA group) and 129 without SRA preservation (controls). After PSM, 75 patients were considered for each group. SRA preservation was associated with fewer complications (OR 0.331, 95% CI 0.116; 0.942) in univariate logistic regression analysis. AL events were significantly fewer in the SRA group than in the control group (0 vs 12, p = 0.028). The SRA group had fewer overall surgical complication and pelvic sepsis rates (p = 0.020 and p = 0.028, respectively). Median operative time was significantly longer in the SRA group (340 min vs 240 min, p<0.001), and median hospital stay was significantly shorter (6 vs 7 days, p=0.017). Twenty-seven patients in the SRA group experienced intraoperative anastomotic bleeding, which was controlled endoscopically. Superimposable results were obtained analyzing the whole patient cohort. Conclusions: SRA preservation can be considered an advantage in this patient population, despite adding a further technical step during surgery and thereby prolonging the operative time. Intraoperative endoscopic checking of possible anastomotic bleeding sites is recommended. |
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| MeSH term(s) | Humans ; Male ; Female ; Young Adult ; Adult ; Middle Aged ; Anastomotic Leak/etiology ; Anastomotic Leak/prevention & control ; Anastomotic Leak/surgery ; Retrospective Studies ; Ileum/surgery ; Rectum/surgery ; Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Adenomatous Polyposis Coli/surgery ; Colectomy/adverse effects ; Colectomy/methods ; Arteries/surgery |
| Language | English |
| Publishing date | 2023-09-09 |
| Publishing country | Italy |
| Document type | Journal Article |
| ZDB-ID | 2083309-X |
| ISSN | 1128-045X ; 1123-6337 |
| ISSN (online) | 1128-045X |
| ISSN | 1123-6337 |
| DOI | 10.1007/s10151-023-02858-3 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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