International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: a case-vignette study

Kevin Talboom, Nynke G. Greijdanus, the TENTACLE-Rectum working group, Frans van Workum, Sander Ubels, Camiel Rosman, Roel Hompes, Johannes H.W. de Wilt, Pieter J. Tanis*

*Corresponding author for this work

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Abstract

Purpose: Little is known about the optimal treatment of anastomotic leakage after low anterior resection (LAR) for rectal cancer and whether treatment strategy depends on leakage features and patient characteristics. The objective of this study was to determine which treatment principles are used by expert colorectal surgeons worldwide. Methods: In this international case-vignette study, participants completed a survey on their preferred treatment for 11 clinical cases with varying leakage features and two patient scenarios depending on surgical risk (a total of 22 cases). Results: In total, 42 of 64 invited surgeons completed the survey from 18 countries worldwide. The majority worked at a university training hospital (62%) and had more than 15 years of experience performing LAR for rectal cancer (52%). Early leaks in septic patients were preferably treated by major salvage surgery, to some extent depending on the patient scenario. In early leaks in non-septic patients, drainage and faecal diversion were the cornerstones of the proposed treatment. Endoscopic vacuum therapy was more often proposed than percutaneous drainage. A minority proposed anastomotic reconstruction, more often for larger defects. Treatment of late leaks ranged from watchful waiting, drainage, or transanal repair to major (non-)restorative salvage surgery, with minimal influence of the degree of symptoms on the proposed strategy. Leaks of the blind loop and rectovaginal fistulae showed high variability in the proposed treatment strategy. Conclusion: This TENTACLE-Rectum case-vignette study demonstrates tailored treatment strategies depending on the clinical type of leak and patient characteristics, with variable degrees of consensus and knowledge gaps which should be addressed in future studies.

Original languageEnglish
Pages (from-to)2049-2059
Number of pages11
JournalInternational Journal of Colorectal Disease
Volume37
Issue number9
Early online date24 Aug 2022
DOIs
Publication statusPublished - Sep 2022

Bibliographical note

Funding Information:
TENTACLE-Rectum working group collaborators: Albert Wolthuis, Alberto Arezzo, Alexander Heriot, Antonino Spinelli, Antonio Caycedo-Marulanda, Beatriz Martin-Perez, Bert Houben, Borja de Lacy, Carl Brown, Charlotte van Kessel, Colin Sietses, Danilo Miskovic, David Clark, Federico Ghignone, Felix Aigner, Frederic Ris, Gerald Seitinger, Gustavo Rossi, Jae Hwan Oh, Janindra Warusavitarne, Jared Torkington, Jeremie H. Lefevre, John Marks, Julian Hayes, Justin Maykel, Mark Whiteford, Martin Rutegård, Masaaki Ito, Matteo Frasson, Michel Adamina, Nader Francis, Nicholas C. Buchs, Patricia Sylla, Rodrigo Perez, Rogier Crolla, Sergio Araujo, Stephen Bell, Teresa deBeche-Adams, Tsuyoshi Konishi, Yves Panis.

Publisher Copyright:
© 2022, The Author(s).

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