Low Anterior Resection Combined With Transanal Reinforcement and Endoluminal Sponge Vacuum Drainage
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 50
- 试验地点
- 1
- 主要终点
- Defunction ileostomy rate
研究概览
简要总结
Background: Dehiscence of colorectal anastomosis is a serious complication associated with increased mortality and impaired functional and oncological outcomes. We hypothesised that anastomosis reinforcement and vacuum trans-anal drainage could eliminate some risk factors of colorectal anastomotic dehiscence,including mechanically stapled anastomosis instability and local infection.
详细描述
The study included consecutive patients older than 18 years who had low anterior resection of the rectum and anastomosis performed by double-stapler technique, for rectal cancer located within 10 cm from the anal verge. All patients had undergone pelvic magnetic resonance imaging. Nutrition screening was performed in all patients. If patients had undergone neoadjuvant chemoradiotherapy (CHRT), restaging was performed within 6 weeks of CHRT completion, and surgery was performed 10 weeks after CHRT completion. For the surgical procedure, low anterior resection (LAR) was performed by experienced surgeons who perform more than 50 rectal procedures per year and have sufficient expertise in minimally invasive surgery. Oral bowel preparation was used preoperatively and antibiotics were administered according to protocol.
- Surgical technique
The procedure milestones (descending colon blood perfusion, tension-free anastomosis, safely performed stapled anastomosis and reinforcement, and safely performed mucosal flap) were defined. Simultaneous checkpoints to control milestones were identified and methodology of their documentation (video, photography) were defined. The purpose was to achieve demonstrable control over the individual steps during the surgical procedure.
1.1 Abdominal phase
Laparoscopic procedures were performed in the Lloyd-Davis position, using the 4-ports technique. During the abdominal phase, dissection was guided by a medio-lateral approach. A high tie of the a. mesenterica inferior (AMI) was performed in all patients. Dissection was performed medio-laterally and down to the pelvic floor according to the principles of total mesorectal excision (TME). The rectum was transected using an endostapler after lavage with Betadine solution (Egis Pharmaceuticals, PLS, Budapest, Hungary). Furthermore, the splenic flexure was fully mobilized using a combination of medio-lateral and lateral approaches. In most cases, the inferior mesenteric vein was divided.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 90 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patients with diagnosed extraperitoneal rectal cancer, cT1-cT4
- •Patient with low anterior resection and double-stapled anastomosis technique
排除标准
- •Patients not provided written informed consent
- •Patients with cT4: with pelvic side wall involement, requiring pelvic more extensive procedure
- •Patients with recurrent rectal cancer
结局指标
主要结局
Defunction ileostomy rate
时间窗: 30 days
Rate of fecal diversion in group of treated patients
Incidence of anastomotic leak
时间窗: 30 days
Leak of colorectal anastomosis proven by endoscopy/or/and computed tomography
次要结局
- Postoperative morbidity(30 days)
研究者
Alexander Ferko
Clinical professor
Comenius University