Early diagnosis and treatment of anastomotic leak after rectal cancer surgery / 中华胃肠外科杂志

Anastomotic leakage is the most common major complication after mid-low rectal cancer surgery. Due to lack of knowledge regarding the virtual mechanisms of anastomotic leakage, not much can be done to prevent its development. The aim of the present review was to discuss the prevention, early diagnosis, and treatment of anastomotic leakage after rectal cancer surgery. For patients with risk factors, such as anastomotic site within 4 cm from anus, obese men, lack of blood supply of the anastomotic site, neoadjuvant chemo radiotherapy, or patients with severe comorbidity, aggressive preventive strategy should be adopted. The effectiveness of diverting stoma, preoperative bowel preparation, and transanal decompression are still in debate. The combination of fluorescence imaging to assess anastomotic perfusion and selective preservation of the left colic artery can be used in the future to prevent anastomotic leakage intraoperatively. With increasing use of neoadjuvant chemo radiotherapy and diverting stoma, more than half of the leaks present in a more subtle and insidious manner, including ileus, diarrhea, anal discharge of pus, mild fever, accelerated heart rate, tachypnea, and oliguria. Surgeons should be more cautious regarding these insidious clinical presentations. Computed tomography scan and endoscopy are among the most important diagnostic workups that can early diagnose leakage and indicate the size of the defect and extent of infection. For patients presenting with diffuse peritonitis, emergency surgical exploration is mandatory along with fluid resuscitation. For those with limited infection, appropriate treatment plan should be made after consideration of the extent of infection, methods to eradicate the infectious source, strategies following adjuvant therapy, and the possibility and necessity of re-establishing bowel continuity.

Clinical effect of restrict rehydration strategy on anastomotic healing of patients with colorectal cancer in fast-track / 中国医师杂志

Objective To discuss the clinical effect of restrict rehydration strategy on anastomotic healing of patients with colorectal cancer.Methods 483 cases of colorectal cancer ( from January 2008 to November 2009) were analyzed retrospectively,166 in fluid restriction group and 317 in tradition therapy group.Postoperative early rehabilitations and complications were studied and compared.Results The first time of passing flatus(3.9 d vs 4.4 d),first ambulation(2.9 d vs 3.3 d),oral intake(2.9 d vs 3.6 d),time with use of urinary catheter(4.6 d vs 5.5 d),and drains(2.2 d vs 3.1 d),and postoperative hospital stay ( 8.7 d vs 11.6 d) in fluid restriction group were significantly earlier or less than those in tradition therapy group ( P ＜ 0.01 ),while there were no significant differences in time with use of nasogastric tubes ( 1.1 d vs 1.2 d) between the 2 groups ( P ＞ 0.05 ).There was significant difference in the postoperative complications rate between the two groups ( P ＜ 0.05 ).Conclusions Restrictive fluid regimen could reduce the incidence of common complications for patients after colorectal surgery,and might have a certain promoter action to the anastomotic healing.