ABSTRACT
Anastomotic leak is one of inevitable postoperative complications of rectal cancer. With the improvement of surgical techniques, the enhancement of the cognization of rectal cancer, and the development of surgical instruments, surgical procedures of rectal cancer are getting more sophisticated. The anastomosis is performed lower and lower, however the incidence of anastomotic leak is not significantly decreased. In addition, different from intraperitoneal anastomotic leak, the low rectal anastomotic leak after low anterior resection has many special issues in the diagnosis and treatment in clinic. The incidence of peritonitis caused by low anastomotic leak is low, the onset time is late, and symptoms of peritonitis are mild. So most low anastomotic leak is treated conservatively, second surgical repair or resection of anastomotic site is rarely performed, and proximal intestinal diversion is commonly performed. In the prevention of low anastomotic leak, some techniques and precautions during the perioperative period and identification of high risk factors might play important roles. Combined our clinical experiences, we introduced the diagnosis, treatment, prevention and research progression of low anastomotic leak after anterior resection of low rectal cancer, we hope it would be helpful.
Subject(s)
Humans , Anastomosis, Surgical , Anastomotic Leak/diagnosis , Postoperative Complications/diagnosis , Proctectomy , Rectal Neoplasms/surgery , Retrospective Studies , Risk FactorsABSTRACT
Objective To explore the effect of perioperative continuous use of aspirin on bleeding in laparoscopic anterior resection for rectal cancer (RC) in patients taking low dose aspirin.Methods The prospective study was conducted.The clinicopathological data of 96 RC patients taking low dose aspirin who were admitted to the Shengjing Hospital of China Medical University from September 2014 to September 2016 were collected.All the 96 patients were divided into the aspirin group (perioperative continuous use of aspirin) and non-aspirin group (discontinuation of aspirin at 7 days preoperatively and taking aspirin at 3 days postoperatively)by random number table.Laparoscopic anterior resection for RC was applied to patients by the same team of doctors.Observation indicators:(1) comparison of surgical and postoperative situations between the 2 groups;(2) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect the postoperative survival of patients up to January 2017.Measurement data with normal distribution were represented as (x)±s.Comparisons between groups were evaluated with the t test.Comparisons of count data were analyzed using the chi-square test and Fisher exact probability.Comparison of ordinal data was analyzed using the nonparametric test.Results All the 96 patients were enrolled into the study,including 50 in the aspirin group and 46 in the non-aspirin group.(1) Comparison of surgical and postoperative situations between the 2 groups:96patients underwent successful laparoscopic anterior resection for RC,including 1 with conversion to open surgery and 95 undergoing laparoscopic anterior resection for RC,without perioperative death,postoperative blood transfusion and rcoperation.Cases with conversion to open surgery,operation time,volume of intraoperative blood loss,decreasing value of postoperative hemoglobin (Hb),time to anal exsufflation,peritoneal drainage volume from 1-3 days postoperatively,cases with postoperative hematoehezia,cardio-cerebrovascular complications and overall complications (including postoperative hematochezia and cardio-cerebrovascular complications),duration of hospital stay,hospital expenses,cases in stage Ⅰ,Ⅱ and Ⅲ of postoperative TNM stage,postoperative coagulation indexes of platelet,prothrombin time,international normalized ratio,prothrombin activity,activated partial thromboplastin time,thrombin time and fibrinogen were 0,(112± 18) minutes,(39± 18) mL,(4.3±2.8)g/L,(57±24)hours,(22±9)mL/d,6,0,10,(8.6±2.5)days,(6 739±481)yuan,11,35,4,(236±80) × 109/L,(12.7± 1.1) seconds,1.00±0.08,101％ ± 15％,(28 ±4) seconds,(15.5 ± 1.9) seconds,(3.2±1.0)g/L in the aspirin group and 1,(118±16)minutes,(38±22)mL,(3.5±3.0)g/L,(55±29)hours,(20±8)mL/d,4,1,8,(9.1±2.3)days,(6606±510)yuan,5,36,5,(211±49)×109/L,(12.5±0.7)seconds,1.00±0.06,103％±11％,(29±3)seconds,(15.3±1.7)seconds,(3.1±0.7)g/L in the non-aspirin group,respectively,with no statistically significant difference between the 2 groups (t =-1.737,0.204,1.416,0.380,1.365,x2=0.038,0.107,t=-1.082,1.322,Z=-1.370,t=1.850,0.978,0.872,-0.712,-1.291,0.311,0.585,P＞0.05).Ten patients with postoperative hematochezia in the 2 groups were cured,without special treatment.One patient in the non-aspirin group was complicated with deep venous thrombosis and then was cured by single anticoagulant drug.Two and 2 patients in the aspirin group were respectively complicated with urinary retention and urinary tract infection.One,1 and 1 patients in the non-aspirin group were respectively complicated with inflammatory intestinal obstruction,urinary retention and urinary tract infection,and then were cured by conservative treatment.(2) Follow-up situations:of 96 patients,95 were followed-up for 4-27 months,with a median time of 13 months.During the follow-up,3 patients died and 92 had survival.Conclusion The perioperative continuous use of aspirin cannot increase risk of bleeding in laparoscopic anterior resection for RC in patients taking low dose aspirin.