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Functional outcomes of patients undergoing successful redo surgery after failed primary colorectal or coloanal anastomosis for rectal cancer

Published:December 01, 2020DOI:https://doi.org/10.1016/j.surg.2020.10.037

      Abstract

      Background

      After a failure of a colorectal or coloanal anastomosis, redo anastomotic surgery aims to avoid the risk of permanent stoma but, overall, to provide a satisfactory functional result and quality of life. Very limited data exist regarding the long-term results after a successful redo anastomosis. The present study aimed to report the long-term functional outcomes and quality of life in patients after a successful redo colorectal anastomosis or coloanal anastomosis.

      Methods

      Between 2007 and 2018, all patients who had a successful restoration of bowel continuity after a failed primary anastomosis performed for a rectal cancer were included. Functional outcomes and quality of life were assessed using the low anterior rectal syndrome score and the Gastrointestinal Quality of Life Index.

      Results

      One hundred and twenty-seven patients were eligible for inclusion in this study, with long-term functional outcomes assessed in 73 patients (57%). After a median follow-up of 69 months, 31 patients presented no or minor low anterior rectal syndrome (42%), whereas 31 patients reported a major low anterior rectal syndrome (42%). A definitive stoma was confectioned in 11 patients (15%), despite the technical success of redo anastomosis due to poor functional results. Only operative interval <36 months was associated with a poor functional outcome (P = .001), whereas all other factors such as pelvic radiotherapy were not (P = .848). An absence of major low anterior rectal syndrome was the only factor associated with improved quality of life (P = .001).

      Conclusion

      After successful redo colorectal anastomosis or coloanal anastomosis, good functional outcomes can be achieved in almost half of patients with a well-preserved quality of life but requires a prolonged postoperative period of rehabilitation.
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      References

        • Chau A.
        • Maggiori L.
        • Debove C.
        • Kanso F.
        • Hennequin C.
        • Panis Y.
        Toward the end of abdominoperineal resection for rectal cancer? An 8-year experience in 189 consecutive patients with low rectal cancer.
        Ann Surg. 2014; 260 (discussion 805-806): 801-805
        • Collard M.
        • Lefevre J.H.
        Ultimate functional preservation with intersphincteric resection for rectal cancer.
        Front Oncol. 2020; 10: 297
        • Dinnewitzer A.
        • Jager T.
        • Nawara C.
        • Buchner S.
        • Wolfgang H.
        • Ofner D.
        Cumulative incidence of permanent stoma after sphincter preserving low anterior resection of mid and low rectal cancer.
        Dis Colon Rectum. 2013; 56: 1134-1142
        • Celerier B.
        • Denost Q.
        • Van Geluwe B.
        • Pontallier A.
        • Rullier E.
        The risk of definitive stoma formation at 10 years after low and ultralow anterior resection for rectal cancer.
        Colorectal Dis. 2016; 18: 59-66
        • Westerduin E.
        • Klaver C.E.L.
        • van Geloven A.A.W.
        • Westerterp M.
        • Bemelman W.A.
        • Tanis P.J.
        Outcome after redo surgery for complicated colorectal and coloanal anastomosis: A systematic review.
        Dis Colon Rectum. 2018; 61: 988-998
        • Fucini C.
        • Gattai R.
        • Urena C.
        • Bandettini L.
        • Elbetti C.
        Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma.
        Ann Surg Oncol. 2008; 15: 1099-1106
        • Pitel S.
        • Lefevre J.H.
        • Tiret E.
        • Chafai N.
        • Parc Y.
        Redo coloanal anastomosis: a retrospective study of 66 patients.
        Ann Surg. 2012; 256 (discussion 810-811): 806-810
        • Lefevre J.H.
        • Bretagnol F.
        • Maggiori L.
        • Ferron M.
        • Alves A.
        • Panis Y.
        Redo surgery for failed colorectal or coloanal anastomosis: a valuable surgical challenge.
        Surgery. 2011; 149: 65-71
        • Genser L.
        • Manceau G.
        • Karoui M.
        • et al.
        Postoperative and long-term outcomes after redo surgery for failed colorectal or coloanal anastomosis: retrospective analysis of 50 patients and review of the literature.
        Dis Colon Rectum. 2013; 56: 747-755
        • Schlegel R.D.
        • Dehni N.
        • Parc R.
        • Caplin S.
        • Tiret E.
        Results of reoperations in colorectal anastomotic strictures.
        Dis Colon Rectum. 2001; 44: 1464-1468
        • Toupet A.
        [Colonectomies with transmesenteric anastomosis].
        Mem Acad Chir (Paris). 1963; 89: 628-630
        • Jouvin I.
        • Pocard M.
        • Najah H.
        Deloyers procedure.
        J Visc Surg. 2018; 155: 493-501
        • Emmertsen K.J.
        • Laurberg S.
        Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer.
        Ann Surg. 2012; 255: 922-928
        • Eypasch E.
        • Williams J.I.
        • Wood-Dauphinee S.
        • et al.
        Gastrointestinal Quality of Life Index: development, validation and application of a new instrument.
        Br J Surg. 1995; 82: 216-222
        • Rosen R.
        • Brown C.
        • Heiman J.
        • et al.
        The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.
        J Sex Marital Ther. 2000; 26: 191-208
        • Wiegel M.
        • Meston C.
        • Rosen R.
        The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores.
        J Sex Marital Ther. 2005; 31: 1-20
        • Gregoire J.P.
        • Moisan J.
        • Labrecque M.
        • Cusan L.
        • Diamond P.
        [Validation of a French adaptation of the international prostatic symptom score].
        Prog Urol. 1996; 6: 240-249
        • Rhoden E.L.
        • Telöken C.
        • Sogari P.R.
        • Vargas Souto C.A.
        The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction.
        Int J Impot Res. 2002; 14: 245-250
        • Croese A.D.
        • Lonie J.M.
        • Trollope A.F.
        • Vangaveti V.N.
        • Ho Y.H.
        A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors.
        Int J Surg. 2018; 56: 234-241
        • Trenti L.
        • Galvez A.
        • Biondo S.
        • et al.
        Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer: A cross-sectional study.
        Eur J Surg Oncol. 2018; 44: 1031-1039
        • Juul T.
        • Elfeki H.
        • Christensen P.
        • Laurberg S.
        • Emmertsen K.J.
        • Bager P.
        Normative data for the Low Anterior Resection Syndrome Score (LARS Score).
        Ann Surg. 2019; 269: 1124-1128
        • Juul T.
        • Battersby N.J.
        • Christensen P.
        • et al.
        • and the UK LARS Study Group
        Validation of the English translation of the low anterior resection syndrome score.
        Colorectal Dis. 2015; 17: 908-916
        • Caille C.
        • Collard M.
        • Moszkowicz D.
        • Prost A la Denise J.
        • Maggiori L.
        • Panis Y.
        Reversal of Hartmann's procedure in patients following failed colorectal or coloanal anastomosis: an analysis of 45 consecutive cases.
        Colorectal Dis. 2020; 22: 203-211
        • Maggiori L.
        • Blanche J.
        • Harnoy Y.
        • Ferron M.
        • Panis Y.
        Redo-surgery by transanal colonic pull-through for failed anastomosis associated with chronic pelvic sepsis or rectovaginal fistula.
        Int J Colorectal Dis. 2015; 30: 543-548
        • Boullenois H.
        • Lefevre J.H.
        • Creavin B.
        • et al.
        Long-term functional results and quality of life after redo rectal surgery: delayed versus immediate colo-anal anastomosis.
        Colorectal Dis. 2020; 22: 885-893
        • Jimenez-Gomez L.M.
        • Espin-Basany E.
        • Trenti L.
        • et al.
        Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer.
        Colorectal Dis. 2017; 20: 195-200
        • Emmertsen K.J.
        • Laurberg S.
        • the Rectal Cancer Function Study Group
        Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer.
        Br J Surg. 2013; 100: 1377-1387
        • Sandberg S.
        • Asplund D.
        • Bisgaard T.
        • et al.
        Low anterior resection syndrome in a Scandinavian population of patients with rectal cancer: a longitudinal follow-up within the QoLiRECT study.
        Colorectal Dis. 2020; 22: 1367-1378
        • Pontallier A.
        • Denost Q.
        • Van Geluwe B.
        • Adam J.P.
        • Celerier B.
        • Rullier E.
        Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision.
        Surg Endosc. 2016; 30: 4924-4933
        • Dulskas A.
        • Samalavicius N.E.
        A prospective study of sexual and urinary function before and after total mesorectal excision.
        Int J Colorectal Dis. 2016; 31: 1125-1130
        • Hendren S.K.
        • O'Connor B.I.
        • Liu M.
        • et al.
        Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer.
        Ann Surg. 2005; 242: 212-223
        • Bulian D.R.
        • Knuth J.
        • Lehmann K.S.
        • Sauerwald A.
        • Heiss M.M.
        Systematic analysis of the safety and benefits of transvaginal hybrid-NOTES cholecystectomy.
        World J Gastroenterol. 2015; 21: 10915-10925
        • Maartense S.
        • Dunker M.S.
        • Slors J.F.
        • et al.
        Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: a randomized trial.
        Ann Surg. 2006; 243 (discussion 150-153): 143-149
        • Dulskas A.
        • Smolskas E.
        • Kildusiene I.
        • Samalavicius N.E.
        Treatment possibilities for low anterior resection syndrome: a review of the literature.
        Int J Colorectal Dis. 2018; 33: 251-260
        • Ram E.
        • Meyer R.
        • Carter D.
        • Gutman M.
        • Rosin D.
        • Horesh N.
        The efficacy of sacral neuromodulation in the treatment of low anterior resection syndrome: a systematic review and meta-analysis.
        Tech Coloproctol. 2020; 24: 803-815
        • Didailler R.
        • Denost Q.
        • Loughlin P.
        • et al.
        Antegrade enema after total mesorectal excision for rectal cancer: The last chance to avoid definitive colostomy for refractory low anterior resection syndrome and fecal incontinence.
        Dis Colon Rectum. 2018; 61: 667-672