Early Enteral Nutrition Could Reduce Risk of Recurrent Leakage After Definitive Resection of Anastomotic Leakage After C
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ORIGINAL SCIENTIFIC REPORT
Early Enteral Nutrition Could Reduce Risk of Recurrent Leakage After Definitive Resection of Anastomotic Leakage After Colorectal Cancer Surgery Weiliang Tian1 • Xin Xu2 • Zheng Yao2 • Fan Yang1 • Ming Huang2 • Risheng Zhao2 • Yunzhao Zhao1,2
Accepted: 21 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The present study aimed to evaluate the effect of early enteral nutrition (EEN) after definitive resection of anastomotic leakage (DRAL) resulting from a sigmoid colon or rectal cancer radical resection. Methods This was a prospective cohort study performed at our center. From January 2014 to May 2016, every patient received a standard postoperative nutritional protocol (SPNP) after DRAL and was included into SPNP group. From June 2016 to December 2018, all patients received an EEN after DRAL and were included into EEN group. The effect of postoperative EEN was evaluated. Results There were a final total of 133 patients enrolled in our study. There were 70 patients in the SPNP group, and 63 patients in the EEN group. There were 12 cases (19.05%) with a recurrent leakage in the EEN group, and 28 cases (40%) in the SPNP group. The recurrent rate was associated with EEN (HR = 0.417, 95% CI 0.196–0.890, p = 0.024). The median defecation time in the EEN group was 5(4–7) days, while in the SPNP group was 7(6–8.25) days. The defecation was associated with EEN (HR = 1.588, 95% CI 1.080–2.336, p = 0.019), as well. Conclusion EEN could reduce the recurrent leakage rate and defecation time after definitive resection of anastomotic leakage resulting from sigmoid colon or rectal cancer radical resection.
Introduction Anastomotic leakage (AL) resulting from a sigmoid colon or rectal cancer radical resection (SCRCRR) is a serious complication that both worsens perioperative morbidity and mortality, and also significantly negatively influences
Xin Xu and Weiliang Tian were the first authors. & Zheng Yao [email protected] & Risheng Zhao [email protected] 1
Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China
2
Department of General Surgery, Nanjing Jiangning Hospital, Hushan Road No. 169, Nanjing 211100, Jiangsu, China
long-term outcomes [1]. The incidence of anastomotic leakage after SCRCRR varies from 5.1 to 13% [2–5]. The primary blood supply for the sigmoid colon and rectum is the inferior mesenteric artery (IMA) [6]. During SCRCRR, ligation of the IMA is required to achieve complete removal of lymph nodes. However, the ligation can lead to a state of anastomotic ischemia, which can cause anastomotic leakage after SCRCRR. Importantly, this ischemia would not likely be improved during the treatment of the anastomotic leakage, due to the anatomy. As a result, after a definitive resection of anastomotic leakage (DRAL), patients are at increased risk of recurrent leakage. In our experience, the risk of recurrent leakage after a DRAL might be as high as 30% (unpublished results from our center). Thus, there is an urgent need for strategies
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