Incidence and Risk Factors for Anastomotic Failure in 1594 Patients Treated by Transanal Total Mesorectal Excision: Results From the International TaTME Registry
Marta Penna, Roel Hompes, Steve Arnold, Greg Wynn, Ralph Austin, Janindra Warusavitarne, Brendan Moran, George B Hanna, Neil J Mortensen, Paris P Tekkis, International TaTME Registry Collaborative, Michel Adamina, Felix Aigner, Cihangir Akyol, Ahmed Alani, Matthew Albert, Hazar Al Furajii, Andrew S Allison, Alberto Arezzo, Steve Arnold, Kamal Aryal, Shady Ashamalla, Shazad Ashraf, Sam Atallah, Ralph Austin, Mirza Khurrum Baig, Balázs Bánky, Jörg Baral, Stephen W Bell, David Berger, Matthias Biebl, Willem A Bemelman, Stefano Berti, Jaap Bonjer, Luigi Boni, Liliana Bordeianou, Dario Borreca, Sylvie Van den Broeck, Carl J Brown, Walter Brunner, Christian Buchli, Nicolas Christian Buchs, Ronan A Cahill, Ken Campbell, Gabriella Teresa Capolupo, Ilaria Capuano, Marco Caricato, Elisa Cassinotti, Antonio Caycedo, William M Chambers, Pramodh Chandrasinghe, Sanjay Chaudhri, Stanislav Chernyshov, David A Clark, Julien Coget, Pablo Collera, Edward Douglas Courtney, Christopher Cunningham, Stephen Dalton, Giulia David, Robin Dawson, Borja DeLacy, Paolo Delrio, Paolo De Paolis, Pieter D'hooge, Andre D'Hoore, Anthony Dixon, Pascal G Doornebosch, Peter van Duijvendijk, Hasan E Dzhumabaev, Tom Edwards, Monika Egenvall, Jens Ravn Eriksen, Miroslava Fabryko, Arne E Faerden, Seraina Faes, Martina Farkašová, Carmen Cagigas Fernández, Vicente Simó Fernández, Håvard M Forsmo, Nader K Francis, Elisa Francone, Bawantha Dilshan Gamage, Veera Garimella, Ethem Gecim, Daniel Geissmann, Bart Van Geluwe, Kathryn Gill, Markus Glöckler, Eelco de Graaf, Felix Grieder, Michele Grieco, Tomáš Grolich, Dieter Hahnloser, Usmaan Hameed, Julian Hance, Tarek A Salem Hany, Ingrid Haunold, Julian L Hayes, Tom Hendrickx, Alexander G Heriot, Theo-Julian Hoffmann, Bert Houben, Masaaki Ito, Marc Janssens, Philippe Du Jardin, Oliver Jones, Howard Joy, Guilherme Pagin São Julião, Guido Jutten, Zdeněk Kala, Aleksei Karachun, Mark Katory, Niels Komen, Stephan Korsgen, Werner Kneist, John Knight, Joep Knol, Neil Kukreja, Reiner Kunz, Antonio M Lacy, Miklós Lakatos, Roshan Lal, Hauke Lang, Antonio La Terra, Emanuele Lezoche, Paul Lidder, Meyline Andrade Lima, Grace Ma, Paul Mackey, Zaman Z Mamedli, Stephen D Mansfield, Steven Marcoen, Paulo Nuno Roquete Marques, Tobias Marcy, Sushil Maslekar, Denzil May, Kathryn McCarthy, Carlos Ramon Silveira Mendes, Arend Eh Merrie, William Frederick Anthony Miles, Sarah Mills, Yevgen Miroshnychenko, Danilo Miskovic, Richard Molloy, Etienne Maurice Moore, Mario Morino, Gabriela Möslein, Andrea Muratore, Deborah Nicol, Yves Van Nieuwenhove, Alex Ochsner, Jae Hwan Oh, Paul O'Loughlin, Susana Margarida Rodrigues Ourô, Steve Pandey, Marius T Paraoan, Carlos Pastor, Cherylin Fu Wan Pei, Gustavo Sevá-Pereira, Rodrigo Oliva Perez, Aleksei Petrov, Frank Pfeffer, Terry P Phang, Andrea Picchetto, Jakob Piehslinger, Yves Pirenne, Peter Pockney, Simon Radley, Arsen O Rasulov, Daniela Rega, Wouter van Riel, Rolf Riis, Frederic Ris, Stefan Riss, Timothy A Rockall, Marcos Gómez Ruiz, Evgeny Rybakov, Andrea Scala, Lope Estévez Schwarz, Gerald Seitinger, Irshad Shaikh, Colin Sietses, Pierpaolo Sileri, Baljit Singh, Stephen Smith, Dae Kyung Sohn, Cristina Soto, Chris Speakman, Antonino Spinelli, Frank van Sprundel, Andrew Rl Stevenson, Anton Stift, Peter Stotland, Patricia Sylla, Alexander Szyszkowitz, Pieter J Tanis, Patricia Tejedor, Enrique Pastor Teso, Jean-Jacques Tuech, Jurriaan Tuynman, Filip Vanrykel, Franky Vansteenkiste, Marioes Veltcamp-Helbach, Arcot Venkatsubramaniam, Luk Verlaeckt, Stephan Vorburger, Oliver Warren, Satish Warrier, Janindra Warusavitarne, Henk Wegstapel, Albert M Wolthuis, Linus Wu, Greg Wynn, Edwin S van der Zaag, Urs Zingg, Marta Penna, Roel Hompes, Steve Arnold, Greg Wynn, Ralph Austin, Janindra Warusavitarne, Brendan Moran, George B Hanna, Neil J Mortensen, Paris P Tekkis, International TaTME Registry Collaborative, Michel Adamina, Felix Aigner, Cihangir Akyol, Ahmed Alani, Matthew Albert, Hazar Al Furajii, Andrew S Allison, Alberto Arezzo, Steve Arnold, Kamal Aryal, Shady Ashamalla, Shazad Ashraf, Sam Atallah, Ralph Austin, Mirza Khurrum Baig, Balázs Bánky, Jörg Baral, Stephen W Bell, David Berger, Matthias Biebl, Willem A Bemelman, Stefano Berti, Jaap Bonjer, Luigi Boni, Liliana Bordeianou, Dario Borreca, Sylvie Van den Broeck, Carl J Brown, Walter Brunner, Christian Buchli, Nicolas Christian Buchs, Ronan A Cahill, Ken Campbell, Gabriella Teresa Capolupo, Ilaria Capuano, Marco Caricato, Elisa Cassinotti, Antonio Caycedo, William M Chambers, Pramodh Chandrasinghe, Sanjay Chaudhri, Stanislav Chernyshov, David A Clark, Julien Coget, Pablo Collera, Edward Douglas Courtney, Christopher Cunningham, Stephen Dalton, Giulia David, Robin Dawson, Borja DeLacy, Paolo Delrio, Paolo De Paolis, Pieter D'hooge, Andre D'Hoore, Anthony Dixon, Pascal G Doornebosch, Peter van Duijvendijk, Hasan E Dzhumabaev, Tom Edwards, Monika Egenvall, Jens Ravn Eriksen, Miroslava Fabryko, Arne E Faerden, Seraina Faes, Martina Farkašová, Carmen Cagigas Fernández, Vicente Simó Fernández, Håvard M Forsmo, Nader K Francis, Elisa Francone, Bawantha Dilshan Gamage, Veera Garimella, Ethem Gecim, Daniel Geissmann, Bart Van Geluwe, Kathryn Gill, Markus Glöckler, Eelco de Graaf, Felix Grieder, Michele Grieco, Tomáš Grolich, Dieter Hahnloser, Usmaan Hameed, Julian Hance, Tarek A Salem Hany, Ingrid Haunold, Julian L Hayes, Tom Hendrickx, Alexander G Heriot, Theo-Julian Hoffmann, Bert Houben, Masaaki Ito, Marc Janssens, Philippe Du Jardin, Oliver Jones, Howard Joy, Guilherme Pagin São Julião, Guido Jutten, Zdeněk Kala, Aleksei Karachun, Mark Katory, Niels Komen, Stephan Korsgen, Werner Kneist, John Knight, Joep Knol, Neil Kukreja, Reiner Kunz, Antonio M Lacy, Miklós Lakatos, Roshan Lal, Hauke Lang, Antonio La Terra, Emanuele Lezoche, Paul Lidder, Meyline Andrade Lima, Grace Ma, Paul Mackey, Zaman Z Mamedli, Stephen D Mansfield, Steven Marcoen, Paulo Nuno Roquete Marques, Tobias Marcy, Sushil Maslekar, Denzil May, Kathryn McCarthy, Carlos Ramon Silveira Mendes, Arend Eh Merrie, William Frederick Anthony Miles, Sarah Mills, Yevgen Miroshnychenko, Danilo Miskovic, Richard Molloy, Etienne Maurice Moore, Mario Morino, Gabriela Möslein, Andrea Muratore, Deborah Nicol, Yves Van Nieuwenhove, Alex Ochsner, Jae Hwan Oh, Paul O'Loughlin, Susana Margarida Rodrigues Ourô, Steve Pandey, Marius T Paraoan, Carlos Pastor, Cherylin Fu Wan Pei, Gustavo Sevá-Pereira, Rodrigo Oliva Perez, Aleksei Petrov, Frank Pfeffer, Terry P Phang, Andrea Picchetto, Jakob Piehslinger, Yves Pirenne, Peter Pockney, Simon Radley, Arsen O Rasulov, Daniela Rega, Wouter van Riel, Rolf Riis, Frederic Ris, Stefan Riss, Timothy A Rockall, Marcos Gómez Ruiz, Evgeny Rybakov, Andrea Scala, Lope Estévez Schwarz, Gerald Seitinger, Irshad Shaikh, Colin Sietses, Pierpaolo Sileri, Baljit Singh, Stephen Smith, Dae Kyung Sohn, Cristina Soto, Chris Speakman, Antonino Spinelli, Frank van Sprundel, Andrew Rl Stevenson, Anton Stift, Peter Stotland, Patricia Sylla, Alexander Szyszkowitz, Pieter J Tanis, Patricia Tejedor, Enrique Pastor Teso, Jean-Jacques Tuech, Jurriaan Tuynman, Filip Vanrykel, Franky Vansteenkiste, Marioes Veltcamp-Helbach, Arcot Venkatsubramaniam, Luk Verlaeckt, Stephan Vorburger, Oliver Warren, Satish Warrier, Janindra Warusavitarne, Henk Wegstapel, Albert M Wolthuis, Linus Wu, Greg Wynn, Edwin S van der Zaag, Urs Zingg
Abstract
Objective: To determine the incidence of anastomotic-related morbidity following Transanal Total Mesorectal Excision (TaTME) and identify independent risk factors for failure.
Background: Anastomotic leak and its sequelae are dreaded complications following gastrointestinal surgery. TaTME is a recent technique for rectal resection, which includes novel anastomotic techniques.
Methods: Prospective study of consecutive reconstructed TaTME cases recorded over 30 months in 107 surgical centers across 29 countries. Primary endpoint was "anastomotic failure," defined as a composite endpoint of early or delayed leak, pelvic abscess, anastomotic fistula, chronic sinus, or anastomotic stricture. Multivariate regression analysis performed identifying independent risk factors of anastomotic failure and an observed risk score developed.
Results: One thousand five hundred ninety-four cases with anastomotic reconstruction were analyzed; 96.6% performed for cancer. Median anastomotic height from anal verge was 3.0 ± 2.0 cm with stapled techniques accounting for 66.0%. The overall anastomotic failure rate was 15.7%. This included early (7.8%) and delayed leak (2.0%), pelvic abscess (4.7%), anastomotic fistula (0.8%), chronic sinus (0.9%), and anastomotic stricture in 3.6% of cases. Independent risk factors of anastomotic failure were: male sex, obesity, smoking, diabetes mellitus, tumors >25 mm, excessive intraoperative blood loss, manual anastomosis, and prolonged perineal operative time. A scoring system for preoperative risk factors was associated with observed rates of anastomotic failure between 6.3% to 50% based on the cumulative score.
Conclusions: Large tumors in obese, diabetic male patients who smoke have the highest risk of anastomotic failure. Acknowledging such risk factors can guide appropriate consent and clinical decision-making that may reduce anastomotic-related morbidity.
Source: PubMed