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Superior rectal artery preservation to reduce anastomotic leak rates in familial adenomatous polyposis patients treated with total colectomy and ileorectal anastomosis

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Abstract

Background

Total colectomy with ileorectal anastomosis (TC/IRA) is one of the prophylactic surgical options in patients with familial adenomatous polyposis (FAP). This study investigated the effectiveness of superior rectal artery (SRA) preservation during TC/IRA in reducing anastomotic leakage (AL).

Methods

This retrospective study was based on prospectively collected data (01/2000 - 12/2022) at the National Cancer Institute, Milan, Italy. FAP patients undergoing TC/IRA were enrolled. A 1:1  propensity score matching (PSM) was performed. Associations between SRA preservation and complications were investigated using univariate and multivariate analysis.

Results

The study population included 211 patients undergoing TC/IRA (Sex: 106 Male, 105 Female; Age: median 30 yrs, IQR: 20-48 yrs), 82 with SRA preservation (SRA group) and 129 without SRA preservation (controls). After PSM, 75 patients were considered for each group. SRA preservation was associated with fewer complications (OR 0.331, 95% CI 0.116; 0.942) in univariate logistic regression analysis. AL events were significantly fewer in the SRA group than in the control group (0 vs 12, p = 0.028). The SRA group had fewer overall surgical complication and pelvic sepsis rates (p = 0.020 and p = 0.028, respectively). Median operative time was significantly longer in the SRA group (340 min vs 240 min, p<0.001), and median hospital stay was significantly shorter (6 vs 7 days, p=0.017). Twenty-seven patients in the SRA group experienced intraoperative anastomotic bleeding, which was controlled endoscopically. Superimposable results were obtained analyzing the whole patient cohort.

Conclusions

SRA preservation can be considered an advantage in this patient population, despite adding a further technical step during surgery and thereby prolonging the operative time. Intraoperative endoscopic checking of possible anastomotic bleeding sites is recommended.

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Data availability

The data presented in this study are available on request from the corresponding author.

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Acknowledgements

The authors acknowledge Mariangela Di Ceglie and Ornella Galuppo of the Hereditary Digestive Tract Tumors Unit for prospectively maintaining the patient database. Marije de Jager is acknowledged for editing assistance. The authors also acknowledge Mrs. Koiana Trencheva, Assistant Professor of Population Health Sciences Research in Surgery of Weill Cornell Medical College, NY, for inspiring this project, and continuous research about colonic anastomotic leakage.

Funding

No specific funding was received from any bodies in the public, commercial or not-for-profit sectors to carry out the work described.

Author information

Authors and Affiliations

  1. Unit of Hereditary Digestive Tract Tumors, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, Italy

    E. Rausa, S. Signoroni, M. T. Ricci, C. Brignola & M. Vitellaro

  2. Colorectal Surgery Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, Italy

    G. Colletti & M. Vitellaro

  3. Unit of Bioinformatics and Biostatistics, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, Italy

    C. M. Ciniselli, V. Duroni & P. Verderio

  4. Gastroenterology and Gastrointestinal Endoscopy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    F. Cavalcoli & A. Magarotto

  5. Pediatric Surgical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    D. Biasoni

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  1. E. Rausa
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Contributions

All authors contributed to the study’s conception and design. Formal analysis and investigation: CMC, VD, PV; Writing—original draft preparation: ER, GC, CMC, MV; Writing—review and editing: ER, PV, MV; Funding acquisition: None; Resources: None; Supervision: MV, PV. All authors read and approved the final manuscript.

Corresponding author

Correspondence to C. M. Ciniselli.

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Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of the Fondazione IRCCS Istituto Nazionale dei Tumori (INT191/19).

Informed Consent Statement

The patients to whom the study will be proposed have already signed a consent pursuant to the current national and European regulations on the protection of personal data (Regulation (EU) 2016/679) for the processing of their personal and sensitive data and for the contact to clinical research purposes (consent of the TEAD INT 12/18 Registry). In the impossibility of requesting consent to the processing of data from patients for ethical-administrative reasons, the study falls within the scope and purposes specified by the Guarantor for the Protection of Personal Data (General authorization for the processing of personal data carried out for of scientific research and General Authorization for the processing of genetic data-15 December 2016-Official Gazette no. 303 of 29 December 2016).

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Rausa, E., Colletti, G., Ciniselli, C.M. et al. Superior rectal artery preservation to reduce anastomotic leak rates in familial adenomatous polyposis patients treated with total colectomy and ileorectal anastomosis. Tech Coloproctol 27, 1327–1334 (2023). https://doi.org/10.1007/s10151-023-02858-3

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