A prospective algorithm to reduce anastomotic leaks after rectosigmoid resection for gynecologic malignancies

Area of Science:

• Colorectal Surgery
• Gynecologic Oncology
• Surgical Quality Improvement

Background:

• Anastomotic leak (AL) is a significant complication following rectosigmoid resection (RSR).
• Cytoreductive surgery for gynecologic cancer often involves RSR, increasing AL risk.
• Standardized protocols may mitigate AL rates.

Purpose of the Study:

• To evaluate the impact of a standardized protocol for temporary bowel diversion on AL rates after RSR.
• To assess the safety and efficacy of this diversion protocol.

Main Methods:

• A prospective quality improvement project was conducted from July 2013 to January 2016.
• Patients undergoing RSR for cytoreduction were assessed for diversion based on predefined criteria (e.g., low albumin, prior radiation, anastomosis location).
• The AL rate was compared to a historic cohort (January 2004 - June 2011).

Main Results:

• Twenty-seven of 77 patients (35.1%) received temporary diversion, compared to 8.1% in the historic cohort.
• No anastomotic leaks occurred in patients who received diversion.
• Excluding a protocol violation case, the theoretical AL rate decreased from 7.8% to 1.3% (P=0.039).
• Stoma-related complications (e.g., dehydration) occurred in 25.9% of diverted patients, with an 88.9% successful reversal rate.

Conclusions:

• Criteria-based temporary bowel diversion effectively reduces anastomotic leak rates after rectosigmoid resection in gynecologic cancer patients.
• The diversion protocol is associated with manageable morbidity and a high rate of successful stoma reversal.
• Standardized diversion protocols are valuable for improving surgical outcomes.