Risk factors and endoscopic treatment for anastomotic stricture after resection in patients with colorectal cancer

Abstract

Introduction: Benign strictures are frequent complications following colorectal surgery, with an incidence of up to 20%. Endoscopic treatment is safe and effective but there is not enough evidence for establishing stricture management at that anatomic level. Aim: To determine the risk factors associated with the development of stricture in patients with colorectal cancer and describe endoscopic treatment in those patients. Materials and methods: A retrospective study was conducted on patients with colorectal cancer that underwent surgery and anastomosis, evaluated through colonoscopy, within the time frame of 2014 to 2019. Results: Of the 213 patients included in the study, 18.3% presented with stricture that was associated with the type of surgery. Intersphincteric resection was a risk factor (OR = 18.81, 95% CI: 3.31-189.40, p < 0.001). A total of 69.2% patients with stricture had a stoma, identifying it as a risk factor for stricture (OR = 7.07, 95% CI: 3.10-16.57, p < 0.001). Mechanical anastomotic stapling was performed in 87.4% of the patients that did not present with stricture, identifying it as a protective factor (OR = 0.41, 95% CI: 0.16-1.1, p = 0.04).Endoscopic treatment was required in 69.2% of the patients and provided favorable results in 83.3%. Only 2.6% of the patients had recurrence. No complications were reported. Conclusion: Intersphincteric resection and the presence of a stoma were independent risk factors for stricture, and mechanical anastomosis was a protective factor against stricture development. Endoscopic treatment was safe and effective. Resumen: Introducción: Las estenosis benignas son complicaciones frecuentes posterior a la cirugía colorectal con una incidencia hasta del 20%. El tratamiento endoscópico es seguro y efectivo pero no hay evidencia suficiente para establecer el manejo de las estenosis a este nivel. Objetivo: Determinar los factores de riesgo asociados al desarrollo de estenosis en pacientes con cáncer y describir el tratamiento endoscópico en estos pacientes Material y métodos: Es un estudio retrospectivo en pacientes con cáncer colorectal sometidos a cirugìa y anastomosis valorados por colonoscopia entre el 2014 y 2019. Resultados: Se incluyeron 213 pacientes, 18.3% con estenosis, la cual se asoció con el tipo de cirugía, siendo la RIE un factor de riesgo OR = 18.81 (IC95% 3.31- 189.40, p < 0.001). La presencia de estoma fue de 69.2% en los pacientes con estenosis identificándose como factor de riesgo para estenosis OR = 7.07 (3.10 - 16.57, p < 0.001). Las anastomosis se hicieron de forma mecánica en el 87.4% de los pacientes sin estenosis, siendo identificado como factor protector OR = 0.41 (IC 0.16 - 1.1, p = 0.04).El 69.2% requirieron tratamiento endoscópico con resultados favorables en el 83.3% y recurrencia en el 2.6% únicamente. No se reportaron complicaciones. Conclusión: La RIE y la presencia de un estoma son factores de riesgo independiente para estenosis y la conformación mecánica de la anastomosis como un factor protector contra el desarrollo de estenosis. El tratamiento endoscópico es una opción segura y efectiva.

Keywords

• Cáncer colorectal
• Anastomosis
• Estenosis
• Estoma