Cancer Management and Research (Jun 2022)
Application of Transurethral Prostate Resection Instrumentation for Treating Low Rectal Anastomotic Leakage: A Pilot Study
Abstract
Zhenming Zhang,1,* Zhentao Hu,1,* Yujie Qin,2,* Jun Qian,3 Song Tu,1,3 Jiaxi Yao3,4 1Department of General Surgery II, Hexi University Affiliated Zhangye People’s Hospital, Zhangye, Gansu, 734000, People’s Republic of China; 2Department of Endoscopy Center, Hexi University Affiliated Zhangye People’s Hospital, Zhangye, Gansu, 734000, People’s Republic of China; 3Institute of Urology, Hexi University, Zhangye, Gansu, 734000, People’s Republic of China; 4Department of Urology, Hexi University Affiliated Zhangye People’s Hospital, Zhangye, Gansu, 734000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jiaxi Yao; Song Tu, Department of Urology, Zhangye People’s Hospital, affiliated to Hexi University, No. 67, Xihuan Road, Ganzhou District, Zhangye City, Gansu, 734000, People’s Republic of China, Tel +86-18093616382, Email [email protected]; [email protected]: To determine an accurate method of inspecting low anastomotic leakages and application of transurethral prostate resection instrumentation for treating low rectal anastomotic leakage.Patients and Methods: Clinical data of eight patients treated for anastomotic leakage after rectal cancer surgery at Zhangye People’s Hospital (affiliated to Hexi University), from August 2019 to November 2021, were retrospectively analyzed. Transanal prostate resection instrumentation was used to assess the leakage and surrounding conditions. Using prostate resection instrumentation, the presacral and perirectal residual cavities were washed and removed, and indwelling suprapubic presacral, transanal presacral, and rectal drainage tubes were placed. Continuous presacral saline irrigation and drainage and open negative-pressure suction in the rectal cavity were performed until the patients’ fistula healed.Results: Of the eight patients with anastomotic leakages, one had grade B and seven had grade C International Study Group of Rectal Cancer anastomotic leakage classifications following Dixon operation. Transanal prostate resection instrumentation showed that the leakage of the one patient with grade B was less than a third of the circumference of the anastomosis. Among the seven patients with grade C, one leakage was less than a third of the anastomotic circumference. One patient had complete separation of the anastomosis and one distal colon necrosis, which necessitated immediate descending colostomy. Conservative treatment was successful in six patients; the conservative overall cure rate was 75%, and the median healing time was 43 (21– 68) days.Conclusion: Transanal examination of rectal anastomotic leakage using prostate resection instrumentation is comprehensive, easy to perform, provides clear visualization, accurately guides catheter placement, and can be combined with continuous open negative-pressure drainage, which is a safe, convenient, and effective method for treating low rectal leakage.Keywords: anastomotic leakage, prostate resection instrumentation, catheter, negative-pressure drainage
