Lower Incidence of Anastomotic Leakage Linked to PGA Sheets

Surgeries for colorectal cancer (CRC) can be particularly dangerous, with mortality and increased hospital stays due to anastomotic leakage being potential complications. A study published in Cureus¹ found that anastomotic leakage can be mitigated through the use of polyglycolic acid (PGA) sheets in gastrointestinal anastomosis.

Anastomotic leakage is a complication with potential fatal implications and can lead to longer hospital stays. Male sex, rectal surgery, and obesity have all been found to be risk factors for anastomotic leakage.^2,3 Transanal drains can be used to prevent anastomotic leakage, along with a blood flow assessment done during the operation. PGA sheets have been able to decrease recurrence of pneumothorax surgery in the past and could be a way to reinforce tissue when it comes to anastomotic leakages. This study aimed to evaluate if anastomotic leakage rate was reduced after using PGA sheets for gastrointestinal anastomosis.

Colorectal cancer | Image credit: UA Creative - stock.adobe.com

Patients were included (N = 239) if they had a surgery for either colon or rectal cancer between January 2021 and January 2023 at any of Nagoya Tokushukai General Hospital, Oogaki Tookushukai Hospital, or Haibara General Hospital in Japan. The primary study end point was Incidence of anastomotic leakage. Automated anastomosis machines were used for the colon specifically by using the functional end-to-end anastomosis or the overlap method. The rectum required the double stapling method. Patients were compared based on whether they used a PGA sheet or not and whether they had an anastomotic leak or not.

The mean patient age was 73 years, and 151 participants were male patients; the mean body mass index (BMI) of the patients was 21.6 kg/m². Fourteen patients had anastomotic leakages, of which 5 were in the colon and 9 were in the rectum.

Significant differences in age, BMI, and gender were not found between the groups who did and did not use PGA sheets. Although the preoperative and procedural factors were not significantly different between the 2 groups as well, there was a statistically significant difference in the incidence of anastomotic leakage. Seven percent of the patients in the group that did not use PGA sheets had cases of anastomotic leakage vs 0% of those who used PGA sheets.

A borderline association between preoperative chemotherapy and Incidence of anastomotic leakage was found (OR, 3.784; 95% CI, 0.613-16.61), and a decreased likelihood of the primary outcome was associated with the use of PGA sheets (OR, 0; 95% CI, 0-1.047). Intraoperative blood transfusion, male gender, renal failure, antiplatelet drugs, preoperative radiotherapy, and peritoneal drain did not show any association to the outcome in a univariate analysis.

There were some limitations to this study. Differences in anastomosis methods were not investigated, and efficacy bias could exist due to the colon and rectum being separated. Further, the sample size was small, which could lead to a smaller number of patients who were at risk prior to the operation. The study also had a retrospective design and will need a future randomized controlled trial to confirm the findings.

The researchers concluded that PGA sheets are effective in reducing the rate of anastomotic leakage in surgeries for CRC. Future studies should focus on trials to compare the efficacy of PGA sheets.

References

1. Takayama S, Tomoda K, Ishikawa K, et al. A retrospective study about the effectiveness of anastomosis with a polyglycolic acid sheet in colorectal cancer. Cureus. Published online March 18, 2024. doi:10.7759/cureus.56415
2. Bonavitacola J. Rectal surgery, male sex risk factors for anastomotic leakage. The American Journal of Managed Care^®. February 5, 2024. Accessed April 24, 2024. https://www.ajmc.com/view/rectal-surgery-male-sex-risk-factors-for-anastomotic-leakage
3. Bonavitacola J. Visceral obesity associated with anastomotic leakage after colon cancer surgery. AJMC^®. September 7, 2023. Accessed April 24, 2024. https://www.ajmc.com/view/visceral-obesity-associated-with-anastomotic-leakage-after-colon-cancer-surgery