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Open Access 01-12-2022 | Magnetic Resonance Imaging | Research

MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience

Authors: Liang Yu, Guangliang Chen, Hua Wang, Xiaojie Wang, Zhifen Chen, Ying Huang, Pan Chi

Published in: BMC Surgery | Issue 1/2022

Abstract

Background

Anastomotic leakage (AL) is one of the most serious postoperative complications after colorectal anastomosis. This study aims to evaluate the feasibility and diagnostic accuracy of magnetic resonance imaging (MRI) in the early detection of AL in patients with clinically suspected AL after rectal anterior resection.

Methods

This was a prospective study including patients who underwent anterior resection and postoperative MRI examination. AL was diagnosed by comprehensive indictors, which were mainly confirmed by clinical signs, symptoms, and retrograde contrast enema (RCE) radiography. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of diagnosing AL with MRI were calculated.

Results

In total, 347 patients received anterior resection for rectal cancer, and 28 patients were suspected to have AL. Finally, 23 patients were included and received MRI examination. The median time interval from surgery to MRI was 10 days (3–21 days). The median distance from anastomosis to anal verge was 4.0 cm (2.0–10 cm), and 11 patients underwent diverted ileostomy. Eighteen patients had an anastomotic leak, including one patient who had a pelvic abscess and five patients who had no evidence of AL in the MRI examination. The overall sensitivity and specificity were 94.4% (95% CI 70.6% to 99.7%) and 80% (95% CI 29.8% to 98.9%), respectively. The PPV was 0.94 (95% CI 0.71 to 0.99) and the NPV was 0.80 (95% CI 0.29 to 0.99). For patients who had anastomosis less than 5 cm, the diagnostic accuracy of MRI was 93.7% (15/16). T2-weighted imaging with fat suppression can effectively reveal the leak track.

Conclusions

The accuracy of plain MRI examination in diagnosing AL was favorable for patients with a suspected AL. T2-weighted imaging with fat suppression was the best imaging modality to diagnose AL. A multicenter prospective study with more samples is needed to further determine the safety and feasibility of MRI in the diagnosis of AL.

Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Ann Surg. 2010;251:807–18. https://doi.org/10.1097/SLA.0b013e3181dae4ed.CrossRef

Ortiz H, Wibe A, Ciga MA, Kreisler E, Garcia-Granero E, Roig JV, et al. Multicenter study of outcome in relation to the type of resection in rectal cancer. Dis Colon Rectum. 2014;57:811–22. https://doi.org/10.1097/dcr.0000000000000026.CrossRef

McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102:462–79. https://doi.org/10.1002/bjs.9697.CrossRef

Nicksa GA, Dring RV, Johnson KH, Sardella WV, Vignati PV, Cohen JL. Anastomotic leaks: what is the best diagnostic imaging study? Dis Colon Rectum. 2007;50:197–203. https://doi.org/10.1007/s10350-006-0708-x.CrossRef

Boström P, Haapamäki MM, Rutegård J, Matthiessen P, Rutegård M. Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer. BJS Open. 2019;3:106–11. https://doi.org/10.1002/bjs5.50106.CrossRef

Ha GW, Kim JH, Lee MR. Oncologic impact of anastomotic leakage following colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg Oncol. 2017;24:3289–99. https://doi.org/10.1245/s10434-017-5881-8.CrossRef

Kaur P, Karandikar SS, Roy-Choudhury S. Accuracy of multidetector CT in detecting anastomotic leaks following stapled left-sided colonic anastomosis. Clin Radiol. 2014;69:59–62. https://doi.org/10.1016/j.crad.2013.08.006.CrossRef

Nasirkhan MU, Abir F, Longo W, Kozol R. Anastomotic disruption after large bowel resection. World J Gastroenterol. 2006;12:2497–504. https://doi.org/10.3748/wjg.v12.i16.2497.CrossRef

Alves A, Panis Y, Pocard M, Regimbeau JM, Valleur P. Management of anastomotic leakage after nondiverted large bowel resection. J Am Coll Surg. 1999;189:554–9. https://doi.org/10.1016/s1072-7515(99)00207-0.CrossRef

10.

Habib K, Gupta A, White D, Mazari FA, Wilson TR. Utility of contrast enema to assess anastomotic integrity and the natural history of radiological leaks after low rectal surgery: systematic review and meta-analysis. Int J Colorectal Dis. 2015;30:1007–14. https://doi.org/10.1007/s00384-015-2225-7.CrossRef

11.

Huiberts AA, Dijksman LM, Boer SA, Krul EJ, Peringa J, Donkervoort SC. Contrast medium at the site of the anastomosis is crucial in detecting anastomotic leakage with CT imaging after colorectal surgery. Int J Colorectal Dis. 2015;30:843–8. https://doi.org/10.1007/s00384-015-2215-9.CrossRef

12.

Kornmann VN, Treskes N, Hoonhout LH, Bollen TL, van Ramshorst B, Boerma D. Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery. Int J Colorectal Dis. 2013;28:437–45. https://doi.org/10.1007/s00384-012-1623-3.CrossRef

13.

Kauv P, Benadjaoud S, Curis E, Boulay-Coletta I, Loriau J, Zins M. Anastomotic leakage after colorectal surgery: diagnostic accuracy of CT. Eur Radiol. 2015;25:3543–51. https://doi.org/10.1007/s00330-015-3795-z.CrossRef

14.

Dohan A, Eveno C, Oprea R, Pautrat K, Placé V, Pocard M, et al. Diffusion-weighted MR imaging for the diagnosis of abscess complicating fistula-in-ano: preliminary experience. Eur Radiol. 2014;24:2906–15. https://doi.org/10.1007/s00330-014-3302-y.CrossRef

15.

Beets-Tan RG, Beets GL, van der Hoop AG, Kessels AG, Vliegen RF, Baeten CG, et al. Preoperative MR imaging of anal fistulas: does it really help the surgeon? Radiology. 2001;218:75–84. https://doi.org/10.1148/radiology.218.1.r01dc0575.CrossRef

16.

Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147:339–51. https://doi.org/10.1016/j.surg.2009.10.012.CrossRef

17.

Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg. 2002;26:499–502. https://doi.org/10.1007/s00268-001-0256-4.CrossRef

18.

Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg. 2007;245:254–8. https://doi.org/10.1097/01.sla.0000225083.27182.85.CrossRef

19.

Daams F, Wu Z, Lahaye MJ, Jeekel J, Lange JF. Prediction and diagnosis of colorectal anastomotic leakage: a systematic review of literature. World J Gastrointest Surg. 2014;6:14–26. https://doi.org/10.4240/wjgs.v6.i2.14.CrossRef

20.

Marres CCM, Engelmann EWM, Buskens CJ, Haak HE, Bemelman WA, van de Ven AWH. The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis. 2021. https://doi.org/10.1111/codi.15764.CrossRef

21.

DuBrow RA, David CL, Curley SA. Anastomotic leaks after low anterior resection for rectal carcinoma: evaluation with CT and barium enema. AJR Am J Roentgenol. 1995;165:567–71. https://doi.org/10.2214/ajr.165.3.7645472.CrossRef

22.

Kitaguchi D, Enomoto T, Ohara Y, Owada Y, Hisakura K, Akashi Y, et al. Exploring optimal examination to detect occult anastomotic leakage after rectal resection in patients with diverting stoma. BMC Surg. 2020;20:53. https://doi.org/10.1186/s12893-020-00706-x.CrossRef

23.

Khoury W, Ben-Yehuda A, Ben-Haim M, Klausner JM, Szold O. Abdominal computed tomography for diagnosing postoperative lower gastrointestinal tract leaks. J Gastrointest Surg. 2009;13:1454–8. https://doi.org/10.1007/s11605-009-0925-4.CrossRef

24.

Feng ST, Huang M, Dong Z, Xu L, Li Y, Jia Y, et al. MRI T2-weighted imaging and fat-suppressed T2-weighted imaging image fusion technology improves image discriminability for the evaluation of anal fistulas. Korean J Radiol. 2019;20:429–37. https://doi.org/10.3348/kjr.2018.0260.CrossRef

25.

Worley G, Burling D, Corr A, Clark S, Baldwin-Cleland R, Faiz O, et al. MRI-enema for the assessment of pelvic intestinal anastomotic integrity. Colorectal Dis. 2021;23:1890–9. https://doi.org/10.1111/codi.15688.CrossRef

Title: MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience
Authors: Liang Yu
Guangliang Chen
Hua Wang
Xiaojie Wang
Zhifen Chen
Ying Huang
Pan Chi
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Computed Tomography
Rectal Cancer
Rectal Cancer
Rectal Extirpation
Computed Tomography
Rectal Extirpation
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01872-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

MRI diagnose post-operative anastomotic leak in patients with rectal cancer: preliminary experience

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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