title: ETVARD (endoscopic transanal vacuum-assisted rectal drainage) leads to complete but delayed closure of extraperitoneal rectal anastomotic leakage cavities following neoadjuvant radiochemotherapy.
abstract: OBJECTIVE
  The purpose of the study was to prospectively assess the impact of neoadjuvant radiochemotherapy on the formation of major anastomotic rectal leaks and treatment by endoscopic transanal vacuum-assisted rectal drainage (ETVARD).
  
  
  METHODS
  Twenty six patients with malignancies with rectal anastomotic leaks were prospectively treated, including 14 of 26 patients following neoadjuvant radiochemotherapy. ETVARD was the first-line treatment.
  
  
  RESULTS
  In 23 of 26 patients, ETVARD was successfully completed. In patients following neoadjuvant radiochemotherapy sizes of leakage cavities, duration of ETVARD, number of sponge exchanges, and endoscopies as well as time to closure of cavities were significantly increased (0.009 < p < 0.035) compared to patients after primary surgery. Increased age showed similar correlations, whereas the level of anastomoses did not influence these parameters. Patients without (ile)ostomies could also be treated by ETVARD. Follow-up endoscopies have not shown any major changes.
  
  
  CONCLUSIONS
  Radiochemotherapy has a significant impact on development and treatment of major anastomotic rectal leaks. Most patients can be successfully treated by ETVARD, avoiding additional resective surgery or permanent (col)ostomies.
authors.affiliation: Department of General, Visceral, Thoracic and Vascular Surgery, Universitätsklinikum Greifswald, Ernst-Moritz-Arndt-University, Greifswald, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: von Bernstorff
authors.forename: Anne
authors.initials: A
authors.lastname: Glitsch
authors.forename: André
authors.initials: A
authors.lastname: Schreiber
authors.forename: Lars Ivo
authors.initials: LI
authors.lastname: Partecke
authors.forename: Claus Dieter
authors.initials: CD
authors.lastname: Heidecke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D004322:Drainage; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D010537:Peritoneum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D012007:Rectum / Q000601:surgery*