Understanding colorectal anastomotic healing.
Research type
Research Study
Full title
Characterising the natural history of mucosal metabolism during colorectal anastomotic healing
IRAS ID
246354
Contact name
James Kinross
Contact email
Sponsor organisation
Imperial College London and Imperial College Healthcare NHS Trust
Duration of Study in the UK
5 years, 0 months, 1 days
Research summary
Colorectal anastomoses (joins) are formed after surgery to remove all or part of the left side of the colon and/or rectum. A major complication of forming an anastomosis is failure of healing leading to a leak. The risk of this is up to 20%, with serious ramifications. Cancer patients experiencing a leak have an increased risk of cancer recurrence.
This study aims to characterise both the natural history of how an anastomosis heals and the role of the intestinal microbiome (the varied community of microbes living in the intestine) in anastomotic healing.
We will be recruiting patients undergoing elective surgery. We will be collecting tissue samples to analyse cellular metabolic activity and the different bacteria present within the bowel with a view to understanding the complex interplay between human and microbial metabolism. If we can identify which bacteria or conditions are associated with healing or non-healing, this may lead to future treatment options to reduce the risk of a leak.
A defunctioning ileostomy (stoma created upstream of the anastomosis) is one method currently employed to reduce the impact of an anastomotic leak. There is evidence that the presence of a stoma and presence of a stoma for a longer period of time is associated with worse bowel function and quality of life after surgery to close the stoma. This may be due to alterations in the microbiome which have been demonstrated following defunctioning ileostomy.
We will recruit 20 patients from within the study to reintroduce stoma output into the downstream bowel once anastomotic healing has been confirmed. The impact on function will be assessed with questionnaires and tissue samples collected to establish any impact upon the microbiome and metabolome.REC name
London - Westminster Research Ethics Committee
REC reference
19/LO/0185
Date of REC Opinion
25 Feb 2019
REC opinion
Further Information Favourable Opinion