Vrije voordracht 25 – Koen Vree Egberts, Medisch Spectrum Twente

09:15 – 09:25 – ALPrES2MA study: Anastomotic Leakage Prevention by Endovascular Stenting of the Superior Mesenteric Artery

Drs Koen Vree Egberts1,5, Prof. dr. Bob Geelkerken1,5, dr. Desiree Leemreis2,3, dr. Ian Faneyete4, drs Floor Metz1,5, dr. Anneriet Dassen1, drs Eric Stassen1, dr. Michelle Kip5, dr. Marjolein Brusse-Keizer1,5, dr. Kay Pieterman3, prof. dr. Hans de Wit6, prof. dr. Marco Bruno3, dr. Eva Deerenberg2
1Medisch Spectrum Twente, Enschede, Nederland, 2Franciscus, Rotterdam, Nederland, 3Erasmus MC, Rotterdam, Nederland, 4ZGT, Almelo, Nederland, 5Universiteit Twente, Enschede, Nederland, 6Radboud Universitair Medisch Centrum, Nijmegen, Nederland

Introduction
Anastomotic leakage (AL) is a severe complication of colorectal surgery, with an incidence of 2.7–11.9%. It is associated with long-term increased mortality, reduced quality of life, and high healthcare costs due to reoperations and prolonged hospitalization. Among colorectal cancer patients, 5-year survival rates are 70% for those with AL compared to 81% for those without. A retrospective case-control study (Harmankaya et al., 2024) identified a >50% stenosis of the Superior Mesenteric Artery (SMA) as a significant risk factor, increasing AL odds by six times (95% CI: 2.78–12.60, p < .001). Objectives The ALPrES2MA study aims to evaluate whether preventive endovascular stenting of a >50% stenosed SMA origin reduces AL risk, improves quality of life, and lowers healthcare costs. Additionally, in hospitals with suitable equipment and experience, the study will explore the use of quantitative fluorescence angiography (Q-FA) with indocyanine green (ICG) fluorescence to measure anastomotic microcirculation and its association with AL risk.

Study Design
Nation-wide randomized controlled trial (RCT) in which patients are randomized 1:1 to undergo either preventive endovascular SMA stenting or no stenting prior to colorectal resection. Patients in the intervention group (stenting of the SMA) will be treated with lifelong antiplatelet therapie (Ascal) following the endovascular procedure.

Study Population
Patients in the Netherlands with a >50% SMA stenosis scheduled for elective colorectal resection with a primary anastomosis for malignant or benign pathology.

Endpoints
The primary endpoint is AL prevalence within 30 days post-surgery. Secondary endpoints include Q-FA measurements, AL classification/severity, calcification scores of aortic and mesenteric vessels, peri-operative hemodynamics, operative duration, stenting complications, hospital stay, patient-reported outcomes (PROMs), and cost-effectiveness (CEA/BIA).