Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: Analysis of risk factors

被引:197
作者
Choi, Hok-Kwok [1 ]
Law, Wai-Lun [1 ]
Ho, Judy W. C. [1 ]
机构
[1] Univ Hong Kong, Med Ctr, Queen Mary Hosp, Dept Surg, Hong Kong, Hong Kong, Peoples R China
关键词
risk factors; anastomotic leakage; intraperitoneal large-bowel anastomosis;
D O I
10.1007/s10350-006-0703-2
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
PURPOSE: The study was designed to identify the risk factors associated with anastomotic leakage after an intraperitoneal large-bowel anastomosis in patients with colorectal malignancy. METHODS: The prospectively collected data of patients who underwent colorectal resection for malignancy with primary anastomosis above the pelvic peritoneal reflection for malignancy between 1996 and 2004 were reviewed. Thirty-five variables were evaluated using univariate and multivariate analysis. RESULTS: A total of 1,417 patients were studied and anastomotic leakage occurred in 25 patients (1.8 percent). Twenty-two patients (88 percent) required reoperation for anastomotic leakage. The hospital stay (28 vs. 10 days, P < 0.001) and mortality rate (32, vs. 4 percent, P < 0.001) of patients with anastomotic leakage were significantly increased compared with those without leakage. Multivariate analysis showed that American Society of Anesthesiologists Grade 3 to 5 (P = 0.04; odds ratio, 5.6; 95 percent confidence interval, 1.6-15.3) and emergency operation (P = 0.03; odds ratio, 4.6; 95 percent confidence interval, 1.9-9.8) were independent factors associated with anastomotic leakage. The risk of anastomotic leakage was 8.1 percent (odds ratio, 10.5; 95 percent confidence interval, 2.7-26.8) if both factors were present. CONCLUSIONS: Intraperitoneal anastomosis after large-bowel resection is associated with a low leakage rate. Emergency surgery and a high American Society of Anesthesiologists grade are independent factors associated with an increased incidence of leakage. A temporary diverting stoma to protect the primary anastomosis or even avoidance of anastomosis could be considered for patients with the two risk factors present.
引用
收藏
页码:1719 / 1725
页数:7
相关论文
共 22 条
[1]  
Agnifili A, 2004, HEPATO-GASTROENTEROL, V51, P1694
[2]   ANASTOMOTIC LEAKS IN COLORECTAL-CANCER SURGERY - A RISK FACTOR FOR RECURRENCE [J].
AKYOL, AM ;
MCGREGOR, JR ;
GALLOWAY, DJ ;
MURRAY, GD ;
GEORGE, WD .
INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 1991, 6 (04) :179-183
[3]   Factors associated with clinically significant anastomotic leakage after large bowel resection: Multivariate analysis of 707 patients [J].
Alves, A ;
Panis, Y ;
Trancart, D ;
Regimbeau, JM ;
Pocard, M ;
Valleur, P .
WORLD JOURNAL OF SURGERY, 2002, 26 (04) :499-502
[4]   Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence [J].
Bell, SW ;
Walker, KG ;
Rickard, MJFX ;
Sinclair, G ;
Dent, OF ;
Chapuis, PH ;
Bokey, EL .
BRITISH JOURNAL OF SURGERY, 2003, 90 (10) :1261-1266
[5]   ANASTOMOTIC INTEGRITY AFTER OPERATIONS FOR LARGE-BOWEL CANCER - A MULTICENTER STUDY [J].
FIELDING, LP ;
STEWARTBROWN, S ;
BLESOVSKY, L ;
KEARNEY, G .
BRITISH MEDICAL JOURNAL, 1980, 281 (6237) :411-414
[6]  
Golub R, 1997, J AM COLL SURGEONS, V184, P364
[7]   Quality of life with a temporary stoma -: Ileostomy vs. colostomy [J].
Gooszen, AW ;
Geelkerken, RH ;
Hermans, J ;
Lagaay, MB ;
Gooszen, HG .
DISEASES OF THE COLON & RECTUM, 2000, 43 (05) :650-655
[8]   Anastomotic leak in colorectal surgery: A single surgeon's experience [J].
Isbister, WH .
ANZ JOURNAL OF SURGERY, 2001, 71 (09) :516-520
[9]   The failed intraperitoneal colon anastomosis after colon resection [J].
Kanellos I. ;
Blouhos K. ;
Demetriades H. ;
Pramateftakis M.G. ;
Mantzoros I. ;
Zacharakis E. ;
Betsis D. .
Techniques in Coloproctology, 2004, 8 (Suppl 1) :S53-S55
[10]   LEAKAGE FROM STAPLED LOW ANASTOMOSIS AFTER TOTAL MESORECTAL EXCISION FOR CARCINOMA OF THE RECTUM [J].
KARANJIA, ND ;
CORDER, AP ;
BEARN, P ;
HEALD, RJ .
BRITISH JOURNAL OF SURGERY, 1994, 81 (08) :1224-1226