Leakage After Resection and Intraperitoneal Anastomosis for Colorectal Malignancy: Analysis of Risk Factors
2006/10/18 by Hok-Kwok Choi, Wai-Lun Law, Wai‐Lun Law +2 · 32 citations
Medicine · #Colorectal Cancer Surgical Treatments #Intraperitoneal and Appendiceal Malignancies #Cardiac, Anesthesia and Surgical Outcomes
paper · doi:10.1007/s10350-006-0703-2
Abstract
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.
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