Predictors for anastomotic leak, postoperative complications, and mortality after right colectomy for cancer: Results from an international snapshot audit
Articolo
Data di Pubblicazione:
2020
Abstract:
Background: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. Objective: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy. Design: This was a snapshot observational prospective study. Setting: The study was conducted as a multicenter international study. Patients: The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients. Main Outcome Measures: Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method. Results: Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p ≥ 0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041). Limitations: This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors. Conclusions: Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery.
Tipologia CRIS:
Articolo su Rivista
Keywords:
Anastomotic leak; Colon cancer; Postoperative outcome; Right colectomy
Elenco autori:
Gallo, G.; Pata, F.; Vennix, S.; Laurberg, S.; Morton, D.; Rubbini, M.; Vaizey, C.; Magill, L.; Perry, R.; Sheward, N.; Hervas, D.; Cillo, M.; Estefania, D.; Uriburu, J. P.; Ruiz, H.; Solomon, M.; Makhmudov, A.; Selnyahina, L.; Varabei, A.; Vizhynis, Y.; Claeys, D.; Defoort, B.; Muysoms, F.; Pletinckx, P.; Vergucht, V.; Debergh, I.; Feryn, T.; Reusens, H.; Nachtergaele, M.; Francart, D.; Jehaes, C.; Markiewicz, S.; Monami, B.; Weerts, J.; Houben, B.; Haeck, L.; Lange, C.; Sommeling, C.; Vindevoghel, K.; Castro, S.; De Bruyn, H.; Huyghe, M.; De Wolf, E.; Reynders, D.; D'Hoore, A.; De Buck Van Overstraeten, A.; Wolthuis, A.; Delibegovic, S.; Christiani, A.; Marchiori, M.; De Moraes, C. R.; Tercioti, V.; Arabadjieva, E.; Bulanov, D.; Dardanov, D.; Stoyanov, V.; Yonkov, A.; Angelov, K.; Maslyankov, S.; Sokolov, M.; Todorov, G.; Toshev, S.; Georgiev, Y.; Karashmalakov, A.; Zafirov, G.; Wang, X.; Condic, D.; Kraljik, D.; Mrkovic, H.; Pavkovic, V.; Raguz, K.; Bencurik, V.; Holaskova, E.; Skrovina, M.; Farkasova, M.; Grolich, T.; Kala, Z.; Antos, F.; Pruchova, V.; Sotona, O.; Chobola, M.; Dusek, T.; Ferko, A.; Orhalmi, J.; Hoch, J.; Kocian, P.; Martinek, L.; Bernstein, I.; Sunesen, K. G.; Leunbach, J.; Thorlacius-Ussing, O.; Oveson, A. U.; Christensen, P.; Chirstensen, S. D.; Gamez, V.; Oeting, M.; Loeve, U. S.; Ugianskis, A.; Jessen, M.; Krarup, P.; Linde, K.; Mirza, Q.; Stovring, J. O.; Erritzoe, L.; Jakobsen, H. L.; Lykke, J.; Colov, E. P.; Madsen, A. H.; Friis, T. L.; Funder, J. A.; Dich, R.; Kjar, S.; Rasmussen, S.; Schlesinger, N.; Kjaer, M. D.; Qvist, N.; Khalid, A.; Ali, G.; El-Hussuna, A.; Hadi, S.; Walker, L. R.; Kivela, A.; Lehtonen, T.; Lepisto, A.; Scheinin, T.; Siironen, P.; Kossi, J.; Kuusanmaki, P.; Tomminen, T.; Turunen, A.; Rautio, T.; Vierimaa, M.; Huhtinen, H.; Karvonen, J.; Lavonius, M.; Rantala, A.; Varpe, P.; Cotte, E.; Francois, Y.; Glehen, O.; Kepenekian, V.; Passot, G.; Maggiori, L.; Manceau, G.; Panis, Y.; Gout, M.; Rullier, E.; Van Geluwe, B.; Chafai, N.; Lefevre, J.; Parc, Y.; Tire, E.; Couette, C.; Duchalais, E.; Agha, A.; Hornberger, M.; Hungbauer, A.; Iesalnieks, I.; Weindl, I.; Crescenti, F.; Keller, M.; Kolodziejski, N.; Scherer, R.; Sterzing, D.; Bock, B.; Boehm, G.; El-Magd, M.; Krones, C.; Niewiera, M.; Buhr, J.; Cordesmeyer, S.; Hoffmann, M.; Kruckemeier, K.; Vogel, T.; Schon, M.; Baral, J.; Lukoschek, T.; Munch, S.; Pullig, F.; Horisberger, K.; Kienle, P.; Magdeburg, J.; Post, S.; Batzalexis, K.; Germanos, S.; Agalianos, C.; Dervenis, C.; Gouvas, N.; Kanavidis, P.; Kottikias, A.; Katsoulis, I.; Korkolis, D.; Plataniotis, G.; Sakorafas, G.; Akrida, I.; Argentou, M.; Kollatos, C.; Lampropoulos, C.; Tsochatzis, S.; Besznyak, I.; Bursics, A.; Egyed, T.; Papp, G.; Svastics, I.; Atladottir, J.; Moller, P.; Sigurdsson, H.; Stefansson, T.; Valsdottir, E.; Andrews, E.; Foley, N.; Hechtl, D.; Majeed, M.; Mccourt, M.; Hanly, A.; Hyland, J.; Martin, S.; O'Connell, R.; Winter, D.; Connelly, T.; Joyce, W.; Wrafter, P.; Berkovitz, R.; Avital, S.; Yahia, I. H.; Herman, N.; Shpitz, B.; White, I.; Lishtzinsky, Y.; Tsherniak, A.; Wasserberg, N.; Horesh, N.; Keler, U.; Pery, R.; Shapiro, R.; Zmora, O.; Tulchinsky, H.; Badran, B.; Dayan, K.; Iskhakov, A.; Lecaros, J.; Nabih, N.; Angrima, I.; Bardini, R.; Pizzolato, E.; Tonello, M.; Arces, F.; Balestri, R.; Ceccarelli, C.; Prosperi, V.; Rossi, E.; Giannini, I.; Vincenti, L.; Di Candido, F.; Di Iena, M.; Guglielmi, A.; Iambrenghi, O.; Marsanic, P.; Mellano, A.; Muratore, A.; Annecchiarico, M.; Bencini, L.; Bonapasta, S.; Coratti, A.; Guerra, F.; Asteria, C.; Boccia, L.; Gerard, L.; Pascariello, A.; Manca, G.; Marino, F.; Casaril, A.; Inama, M.; Moretto, G.; Bacchelli, C.; Carvello, M.; Mariani, N.; Montorsi, M.; Spinelli, A.; Romairone, E.; Scabini, S.; Belli, A.; Bianco, F.; De Franciscis, S.; Romano, G. M.; Delrio, P.; Pace, U.; Rega, D.; Sassaroli, C.; Scala, D.; De Luca, R.; Ruggieri, E.; Elbetti, C.; Garzi, A.; Romoli, L.; Scatizzi, M.; Vannucchi, A.; Curletti, G.
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