Risk Factors for Anastomotic Leak After Colon Resection for Cancer Multivariate Analysis and Nomogram From a Multicentric, Prospective, National Study With 3193 Patients
Risk Factors for Anastomotic Leak After Colon Resection for Cancer Multivariate Analysis and Nomogram From a Multicentric, Prospective, National Study With 3193 Patients
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DOI：
10.1097/sla.0000000000000973
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发表时间：
2015-08-01
影响因子：
9
通讯作者：
Garcia-Granero, Eduardo
中科院分区：
文献类型：
--
作者：
Frasson, Matteo;Flor-Lorente, Blas;Garcia-Granero, Eduardo
目的：目的探讨结肠癌切除术后吻合口瘘的术前/术中危险因素，建立一种实用的预测吻合口瘘风险的工具。背景：吻合口瘘仍然是结直肠手术中最可怕的并发症。许多危险因素已被确定到目前为止，但多中心的前瞻性研究结肠切除术后吻合口瘘lacking.Methods：五十二家医院参加了这项前瞻性，观察性研究。前瞻性在线数据库（2011年9月至2012年9月）中纳入了3193例结肠癌患者的数据，这些患者接受了一期吻合术（无造口）。分析了42个与患者、肿瘤、外科手术和医院相关的术前/术中变量，作为吻合口瘘的潜在独立风险因素（60天随访）。一个诺模图创建一个给定patient.Results的吻合口瘘的风险很容易预测：吻合口瘘率为8.7%，医院之间的差异很大（0.24的logit量表的方差）。吻合口漏显著增加死亡率（15.2% vs 1.9%，无吻合口漏患者，P < 0.0001）和住院时间（中位数23 vs 7天，无并发症患者，P < 0.0001）。在多变量分析中，以下变量是吻合口瘘的独立风险因素：肥胖[P = 0.003，OR = 2.7]，术前血清总蛋白（P = 0.03，OR = 0.7/g/dL），男性（P = 0.03，OR = 1.6），正在接受抗凝治疗（P = 0.05，OR = 1.8），术中并发症（P = 0.03，OR = 2.2）、住院床位数结论：结肠癌切除术后吻合口漏是一种常见的相关并发症。患者、手术技术和医院都是吻合口漏风险的重要决定因素。
Objective: To determine pre-/intraoperative risk factors for anastomotic leak after colon resection for cancer and to create a practical instrument for predicting anastomotic leak risk.Background: Anastomotic leak is still the most dreaded complication in colorectal surgery. Many risk factors have been identified to date, but multicentric prospective studies on anastomotic leak after colon resection are lacking.Methods: Fifty-two hospitals participated in this prospective, observational study. Data of 3193 patients, operated for colon cancer with primary anastomosis without stoma, were included in a prospective online database (September 2011-September 2012). Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak (60-day follow-up). A nomogram was created to easily predict the risk of anastomotic leak for a given patient.Results: The anastomotic leak rate was 8.7%, and widely varied between hospitals (variance of 0.24 on the logit scale). Anastomotic leak significantly increased mortality (15.2% vs 1.9% in patients without anastomotic leak, P < 0.0001) and length of hospitalization (median 23 vs 7 days in uncomplicated patients, P < 0.0001). In the multivariate analysis, the following variables were independent risk factors for anastomotic leak: obesity [P = 0.003, odds ratio (OR) = 2.7], preoperative serum total proteins (P = 0.03, OR = 0.7 per g/dL), male sex (P = 0.03, OR = 1.6), ongoing anticoagulant treatment (P = 0.05, OR = 1.8), intraoperative complication (P = 0.03, OR = 2.2), and number of hospital beds (P = 0.04, OR = 0.95 per 100 beds).Conclusions: Anastomotic leak after colon resection for cancer is a frequent, relevant complication. Patients, surgical technique, and hospital are all important determining factors of anastomotic leak risk.