Different Risk Factors for Early and Late Colorectal Anastomotic Leakage in a Nationwide Audit
Different Risk Factors for Early and Late Colorectal Anastomotic Leakage in a Nationwide Audit
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DOI：
10.1097/dcr.0000000000001202
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发表时间：
2018-11-01
影响因子：
3.9
通讯作者：
Lange, Johan F.
中科院分区：
文献类型：
--
作者：
Sparreboom, Cloe L.;van Groningen, Julia T.;Lange, Johan F.
背景：吻合口漏仍然是结直肠癌术后的主要并发症，但其原因尚不清楚。我们的假设是早期吻合口漏主要与吻合技术失败有关，晚期吻合口漏主要与愈合缺陷有关。目的：本研究的目的是评估早期和晚期吻合口漏危险因素的差异。设计：这是一项回顾性队列研究。设置：荷兰结直肠审计是一个全国性的项目，收集所有接受结直肠癌手术的荷兰患者的信息。研究纳入了2011年至2015年间在荷兰接受结直肠癌手术切除的所有患者。晚期吻合口漏定义为术后6天后再次介入治疗的吻合口漏。早期吻合口瘘863例（2.3%），晚期吻合口瘘674例（1.8%）。根据多变量多项logistic回归模型，早期吻合口漏相对于无吻合口漏和晚期吻合口漏相对于无吻合口漏的独立预测因素包括男性（OR，1.8; p < 0.001和OR，1.2; p = 0.013）和直肠癌（OR，2.1; p < 0.001和OR，1.6; p = 0.046）。早期吻合口瘘相对于无吻合口瘘的其他独立预测因素包括BMI（OR，1.1; p = 0.001）、腹腔镜检查（OR，1.2; p = 0.019）、急诊手术（OR，1.8; p < 0.001）和无回肠造口术（OR，0.3; p < 0.001）。相对于无吻合口瘘，晚期吻合口瘘的独立预测因子为Charlson合并症指数II（OR，1.3; p = 0.003），阿萨评分III至V（OR，1.2; p = 0.030），术前肿瘤并发症（OR，1.1; p = 0.048），由于肿瘤生长而进行广泛额外切除（OR，1.7; p = 0.003），术前放疗（OR，2.0; p = 0.010）。局限性：这是一项观察性队列研究。结论：早期吻合口瘘的危险因素多为手术相关因素，代表手术难度，可能导致吻合技术失败。晚期吻合口瘘的大多数危险因素是患者相关因素，代表患者和组织的脆弱性，这可能意味着愈合缺陷。参见http://links.lww.com/DCR/A730上的视频摘要。
BACKGROUND: Anastomotic leakage remains a major complication after surgery for colorectal carcinoma, but its origin is still unknown. Our hypothesis was that early anastomotic leakage is mostly related to technical failure of the anastomosis, and that late anastomotic leakage is mostly related to healing deficiencies.OBJECTIVE: The aim of this study was to assess differences in risk factors for early and late anastomotic leakage.DESIGN: This was a retrospective cohort study.Settings: The Dutch ColoRectal Audit is a nationwide project that collects information on all Dutch patients undergoing surgery for colorectal cancer.PATIENTS: All patients undergoing surgical resection for colorectal cancer in the Netherlands between 2011 and 2015 were included.MAIN OUTCOME MEASURES: Late anastomotic leakage was defined as anastomotic leakage leading to reintervention later than 6 days postoperatively.RESULTS: In total, 36,929 patients were included; early anastomotic leakage occurred in 863 (2.3%) patients, and late anastomotic leakage occurred in 674 (1.8%) patients. From a multivariable multinomial logistic regression model, independent predictors of early anastomotic leakage relative to no anastomotic leakage and late anastomotic leakage relative to no anastomotic leakage included male sex (OR, 1.8; p < 0.001 and OR, 1.2; p = 0.013) and rectal cancer (OR, 2.1; p < 0.001 and OR, 1.6; p = 0.046). Additional independent predictors of early anastomotic leakage relative to no anastomotic leakage included BMI (OR, 1.1; p = 0.001), laparoscopy (OR, 1.2; p = 0.019), emergency surgery (OR, 1.8; p < 0.001), and no diverting ileostomy (OR, 0.3; p < 0.001). Independent predictors of late anastomotic leakage relative to no anastomotic leakage were Charlson Comorbidity Index of II (OR, 1.3; p = 0.003), ASA score III to V (OR, 1.2; p = 0.030), preoperative tumor complications (OR, 1.1; p = 0.048), extensive additional resection because of tumor growth (OR, 1.7; p = 0.003), and preoperative radiation (OR, 2.0; p = 0.010).LIMITATIONS: This was an observational cohort study.CONCLUSIONS: Most risk factors for early anastomotic leakage were surgery-related factors, representing surgical difficulty, which might lead to technical failure of the anastomosis. Most risk factors for late anastomotic leakage were patient-related factors, representing the frailty of patients and tissues, which might imply healing deficiencies. See Video Abstract at http://links.lww.com/DCR/A730.