PDF herunterladen
CC BY-NC-ND 4.0 · Journal of Coloproctology 2022; 42(01): 038-046
DOI: 10.1055/s-0041-1740207
Original Article

Risk Factors for Anastomotic Leakage Following Total or Subtotal Colectomy

J. Ocaña 
1   Department of General and Digestive Surgery, Division of Coloproctology, Ramón y Cajal University Hospital, Madrid, Spain.
,
P. Pastor-Peinado
1   Department of General and Digestive Surgery, Division of Coloproctology, Ramón y Cajal University Hospital, Madrid, Spain.
,
P. Abadía
1   Department of General and Digestive Surgery, Division of Coloproctology, Ramón y Cajal University Hospital, Madrid, Spain.
,
A. Ballestero
1   Department of General and Digestive Surgery, Division of Coloproctology, Ramón y Cajal University Hospital, Madrid, Spain.
,
D. Ramos
1   Department of General and Digestive Surgery, Division of Coloproctology, Ramón y Cajal University Hospital, Madrid, Spain.
,
JC. García-Pérez
1   Department of General and Digestive Surgery, Division of Coloproctology, Ramón y Cajal University Hospital, Madrid, Spain.
,
JM. Fernández-Cebrián
1   Department of General and Digestive Surgery, Division of Coloproctology, Ramón y Cajal University Hospital, Madrid, Spain.
,
J. Die
1   Department of General and Digestive Surgery, Division of Coloproctology, Ramón y Cajal University Hospital, Madrid, Spain.
› Institutsangaben Funding No funding or grant was received for the preparation of this manuscript.
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Introduction A higher rate of anastomotic leakage (AL) is reported after ileosigmoid anastomosis (ISA) or ileorectal anastomosis (IRA) in total or subtotal colectomy (TSC) compared with colonic or colorectal anastomosis. The main aim of the present study was to assess potential risk factors for AL after ISA or IRA and to investigate determinants of morbidity.

Methods We identified 180 consecutive patients in a prospective referral, single center database, in which 83 of the patients underwent TSC with ISA or IRA. Data regarding the clinical characteristics, surgical treatment, and outcome were assessed to determine their association with the cumulative incidence of AL and surgical morbidity.

Results Ileosigmoid anastomosis was performed in 51 of the patients (61.5%) and IRA in 32 patients (38.6%). The cumulative incidence of AL was 15.6% (13 of 83 patients). A higher AL rate was found in patients under 50 years-old (p = 0.038), in the elective-laparoscopic approach subgroup (p = 0.049), and patients in the inflammatory bowel disease (IBD) subgroup (p = 0.009). Furthermore, 14 patients (16.9%) had morbidity classified as Clavien-Dindo ≥ IIIA.

Discussion A relatively high incidence of AL after TSC was observed in a relatively safe surgical procedure. Our findings suggest that the risk of AL may be higher in IBD patients. According to our results, identifying risk factors prior to surgery may improve short-term outcomes.

Keywords

total or subtotal colectomy - ileorectal anastomosis - ileosigmoid anastomosis - anastomotic leakage


Publikationsverlauf

Eingereicht: 22. März 2021

Angenommen: 06. August 2021

Artikel online veröffentlicht:
17. Januar 2022

© 2022. Sociedade Brasileira de Coloproctologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Raahave D, Loud FB, Christensen E, Knudsen LL. Colectomy for refractory constipation. Scand J Gastroenterol 2010; 45 (05) 592-602
    CrossrefPubMedGoogle Scholar
  • 2 Moszkowicz D, Mariani A, Trésallet C, Menegaux F. Ischemic colitis: the ABCs of diagnosis and surgical management. J Visc Surg 2013; 150 (01) 19-28
    CrossrefPubMedGoogle Scholar
  • 3 Washington C, Carmichael JC. Management of ischemic colitis. Clin Colon Rectal Surg 2012; 25 (04) 228-235
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 4 Bakker IS, Grossmann I, Henneman D, Havenga K, Wiggers T. Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 2014; 101 (04) 424-432 , discussion 432
    CrossrefPubMedGoogle Scholar
  • 5 Elton C, Makin G, Hitos K, Cohen CRG. Mortality, morbidity and functional outcome after ileorectal anastomosis. Br J Surg 2003; 90 (01) 59-65
    CrossrefPubMedGoogle Scholar
  • 6 Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011; 253 (05) 890-899
    CrossrefPubMedGoogle Scholar
  • 7 Law WL, Choi HK, Lee YM, Ho JWC, Seto CL. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg 2007; 11 (01) 8-15
    CrossrefPubMedGoogle Scholar
  • 8 Lu ZR, Rajendran N, Lynch AC, Heriot AG, Warrier SK. Anastomotic leaks after restorative resections for rectal cancer compromise cancer outcomes and survival. Dis Colon Rectum 2016; 59 (03) 236-244
    CrossrefPubMedGoogle Scholar
  • 9 Duclos J, Lefevre JH, Lefrançois M. et al. Immediate outcome, long-term function and quality of life after extended colectomy with ileorectal or ileosigmoid anastomosis. Colorectal Dis 2014; 16 (08) O288-O296
    Google Scholar
  • 10 2015 European Society of Coloproctology Collaborating Group. Predictors for Anastomotic Leak, Postoperative Complications, and Mortality After Right Colectomy for Cancer: Results From an International Snapshot Audit. Dis Colon Rectum 2020; 63 (05) 606-618
    CrossrefPubMedGoogle Scholar
  • 11 Platell C, Barwood N, Dorfmann G, Makin G. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis 2007; 9 (01) 71-79
    CrossrefPubMedGoogle Scholar
  • 12 Nakamura T. Are complications of TSC with ileorectal anastomosis related to the original disease?. Am Surg 2001
    PubMedGoogle Scholar
  • 13 Pastore RLO, Wolff BG, Hodge D. Total abdominal colectomy and ileorectal anastomosis for inflammatory bowel disease. Dis Colon Rectum 1997; 40 (12) 1455-1464
    CrossrefPubMedGoogle Scholar
  • 14 Loftus Jr EV, Delgado DJ, Friedman HS, Sandborn WJ. Colectomy and the incidence of postsurgical complications among ulcerative colitis patients with private health insurance in the United States. Am J Gastroenterol 2008; 103 (07) 1737-1745
    CrossrefPubMedGoogle Scholar
  • 15 Björk J, Åkerbrant H, Iselius L. et al. Outcome of primary and secondary ileal pouch-anal anastomosis and ileorectal anastomosis in patients with familial adenomatous polyposis. Dis Colon Rectum 2001; 44 (07) 984-992
    CrossrefPubMedGoogle Scholar
  • 16 Segelman J, Mattsson I, Jung B, Nilsson PJ, Palmer G, Buchli C. Risk factors for anastomotic leakage following ileosigmoid or ileorectal anastomosis. Colorectal Dis 2018; 20 (04) 304-311
    CrossrefPubMedGoogle Scholar
  • 17 Rahbari NN, Weitz J, Hohenberger W. et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 2010; 147 (03) 339-351
    CrossrefPubMedGoogle Scholar
  • 18 Kulu Y, Ulrich A, Bruckner T. et al; International Study Group of Rectal Cancer. Validation of the International Study Group of Rectal Cancer definition and severity grading of anastomotic leakage. Surgery 2013; 153 (06) 753-761
    CrossrefPubMedGoogle Scholar
  • 19 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
    CrossrefPubMedGoogle Scholar
  • 20 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg 2014; 12 (12) 1495-1499
    CrossrefPubMedGoogle Scholar
  • 21 Hennekinne-Mucci S, Tuech JJ, Bréhant O. et al. Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma. Int J Colorectal Dis 2006; 21 (06) 538-541
    CrossrefPubMedGoogle Scholar
  • 22 O'Riordan JM, O'Connor BI, Huang H. et al. Long-term outcome of colectomy and ileorectal anastomosis for Crohn's colitis. Dis Colon Rectum 2011; 54 (11) 1347-1354
    CrossrefPubMedGoogle Scholar
  • 23 Boccola MA, Buettner PG, Rozen WM. et al. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg 2011; 35 (01) 186-195
    CrossrefPubMedGoogle Scholar
  • 24 Torralba JA, Robles R, Parrilla P. et al. TSC vs. intraoperative colonic irrigation in the management of obstructed left colon carcinoma. Dis Colon Rectum 1998
    PubMedGoogle Scholar
  • 25 Stephenson BM, Shandall AA, Farouk R, Griffith G. Malignant left-sided large bowel obstruction managed by subtotal/total colectomy. Br J Surg 1990; 77 (10) 1098-1102
    CrossrefPubMedGoogle Scholar
  • 26 Ross S, Krukowski ZH, Munro A, Russell IT. Single-stage treatment for malignant left-sided colonic obstruction: A prospective randomized clinical trial comparing TSC with segmental resection following intraoperative irrigation. Br J Surg 1995
    PubMedGoogle Scholar
  • 27 Yamamoto T, Keighley MRB. Proctocolectomy is associated with a higher complication rate but carries a lower recurrence rate than total colectomy and ileorectal anastomosis in Crohn colitis. Scand J Gastroenterol 1999; 34 (12) 1212-1215
    CrossrefPubMedGoogle Scholar
  • 28 Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H. Association of comorbidity with anastomotic leak, 30-day mortality, and length of stay in elective surgery for colonic cancer: A nationwide cohort study. Dis Colon Rectum 2015; 58 (07) 668-676
    CrossrefPubMedGoogle Scholar
  • 29 Sparreboom CL, van Groningen JT, Lingsma HF. et al; Dutch ColoRectal Audit group. Different risk factors for early and late colorectal anastomotic leakage in a nationwide audit. Dis Colon Rectum 2018; 61 (11) 1258-1266
    CrossrefPubMedGoogle Scholar
  • 30 Sciuto A, Merola G, De Palma GD. et al. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol 2018; 24 (21) 2247-2260
    CrossrefPubMedGoogle Scholar
  • 31 Trencheva K, Morrissey KP, Wells M. et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 2013; 257 (01) 108-113
    CrossrefPubMedGoogle Scholar
  • 32 Lin X, Li J, Chen W. et al. Diabetes and risk of anastomotic leakage after gastrointestinal surgery. J Surg Res 2015; 196 (02) 294-301
    CrossrefPubMedGoogle Scholar
  • 33 McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 2015; 102 (05) 462-479
    CrossrefPubMedGoogle Scholar
  • 34 Neutzling CB, Lustosa SA, Proenca IM, da Silva EM, Matos D. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev 2012; (02) CD003144
    PubMedGoogle Scholar
  • 35 Naumann DN, Bhangu A, Kelly M, Bowley DM. Stapled versus handsewn intestinal anastomosis in emergency laparotomy: a systemic review and meta-analysis. Surgery 2015; 157 (04) 609-618
    CrossrefPubMedGoogle Scholar
  • 36 Watanabe K, Funayama Y, Fukushima K, Shibata C, Takahashi KI, Sasaki I. Hand-assisted laparoscopic vs. open TSC for severe ulcerative colitis. Dis Colon Rectum 2009
    PubMedGoogle Scholar
  • 37 Veldkamp R, Kuhry E, Hop WC. et al; COlon cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005; 6 (07) 477-484
    CrossrefPubMedGoogle Scholar