Risk factors and outcomes for anastomotic leakage in colorectal surgery: A single-institution analysis of 1576 patients

Boccola, Mark A., Buettner, Petra G., Rozen, Warren M., Siu, Simon K., Stevenson, Andrew R. L., Stitz, Russell and Ho, Yik-Hong (2011) Risk factors and outcomes for anastomotic leakage in colorectal surgery: A single-institution analysis of 1576 patients. World Journal of Surgery, 35 1: 186-195. doi:10.1007/s00268-010-0831-7


Author Boccola, Mark A.
Buettner, Petra G.
Rozen, Warren M.
Siu, Simon K.
Stevenson, Andrew R. L.
Stitz, Russell
Ho, Yik-Hong
Title Risk factors and outcomes for anastomotic leakage in colorectal surgery: A single-institution analysis of 1576 patients
Journal name World Journal of Surgery   Check publisher's open access policy
ISSN 0364-2313
1432-2323
Publication date 2011-01
Year available 2010
Sub-type Article (original research)
DOI 10.1007/s00268-010-0831-7
Volume 35
Issue 1
Start page 186
End page 195
Total pages 10
Place of publication New York NY, United States
Publisher Springer New York
Collection year 2012
Language eng
Formatted abstract
Background : Anastomotic leakage is associated with high mortality, high reoperation rate, and increased hospital length of stay. Although many studies have examined the risk factors for anastomotic leak, large prospective series that report on long-term survival rates are lacking.

Methods:
Data of 1576 patients who underwent primary resection and anastomosis for colorectal adenocarcinoma at a single institution from 1984 to 2004 were prospectively collected. Anastomotic leaks (LEK) were classified as radiological (RAD), local (LOC), or generalised (GEN). Logistic regression analysis of 21 variables was undertaken. Overall survival, cancer-related survival, and disease-free survival were analysed using the Kaplan-Meier method.

Results: Mean age of the patients was 67 years (SD = 12.5) and 834 (52.9%) were male. An LEK was more likely when relatively major gynaecological (tubo-oophorectomy, P = 0.004; hysterectomy, P = 0.006) or urological (total cystectomy, P = 0.014) procedures were performed during the same operative session. Other significant factors were anterior resection (P\0.001), anastomosis using an intraluminal stapling device (P = 0.005), abdominal drain via laparoscopic port  (P = 0.024), postoperative blood transfusion (P\0.001), primary cancer site at the rectum (P = 0.016), and TNM stage of T2 or higher (P = 0.026). Having an LEK showed significant impact on overall (P = 0.021), cancer-related (P = 0.006), and disease-free (P = 0.001) survival.

Conclusion:
In this prospective study, advanced tumour stage, distal site, and need for postoperative blood transfusion were associated with increased rates of anastomotic leakage. In addition to their high risk of immediate postoperative morbidity and mortality, both localized and generalized leaks had similarly negative impacts on overall, cancer related, and disease-free survival.
Keyword Systemic inflammatory response
Potentially curative resection
Long-term Survival
Rectal-cancer
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online: 23 October 2010

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
School of Medicine Publications
 
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Created: Sun, 27 Feb 2011, 00:00:15 EST