Colon/RectumIndividual surgeon is an independent risk factor for leak after double-stapled colorectal anastomosis: An institutional analysis of 800 patients
Section snippets
Design, patients, and variables
Since 1993, the Multidisciplinary Colorectal Cancer Group of our Unit at a tertiary University Hospital has maintained a prospective database of all patients operated on for colorectal diseases. From January 1993 to December 2009, 1,598 patients were operated on electively at our unit for colorectal cancer, with curative intent. After exclusion of 487 patients with right or transverse colon cancer and 311 patients with no anastomosis or coloanal manual anastomosis, 800 consecutive patients who
Results
The present analysis included 800 patients with a mean age of 66.7 years; 385 patients (48.1%) presented left-sided or sigmoid colon cancer, while 415 had rectal cancer of which 156 (19.5%) were rectal cancer of the upper third, 173 (21.6%) of the mid third, and 86 (10.8%) of the lower third. Demographic, tumor, and operative data are detailed in Table I. Table II details patient data for each surgeon.
Anastomotic leak was diagnosed in 49 patients (6.1%), 11 of whom had a loop ileostomy
Discussion
In the present analysis, the individual surgeon is one of the most important independent risk factors for anastomotic leak in double-stapled colorectal anastomosis after cancer resection. In addition, several patient-related factors, such as male sex, malnourishment, and recent weight loss, hypoalbuminemia, high American Society of Anesthesiologists score, hypertension, obesity, smoking, and alcohol use have been associated previously with an increased risk of AL.10, 21, 22, 23, 24 Moreover,
References (43)
- et al.
Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients
J Am Coll Surg
(1997) - et al.
Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance
J Am Coll Surg
(2006) - et al.
Predicting the risk of anastomotic leakage in left-sided colorectal surgery using a colon leakage score
J Surg Res
(2011) - et al.
Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality
Eur J Surg Oncol
(2012) - et al.
Standard outcome indicators after colon cancer resection. Creation of a nomogram for autoevaluation
Cir Esp
(2017) - et al.
The role of multimedia in surgical skills training and assessment
Surgeon
(2016) - et al.
The double stapling technique for low anterior resection. Results, modifications, and observations
Ann Surg
(1990) - et al.
Volume-outcome analysis of colorectal cancer-related outcomes
Br J Surg
(2010) - et al.
Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence
Br J Surg
(2003) - et al.
Risk factors and consequences of anastomotic leak after colectomy: a national analysis
Dis Colon Rectum
(2015)
End-to-end versus end-to-side stapled anastomoses after anterior resection for rectal cancer
J Surg Oncol
Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 Randomized Clinical Trial
JAMA
Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks
Br J Surg
Identifying important predictors for anastomotic leak after colon and rectal resection: Prospective study on 616 patients
Ann Surg
Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients
Ann Surg
Anastomotic leakage after low anterior resection for rectal cancer is different between minimally invasive surgery and open surgery
Ann Surg
Impact of surgeon organization and specialization in rectal cancer outcome
Colorectal Dis
Workload and surgeon's specialty for outcome after colorectal cancer surgery
Cochrane Database Syst Rev
Specialized referral centers for rectal cancer
Cir Esp
Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival
BMJ
Anastomotic integrity after operations for large-bowel cancer: a multicentre study
Br Med J
Cited by (51)
Postoperative NSAIDs use and the risk of anastomotic leakage after restorative resection for colorectal cancer
2023, Asian Journal of SurgeryComprehensive literature review of the outcome, modifications, and alternatives to double-stapled low pelvic colorectal anastomosis
2022, Surgery (United States)Citation Excerpt :Male sex (OR: 4.12, P = .006) and absence of a transanal decompression tube (OR: 3.11, P = .0484) were the independent predictive factors of AL. A retrospective study25 reviewed prospective data of 800 patients who underwent DST after left colon or rectal resection. The study diagnosed AL by radiologic, clinical, and endoscopic means or intraoperatively and considered pelvic abscesses also as AL.
Anastomotic leakage in colorectal cancer surgery
2022, Surgical OncologyCitation Excerpt :In some studies, any leakage detected both clinically or radiologically is defined as AL; in others, AL is only a leakage needing and early re-do surgery. Evidence have demonstrated the risk factors for AL (Table 3) [8,14,41–51], [52–86]. Preoperative risk factors are generally divided into two types: modifiable, meaning that the patient or the physician can take measures to change them; or non-modifiable, meaning that they cannot be changed [87].
Peritoneal invasion and metachronous peritoneal metastases after colon cancer surgery: The role of homogeneous, reliable assessment and confounders
2021, European Journal of Surgical OncologyPresurgical mild anemia is a risk factor for severe postoperative complications of rectal cancer surgery: A Japanese nationwide retrospective cohort study
2024, Annals of Gastroenterological Surgery