Richardson Debra L, Mariani Andrea, Cliby William A
Department of Obstetrics and Gynecology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Gynecol Oncol. 2006 Nov;103(2):667-72. doi: 10.1016/j.ygyno.2006.05.003. Epub 2006 Jun 23.
Anastomotic leak after recto-sigmoid (RS) resection for ovarian cancer (OC) is a life-threatening complication. Selection of patients for protective diverting stomas has been based on observations from the colorectal literature. Our objective was to identify primary risk factors for anastomotic leak in OC patients undergoing RS resection to better determine who would most benefit from protective diversion.
All patients with OC or primary peritoneal cancer who underwent a debulking procedure with RS resection between January 1999 and December 2004 were included. Retrospective chart review including review of operative notes, pathology reports, and medical records including follow-up visits was done. Cases with inadequate postoperative follow-up, primary end colostomies, or diverting stomas were excluded.
177 patients form our study cohort. There were a total of 12/177 anastomotic leaks (6.8%). The mean time to diagnosis of anastomotic leak was 19 days (range 4-32). The leak rate for primary debulking operations was 8.7% (10/115), whereas the leak rate in secondary debulking procedures was 3.2% (2/62) (NS, P = 0.22). In univariate analysis, only perioperative serum albumin was significantly associated with an increased risk of anastomotic leak (mean 3.4 g/dL vs. 2.4 g/dL, P = 0.002). Based on serum albumin, the leak rate was 6/29 (21%) for levels <3.0 g/dL and 2/58 (3.4%) for patients with albumin greater than or equal to 3.0 g/dL (OR 7.3, 95% CI 1.37-38.87).
Low serum albumin is associated with an increased risk of anastomotic leak after RS resection for OC. Patients with a low albumin level may benefit from a protective diverting colostomy/ileostomy.
卵巢癌（OC）行直肠乙状结肠（RS）切除术后发生吻合口漏是一种危及生命的并发症。选择患者行保护性转流造口术一直基于结直肠文献中的观察结果。我们的目的是确定接受RS切除术的OC患者发生吻合口漏的主要危险因素，以便更好地确定谁将从保护性转流中获益最大。
纳入1999年1月至2004年12月期间接受RS切除减瘤手术的所有OC或原发性腹膜癌患者。进行回顾性病历审查，包括手术记录、病理报告以及包括随访在内的医疗记录审查。排除术后随访不充分、原发性末端结肠造口术或转流造口术的病例。
我们的研究队列中有177例患者。共有12/177例发生吻合口漏（6.8%）。诊断吻合口漏的平均时间为19天（范围4 - 32天）。初次减瘤手术的漏率为8.7%（10/115），而二次减瘤手术的漏率为3.2%（2/62）（无统计学差异，P = 0.22）。在单因素分析中，仅围手术期血清白蛋白与吻合口漏风险增加显著相关（平均3.4 g/dL对2.4 g/dL，P = 0.002）。基于血清白蛋白，白蛋白水平<3.0 g/dL的患者漏率为6/29（21%），白蛋白大于或等于3.0 g/dL的患者漏率为2/58（3.4%）（比值比7.3，95%可信区间1.37 - 38.87）。
血清白蛋白水平低与OC行RS切除术后吻合口漏风险增加相关。白蛋白水平低的患者可能从保护性转流结肠造口术/回肠造口术中获益。
