Eberhardt Joshua M, Kiran Ravi P, Lavery Ian C
The Cleveland Clinic Foundation, Department of Colorectal Surgery, Cleveland, Ohio 44195, USA.
Dis Colon Rectum. 2009 Mar;52(3):380-6. doi: 10.1007/DCR.0b013e31819ad488.
This study was designed to analyze the impact of anastomotic leak and intra-abdominal abscess on cancer recurrence and survival in patients who underwent resection for colorectal cancer.
Data for patients who underwent resection for colon or rectal cancer were retrieved from a prospective colorectal cancer database. Patients with inflammatory bowel disease, familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer, palliative resection, or perioperative mortality were excluded. Patients with postoperative anastomotic leak or intra-abdominal abscess were matched at a 1:2 ratio to patients from the same database who had no leak or abscess. Matched characteristics were age, gender, cancer stage, tumor histology, and operation occurring within three years of each other. Survival and cancer recurrence at five-year follow-up were evaluated with the Kaplan-Meier method and log rank test.
In patients with colon cancer, comparison of the 59 patients with a leak or an abscess with 118 matched controls showed no differences in demographic or treatment characteristics, recurrence, or mortality. In patients with rectal cancer, comparison of the 97 patients with a leak or an abscess with 194 matched controls showed that at five-year follow-up the complication group had higher rates of overall mortality (46.8 vs. 28.9, P < 0.01), cancer-specific mortality (28.7 percent vs. 18.0 percent, P = 0.03), overall recurrence (28.6 vs. 15.7, P = 0.01) and local recurrence (11.0 percent vs. 5.0 percent, P = 0.04).
Anastomotic leak and intra-abdominal abscess were not associated with worsened 5-year survival or recurrence in patients who underwent resection for colon cancer. However, these complications were associated with increased overall and cancer-specific mortality and increased overall and local recurrence in patients who underwent resection for rectal cancer.
本研究旨在分析吻合口漏和腹腔内脓肿对接受结直肠癌切除术患者的癌症复发及生存的影响。
从一个前瞻性结直肠癌数据库中检索接受结肠癌或直肠癌切除术患者的数据。排除患有炎症性肠病、家族性腺瘤性息肉病、遗传性非息肉病性结直肠癌、姑息性切除术或围手术期死亡的患者。术后发生吻合口漏或腹腔内脓肿的患者与来自同一数据库中无漏或脓肿的患者按1:2的比例进行匹配。匹配的特征包括年龄、性别、癌症分期、肿瘤组织学以及在彼此三年之内进行的手术。采用Kaplan-Meier法和对数秩检验评估五年随访时的生存情况和癌症复发情况。
在结肠癌患者中，将59例有漏或脓肿的患者与118例匹配的对照进行比较，结果显示在人口统计学或治疗特征、复发或死亡率方面无差异。在直肠癌患者中，将97例有漏或脓肿的患者与194例匹配的对照进行比较，结果显示在五年随访时，并发症组的总死亡率（46.8%对28.9%，P<0.01）、癌症特异性死亡率（28.7%对18.0%，P = 0.03）、总复发率（28.6%对15.7%，P = 0.01）和局部复发率（11.0%对5.0%，P = 0.04）更高。
吻合口漏和腹腔内脓肿与接受结肠癌切除术患者的五年生存率恶化或复发无关。然而，这些并发症与接受直肠癌切除术患者的总死亡率和癌症特异性死亡率增加以及总复发率和局部复发率增加有关。
