Vermeer T A, Orsini R G, Daams F, Nieuwenhuijzen G A P, Rutten H J T
Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
Eur J Surg Oncol. 2014 Nov;40(11):1502-9. doi: 10.1016/j.ejso.2014.03.019. Epub 2014 Apr 4.
Anastomotic leakage (AL) and presacral abscess (PA) after rectal cancer surgery are a major concern for the colorectal surgeon. In this study, incidence, prognosis and treatment was assessed.
Patients operated on in our institute, between 1994 and 2011, for locally advanced rectal cancer (LARC, T3+/T4M0) were included. Morbidity was scored using the Clavien-Dindo classification. Prognostic factors were analysed using binary logistic regression.
517 patients were included after a low anterior resection (n = 219) or abdominoperineal resection (n = 232). AL occurred in 25 patients (11.4%); 50 patients (9.7%) developed a PA. We identified intraoperative blood loss ≥4500 cc (p = 0.038) and the era of surgery; patients operated on before the year 2006 (p = 0.042); as risk factors for AL. The time between last day of neo-adjuvant treatment and surgery, <8 weeks is significantly associated with the development of PA (p = 0.010).
In our population of LARC patients we found an incidence of 9.7% PA and 11.4% AL, with a 12% mortality rate for AL, which is comparable to surgery in general colorectal cancer. Increased intraoperative blood loss and surgery prior to 2006 are associated with AL. Increased intraoperative blood loss and a timing interval <8 weeks increases the risk of PA formation.
直肠癌手术后的吻合口漏（AL）和骶前脓肿（PA）是结直肠外科医生主要关注的问题。本研究评估了其发生率、预后及治疗情况。
纳入1994年至2011年间在我院接受手术治疗的局部进展期直肠癌（LARC，T3+/T4M0）患者。采用Clavien-Dindo分类法对并发症进行评分。使用二元逻辑回归分析预后因素。
517例患者接受了低位前切除术（n = 219）或腹会阴联合切除术（n = 232）。25例患者（11.4%）发生AL；50例患者（9.7%）发生PA。我们确定术中失血≥4500 cc（p = 0.038）和手术年代；2006年前接受手术的患者（p = 0.042）；为AL的危险因素。新辅助治疗最后一天与手术之间的时间<8周与PA的发生显著相关（p = 0.010）。
在我们的LARC患者群体中，我们发现PA的发生率为9.7%，AL的发生率为11.4%，AL的死亡率为12%，这与一般结直肠癌手术相当。术中失血增加和2006年前的手术与AL相关。术中失血增加和时间间隔<8周会增加PA形成的风险。
