Nachiappan Subramanian, Askari Alan, Malietzis George, Giacometti Marco, White Ian, Jenkins John T, Kennedy Robin H, Faiz Omar
Surgical Epidemiology, Trials and Outcomes Centre (SETOC), St Mark's Hospital & Academic Institute, Watford Road, Harrow, Middlesex, HA1 3UJ, UK,
World J Surg. 2015 Apr;39(4):1052-8. doi: 10.1007/s00268-014-2887-2.
Anastomotic leakage is a serious complication in restorative colorectal surgery. Anastomotic leakage and its subsequent management may have long-term impact on survival. This study aims to assess the impact of colorectal anastomotic leak (AL) on overall survival (OS) and disease-free survival (DFS).
A prospective database of 1,048 patients undergoing restorative colorectal cancer resections at St Mark's hospital between October 2004 and October 2013 was examined.
The overall leak rate was 99/1,048 (9.4%). 43 ALs were managed conservatively with antibiotics or radiological drainage and 56 with reoperations. OS was significantly reduced in the AL group treated with a reoperation (HR 2.74, 95% CI 1.67-4.52, p < 0.001). AL was not significantly associated with worse DFS [conservatively managed AL's vs. no AL-HR 2.07 (95% CI 1.05-4.10); reoperated AL's vs. no AL-HR 1.56 (95% CI 0.81-2.99), overall p value = 0.058].
Patients who suffer anastomotic leaks requiring reoperations have worse OS compared to patients who do not leak, but there were no significant differences in DFS between patients who leaked and those who did not.
吻合口漏是结直肠修复手术中的一种严重并发症。吻合口漏及其后续处理可能对生存产生长期影响。本研究旨在评估结直肠吻合口漏（AL）对总生存期（OS）和无病生存期（DFS）的影响。
对2004年10月至2013年10月在圣马克医院接受结直肠癌修复手术的1048例患者的前瞻性数据库进行了检查。
总体漏率为99/1048（9.4%）。43例吻合口漏采用抗生素或放射引流保守治疗，56例采用再次手术治疗。接受再次手术的吻合口漏组患者的总生存期显著降低（风险比2.74，95%置信区间1.67 - 4.52，p < 0.001）。吻合口漏与较差的无病生存期无显著相关性[保守治疗的吻合口漏组与无吻合口漏组相比，风险比2.07（95%置信区间1.05 - 4.10）；再次手术的吻合口漏组与无吻合口漏组相比，风险比1.56（95%置信区间0.81 - 2.99），总体p值 = 0.058]。
与未发生吻合口漏的患者相比，发生吻合口漏且需要再次手术的患者总生存期较差，但吻合口漏患者与未发生漏的患者在无病生存期方面无显著差异。
