Department of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany; Department of General Gynecology and Gynecologic Oncology, Gynecologic Cancer Center, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria.
Department of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany.
Gynecol Oncol. 2017 Sep;146(3):498-503. doi: 10.1016/j.ygyno.2017.06.007. Epub 2017 Jun 10.
To identify risk factors for anastomotic leakage (AL) in patients undergoing primary advanced ovarian cancer surgery and to evaluate the prognostic implication of AL on overall survival in these patients.
We analyzed our institutional database for primary EOC and included all consecutive patients treated by debulking surgery including any type of full circumferential bowel resection beyond appendectomy between 1999 and 2015. We performed logistic regression models to identify risk factors for AL and log-rank tests and Cox proportional hazards models to evaluate the association between AL and survival.
AL occurred in 36/800 (4.5%; 95% confidence interval [3%-6%]) of all patients with advanced ovarian cancer and 36/518 (6.9% [5%-9%]) patients undergoing bowel resection during debulking surgery. One hundred fifty-six (30.1%) patients had multiple bowel resections. In these patients, AL rate per patient was only slightly higher (9.0% [5%-13%]) than in patients with rectosigmoid resection only (6.9% [4%-10%]), despite the higher number of anastomosis. No independent predictive factors for AL were identified. AL was independently associated with shortened overall survival (HR 1.9 [1.2-3.4], p=0.01).
In the present study, no predictive pre- and/or intraoperative risk factors for AL were identified. AL rate was mainly influenced by rectosigmoid resection and only marginally increased by additional bowel resections.
确定接受原发性晚期卵巢癌手术的患者发生吻合口漏（AL）的风险因素，并评估 AL 对这些患者总生存的预后意义。
我们分析了机构的原发性卵巢上皮癌数据库，纳入了 1999 年至 2015 年间接受肿瘤细胞减灭术治疗且包括任何类型的全圆周肠切除（超出阑尾切除术）的所有连续患者。我们采用逻辑回归模型来确定 AL 的风险因素，并采用对数秩检验和 Cox 比例风险模型来评估 AL 与生存之间的关系。
在 800 例晚期卵巢癌患者中，有 36 例（4.5%；95%置信区间[3%-6%]）发生了 AL，在减瘤术中行肠切除术的 518 例患者中，有 36 例（6.9%[5%-9%]）发生了 AL。156 例患者行多次肠切除术。在这些患者中，每位患者的 AL 发生率仅略高（9.0%[5%-13%]），尽管吻合口数量较多，但直肠乙状结肠切除术患者的 AL 发生率为 6.9%（4%-10%）。未确定 AL 的独立预测因素。AL 与总生存时间缩短独立相关（HR 1.9 [1.2-3.4]，p=0.01）。
在本研究中，未确定 AL 的预测性术前和/或术中风险因素。AL 发生率主要受直肠乙状结肠切除术影响，仅略受额外肠切除术影响。
