García-Granero Eduardo, Navarro Francisco, Cerdán Santacruz Carlos, Frasson Matteo, García-Granero Alvaro, Marinello Franco, Flor-Lorente Blas, Espí Alejandro
Department of General Surgery, Digestive Surgery Unit. Hospital Universitario y Politécnico la Fe, University of Valencia, Valencia, Spain.
Department of General Surgery, Colorectal Surgery Unit. Hospital de Manises, Manises, Valencia, Spain.
Surgery. 2017 Nov;162(5):1006-1016. doi: 10.1016/j.surg.2017.05.023. Epub 2017 Jul 21.
Our aim was to assess whether the individual surgeon is an independent risk factor for anastomotic leak in double-stapled colorectal anastomosis after left colon and rectal cancer resection.
This retrospective analysis of a prospectively collected database consists of a consecutive series of 800 patients who underwent an elective left colon and rectal resection with a colorectal, double-stapled anastomosis between 1993 and 2009 in a specialized colorectal unit of a tertiary hospital with 7 participating surgeons. The main outcome variable was anastomotic leak, defined as leak of luminal contents from a colorectal anastomosis between 2 hollow viscera diagnosed radiologically, clinically, endoscopically, or intraoperatively. Pelvic abscesses were also considered to be an anastomotic leak. Radiologic examination was performed when there was clinical suspicion of leak.
Anastomotic leak occurred in 6.1% of patients, of which 33 (67%) were treated operatively, 6 (12%) with radiologic drains, and 10 (21%) by medical treatment. Postoperative mortality rate was 2.9% for the whole group of 800 patients. In patients with anastomotic leak, mortality rate increased up to 16% vs 2.0% in patients without anastomotic leak (P < .0001). At multivariate analysis, rectal location of tumor, male sex, bowel obstruction preoperatively, tobacco use, diabetes, perioperative transfusion, and the individual surgeon were independent risk factors for anastomotic leak. The surgeon was the most important factor (mean odds ratio 4.9; range 1.0 to 13.5). The variance of anastomotic leak between the different surgeons was 0.56 in the logit scale.
The individual surgeon is an independent risk factor for leakage in double-stapled, colorectal, end-to-end anastomosis after oncologic left-sided colorectal resection.
我们的目的是评估在左半结肠癌和直肠癌切除术后双吻合器结直肠吻合术中，个体外科医生是否是吻合口漏的独立危险因素。
这项对前瞻性收集数据库的回顾性分析，纳入了1993年至2009年期间在一家三级医院的专业结直肠科室接受择期左半结肠和直肠切除并进行结直肠双吻合器吻合术的800例连续患者，该科室有7名参与手术的外科医生。主要结局变量为吻合口漏，定义为通过放射学、临床、内镜或术中诊断的两个中空脏器之间的结直肠吻合口出现腔内内容物漏出。盆腔脓肿也被视为吻合口漏。当临床怀疑有漏时进行放射学检查。
6.1%的患者发生了吻合口漏，其中33例（67%）接受了手术治疗，6例（12%）采用放射引流治疗，10例（21%）接受药物治疗。800例患者的全组术后死亡率为2.9%。发生吻合口漏的患者死亡率高达16%，而无吻合口漏的患者死亡率为2.0%（P <.0001）。多因素分析显示，肿瘤位于直肠、男性、术前肠梗阻、吸烟、糖尿病、围手术期输血以及个体外科医生是吻合口漏的独立危险因素。外科医生是最重要的因素（平均比值比为4.9；范围为1.0至13.5）。不同外科医生之间吻合口漏的方差在对数尺度上为0.56。
在肿瘤性左侧结直肠切除术后的双吻合器结直肠端端吻合术中，个体外科医生是吻合口漏的独立危险因素。
