Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
Institution of Clinical Sciences, Lund University, Lund, Sweden.
Colorectal Dis. 2018 Feb;20(2):150-159. doi: 10.1111/codi.13914.
Anastomotic leakage (AL) is common after anterior resection (AR). Long term clinical outcomes of AL including late presenting leakage (LL) are not well studied. This study was undertaken to assess clinical features of LL with respect to incidence, association with predisposing factors and need for re-intervention.
The Swedish Colorectal Cancer Registry (SCRCR) was explored for AL cases after AR for rectal cancer in patients operated in the south of Sweden from 1 January 2001 to 31 December 2011. Demographic data, surgical technical details, number of postoperative days (POD) until diagnosis of AL, presenting symptoms, methods of diagnosis and treatment were retrieved from medical records. LL was defined according to different cut-offs as leakages occurring after hospital discharge (LLAHD), after 30 POD (LL ≥ POD 30) and after 90 POD (LL ≥ POD 90).
In total, 1442 patients were operated on with AR of whom 144 cases of AL (10%) were identified. Median time from operation to follow-up was 87 months (range 21-162). LLAHD, LL ≥ POD 30 and LL ≥ POD 90 were present in 51%, 24% and 9% respectively. All categories of LL were associated with a defunctioning stoma. Relaparotomy was significantly less often employed in LLAHD, but not in other categories of LL.
LL constitutes a substantial portion of all AL after AR for rectal cancer. The large proportion of LLAHD calls for awareness in the outpatient setting.
前切除术（AR）后吻合口漏（AL）很常见。AL 的长期临床结果（包括迟发性漏出）尚未得到很好的研究。本研究旨在评估迟发性漏出（LL）的临床特征，包括其发生率、与易患因素的关系以及是否需要再次干预。
从瑞典南部 2001 年 1 月 1 日至 2011 年 12 月 31 日接受直肠 AR 手术的患者中，在瑞典结直肠癌登记处（SCRCR）中探索 AR 后 AL 的病例。从病历中检索人口统计学数据、手术技术细节、AL 诊断至术后天数（POD）、临床表现、诊断和治疗方法。LL 根据不同的截止值定义为出院后发生的漏出（LLAHD）、术后 30 天（LL≥POD 30）和术后 90 天（LL≥POD 90）漏出。
共有 1442 例患者接受了 AR，其中 144 例发生了 AL（10%）。从手术到随访的中位时间为 87 个月（范围 21-162）。LLAHD、LL≥POD 30 和 LL≥POD 90 的发生率分别为 51%、24%和 9%。所有类型的 LL 均与造口功能障碍有关。LLAHD 患者再次剖腹手术明显减少，但在其他类型的 LL 中则不然。
LL 构成了 AR 后直肠癌 AL 的主要部分。LLAHD 的比例较大，需要在门诊中引起重视。
