Hain Elisabeth, Maggiori Léon, Zappa Magaly, Prost À la Denise Justine, Panis Yves
Department of Colorectal Surgery.
Department of Radiology, Beaujon Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Université Denis Diderot Paris VII, Clichy, France.
Colorectal Dis. 2018 Jan 6. doi: 10.1111/codi.14005.
To assess outcome according to location of anastomotic leakage (AL) after side-to-end stapler or manual low colorectal or coloanal anastomosis following laparoscopic total mesorectal excision (TME) for rectal cancer.
All patients presenting with symptomatic or asymptomatic AL after TME and side-to-end low anastomosis for rectal cancer performed from 2005 to 2014 were identified from our prospective database. CT-scans with contrast enema were reviewed to assess location of AL origin.
Among 279 patients who underwent TME with side-to-end anastomosis from 2005 to 2014, 70 patients presented with AL and were included: 43 (61%) patients with AL on the circular anastomosis (CAL) were compared to 27 (39%) with AL on the transverse stapling line of the colonic stump (TAL). CAL and TAL were associated with similar rates of symptomatic AL (63% versus 48%, respectively; p=0.339), severe postoperative morbidity rate (33% versus 18%; p=0.313), and long-term outcomes, including definitive stoma rate (10 versus 11%; p=0.622), and major low anterior resection syndrome rate (56% vs 57%; p=0.961).
Our study showed that whatever the location of AL on a side-to-end low colorectal or coloanal anastomosis after TME for cancer, both short and long-term outcomes are similar. This article is protected by copyright. All rights reserved.
评估腹腔镜全直肠系膜切除术（TME）治疗直肠癌后，采用端端吻合器或手工低位结直肠或结肠肛管吻合术时，吻合口漏（AL）的位置与预后的关系。
从我们的前瞻性数据库中识别出2005年至2014年期间接受TME及直肠癌低位端端吻合术后出现有症状或无症状AL的所有患者。回顾增强CT扫描以评估AL的起源位置。
在2005年至2014年接受TME端端吻合术的279例患者中，70例出现AL并被纳入研究：43例（61%）环形吻合口处出现AL（CAL）的患者与27例（39%）结肠残端横向吻合线处出现AL（TAL）的患者进行比较。CAL和TAL的有症状AL发生率相似（分别为63%和48%；p = 0.339），术后严重发病率相似（33%和18%；p = 0.313），长期预后也相似，包括确定性造口率（10%和11%；p = 0.622）以及主要低位前切除综合征发生率（56%和57%；p = 0.961）。
我们的研究表明，对于癌症TME术后低位结直肠或结肠肛管端端吻合术中AL的位置，无论其位于何处，短期和长期预后均相似。本文受版权保护。保留所有权利。
