Eriksen Jens Ravn, Ovesen Henrik, Gögenur Ismail
Department of Surgery, Colorectal Cancer Unit, Zealand University Hospital, Roskilde, Sygehusvej 10, 4000, Roskilde, Denmark.
Int J Colorectal Dis. 2018 Aug;33(8):1097-1105. doi: 10.1007/s00384-018-3079-6. Epub 2018 May 12.
Anastomotic leakage is the most serious surgical complication following colorectal resection, and surgical intervention is often required. The purpose of the study was to investigate short- and long-term outcomes after reoperation for anastomotic leakage.
Patients with a symptomatic anastomotic leakage following a laparoscopic colorectal cancer resection from January 2009 to December 2014 were identified from our local prospective database. Patients were grouped according to the management of anastomotic leaks: local, lap, or open approach. Primary outcomes were length of stay, chance of bowel continuity, and overall mortality.
A total of 113 patients were included. The median follow-up time was 40 months (0-82 months). Overall mortality was significantly associated with UICC stage III-VI disease (vs. UICC stage I-II disease) [adj. HR 5.35 (CI 2.32-12.4), p = 0.0001] and minimal invasive reoperation compared with open approach [local: adj. HR 0.12 (CI 0.03-0.52), p = 0.004; lap: adj. HR 0.32 (CI 0.12-0.86), p = 0.024]. Chance of bowel continuity was significantly increased in younger patients below 67 years [adj. OR 6.15 (1.76-21.5), p = 0.004] and following a local procedure [adj. OR 7.45 (1.07-51.8), p = 0.043]. Patients in the open group had significantly longer length of stay and time to initiation of adjuvant chemotherapy compared with those in the lap group.
Our data confirms that minimal invasive reoperation for anastomotic leakage is a safe and feasible approach associated with short- and long-term advantages and can be chosen in selected cases.
吻合口漏是结直肠切除术后最严重的手术并发症，通常需要手术干预。本研究的目的是调查吻合口漏再次手术后的短期和长期结果。
从我们当地的前瞻性数据库中确定2009年1月至2014年12月期间接受腹腔镜结直肠癌切除术后出现有症状吻合口漏的患者。根据吻合口漏的处理方式将患者分组：局部、腹腔镜或开放手术。主要结局指标为住院时间、肠道连续性恢复机会和总死亡率。
共纳入113例患者。中位随访时间为40个月（0 - 82个月）。总死亡率与国际抗癌联盟（UICC）III - VI期疾病（对比UICC I - II期疾病）显著相关[校正风险比（adj. HR）5.35（可信区间CI 2.32 - 12.4），p = 0.0001]，与开放手术相比，微创再次手术总死亡率也显著相关[局部手术：adj. HR 0.12（CI 0.03 - 0.52），p = 0.004；腹腔镜手术：adj. HR 0.32（CI 0.12 - 0.86），p = 0.024]。67岁以下的年轻患者[adj. 比值比（OR）6.15（1.76 - 21.5），p = 0.004]以及接受局部手术的患者[adj. OR 7.45（1.07 - 51.8），p = 0.043]肠道连续性恢复机会显著增加。与腹腔镜组相比，开放手术组患者的住院时间和开始辅助化疗的时间显著更长。
我们的数据证实，吻合口漏的微创再次手术是一种安全可行的方法，具有短期和长期优势，在某些特定情况下可以选择。
