Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.
Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Università della Campania 'Luigi Vanvitelli', Naples, Italy.
Colorectal Dis. 2018 Nov;20(11):986-995. doi: 10.1111/codi.14309. Epub 2018 Jul 11.
Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies.
We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method.
We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001).
Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.
详细报告左结肠切除术的发病率和死亡率的文献很少，无法得出明确的结论。我们旨在确定左结肠癌切除术吻合口漏、围手术期死亡率和并发症的危险因素。
我们对一个全国性的前瞻性在线数据库中包含的左结肠切除术进行了 STROBE 一致性分析。分析了 42 个变量作为吻合口漏、术后发病率和死亡率的潜在独立危险因素。使用“最小绝对值收缩和选择算子”（LASSO）方法选择变量。
我们分析了 1111 名患者。8%的患者发生漏口，其中 80%需要再次手术或外科引流。四分之一的患者（24.9%）至少出现了一种轻微并发症。围手术期死亡率为 2%，漏口是导致 47.6%死亡的原因。肥胖（OR 2.8，95%CI 1.00-7.05，P=0.04）和全肠外营养（TPN）（OR 3.7，95%CI 1.58-8.51，P=0.002）与漏口风险增加相关，而女性患者的风险较低（OR 0.36，95%CI 0.18-0.67，P=0.002）。皮质类固醇（P=0.03）和口服抗凝剂（P=0.01）使并发症的风险增加了一倍，而高脂血症（OR 0.3，P=0.02）则降低了风险。接受 TPN 的患者并发症更多（OR 4.02，95%CI 2.03-8.07，P=0.04），死亡率更高（OR 8.7，95%CI 1.8-40.9，P=0.006）。肝脏疾病和高龄会影响生存率，皮质类固醇是死亡率的最强预测因素（OR 21.5，P=0.001）。
TPN 的需求与更多的漏口、并发症和死亡率有关。漏口可能导致近一半的死亡。高脂血症和女性性别与较低的并发症发生率相关。这些发现需要更好地了解左结肠癌切除术后围手术期代谢状态对结果的影响。
