Updates Surg. 2019 Jun;71(2):339-347. doi: 10.1007/s13304-018-00612-1. Epub 2019 Feb 11.
During a recent prospective trial on early diagnosis of anastomotic leakage (AL) after colorectal surgery, we gathered a large database on more than 1500 procedures performed in 19 surgical centers in Italy over a 12-month period. Main purpose of the present paper is to show the epidemiological data about colorectal procedures and anastomotic leakage. Prospective enrollment for all elective colorectal resections with anastomosis (September 2017-September 2018). Primary endpoint was AL; secondary endpoints were morbidity and mortality rates, readmission and reoperation rates, and length of post-operative hospital stay (ClinicalTrials.gov; Identifier: NCT03560180). There were 1546 enrolled cases (56.9% of 2717 total resected cases). The rate of minimally invasive resections was 83.5%. Overall AL rate was 4.92% (76 cases; range per center 0-12.12%). Mean ± SD time to AL diagnosis was 5.95 ± 4.78 days (median 5, range 1-31). Overall morbidity rate was 30.20%, mortality 1.29% (20 cases; range per center 0-3.27), readmission 0.90%, and reoperation 6.92%. Mean ± SD post-operative LOS was 7.89 ± 5.97 days (median 6; range 1-120). AL significantly influenced all other secondary endpoints. This study offers a good snapshot of colorectal resections in Italy. There was a high rate of laparoscopic resections, reflecting the special interest in this kind of surgery by the participating centers. AL, morbidity, mortality, readmission and reoperation rates are compared to those reported in previous population-based studies. Compared to series dealing with open colorectal resections, the time to diagnosis of AL was shortened by several days.
在最近一项关于结直肠手术后吻合口漏（AL）早期诊断的前瞻性研究中，我们收集了意大利 19 家外科中心在 12 个月内进行的超过 1500 例手术的大型数据库。本文的主要目的是展示关于结直肠手术和吻合口漏的流行病学数据。前瞻性纳入所有择期结直肠吻合术（2017 年 9 月至 2018 年 9 月）。主要终点为 AL；次要终点为发病率和死亡率、再入院率和再次手术率以及术后住院时间（ClinicalTrials.gov；标识符：NCT03560180）。共纳入 1546 例病例（2717 例总切除病例的 56.9%）。微创手术率为 83.5%。总的 AL 发生率为 4.92%（76 例；各中心范围为 0-12.12%）。AL 诊断的平均时间为 5.95±4.78 天（中位数为 5，范围为 1-31）。总的发病率为 30.20%，死亡率为 1.29%（20 例；各中心范围为 0-3.27%），再入院率为 0.90%，再次手术率为 6.92%。平均术后住院时间为 7.89±5.97 天（中位数为 6；范围为 1-120）。AL 显著影响所有其他次要终点。本研究提供了意大利结直肠切除术的一个良好概览。腹腔镜切除术比例较高，反映了参与中心对此类手术的特殊兴趣。AL、发病率、死亡率、再入院率和再次手术率与以前的基于人群的研究报告的结果进行了比较。与涉及开放性结直肠切除术的系列研究相比，AL 的诊断时间缩短了数天。
