Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain.
Department of Gynecologic Oncology, Imperial College London, London, United Kingdom.
Gynecol Oncol. 2019 Jun;153(3):549-554. doi: 10.1016/j.ygyno.2019.03.241. Epub 2019 Apr 3.
To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk.
In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak.
Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient.
The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018).
Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided.
确定改良后盆腔切除术（MPE）或卵巢癌结直肠切除术后吻合口漏的术前/术中危险因素，并创建一种实用的预测吻合口漏风险的工具。
在晚期卵巢癌手术中，由于样本量较小，目前仅有有限的已发表证据可以提供关于吻合口漏危险因素的信息。
8 家医院参与了这项回顾性研究。共纳入 695 例原发性吻合术治疗卵巢癌患者的数据（2010 年 1 月至 2018 年 6 月）。分析了 12 个术前/术中变量作为吻合口漏的潜在独立危险因素。创建了一个预测模型，以确定特定患者发生吻合口漏的风险。
吻合口漏发生率为 6.6%（46/695；范围 1.7%-12.5%）。共有 457 例患者纳入最终的多变量分析。结果发现，以下变量与吻合口漏有关：手术时年龄（OR 1.046，95%CI 1.013-1.080，p=0.005）、血清白蛋白水平（OR 0.621，95%CI 0.407-0.948，p=0.027）、一次或多次额外的小肠切除术（OR 3.544，95%CI 1.228-10.23，p=0.019）、手工吻合（OR 8.356，95%CI 1.777-39.301，p=0.007）和吻合口距肛缘的距离（OR 0.839，95%CI 0.726-0.971，p=0.018）。
由于卵巢癌患者吻合口漏的发生率较低，基于危险因素的限制性造口术策略应是实际推荐。应避免手工吻合。
