Peritoneal Malignancies Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain.
Colorectal Surgery Unit, Department of Surgery, Hospital Moisés Broggi, Consorci Sanitari Integral, Barcelona, Spain.
Ann Surg Oncol. 2021 Nov;28(12):7784-7792. doi: 10.1245/s10434-021-09842-x. Epub 2021 Apr 14.
Gastrointestinal complications, predominantly anastomotic leak (AL), are the most frequent source of severe morbidity after cytoreductive surgery (CRS).
The aim of this study was to present the technical standards for colorectal anastomoses developed and systematically applied to all patients undergoing CRS in a high-volume tertiary center, and the associated AL rates.
This was a descriptive study reporting the technical characteristics of a standardized protocol for three types of colorectal anastomoses (colorectal, ileorectal, and ileocolic) in CRS with heated intraperitoneal chemotherapy (HIPEC), and a retrospective analysis of prospectively collected data on anastomotic outcomes. All patients (1172) undergoing CRS with HIPEC from September 2006 to September 2020 were included. The anastomotic complications were classified according to the International Study Group of Rectal Cancer Surgery (ISGRCS) classification.
Overall, 1172 patients underwent 1300 procedures and 1359 gastrointestinal anastomoses. An ileocolic anastomosis was performed in 408 patients, colorectal anastomosis in 469 patients, and ileorectal anastomosis in 16 patients, none with diverting ileostomy; 345 other gastrointestinal reconstructions and 82 urinary reconstructions were performed in these patients. The AL rate was 1% (4/408) for the ileocolic anastomosis, 0.85% (4/469) for the colorectal anastomosis, and 0% (0/16) for the ileorectal anastomosis. One patient died postoperatively due to AL.
Systematic application of standardized techniques adapted to ensure optimal tissue healing (stapled anastomoses avoiding overlap, accurate staple deployment, and hand-sewn reinforcement) are associated with a very high level of anastomotic safety in a large cohort of patients undergoing CRS and HIPEC.
胃肠道并发症，主要是吻合口漏（AL），是细胞减灭术后（CRS）最常见的严重发病原因。
本研究旨在介绍在高容量三级中心为所有接受 CRS 的患者制定并系统应用的结直肠吻合技术标准，以及相关的 AL 发生率。
这是一项描述性研究，报告了在接受加热腹腔内化疗（HIPEC）的 CRS 中三种类型的结直肠吻合术（结直肠、回肠直肠和回肠结肠）的标准化方案的技术特点，并对前瞻性收集的吻合口结局数据进行回顾性分析。所有（1172 例）于 2006 年 9 月至 2020 年 9 月期间接受 CRS+HIPEC 的患者均被纳入研究。根据国际直肠癌研究组（ISGRCS）分类法对吻合口并发症进行分类。
共有 1172 例患者接受了 1300 次手术和 1359 次胃肠吻合术。其中 408 例患者行回肠结肠吻合术，469 例患者行结直肠吻合术，16 例患者行回肠直肠吻合术，均未行预防性回肠造口术；这些患者还进行了 345 例其他胃肠重建和 82 例尿流重建。回肠结肠吻合术的 AL 发生率为 1%（4/408），结直肠吻合术的 AL 发生率为 0.85%（4/469），回肠直肠吻合术的 AL 发生率为 0%（0/16）。有 1 例患者术后因 AL 死亡。
系统应用适应确保组织愈合最佳的标准化技术（避免吻合口重叠的吻合器吻合、准确的吻合器部署和手工加固）与大量接受 CRS+HIPEC 的患者的高吻合安全性相关。
