Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2023 Jun;93(6):1646-1651. doi: 10.1111/ans.18337. Epub 2023 Feb 24.
Surgery remains mainstay management for colon cancer. Post-operative anastomotic leak (AL) carries significant morbidity and mortality. Rates of, and risk factors associated with AL following right hemicolectomy remain poorly documented across Australia and New Zealand. This study examines the Bowel Cancer Outcomes Registry (BCOR) to address this.
A retrospective cohort study was undertaken of consecutive BCOR-registered right hemicolectomy patients undergoing resection for colon cancer (2007-2021). The primary outcome measure was AL incidence. Clinicopathological data were extracted from the BCOR. Factors associated with AL and primary anastomosis were identified using logistic regression. AL-rate trends were assessed by linear regression.
Of 13 512 patients who had a right hemicolectomy (45.2% male, mean age 72.5 years, SD 12.1), 258 (2.0%) had an AL. On multivariate analysis, male sex (OR 1.33; 95% CI 1.03-1.71) and emergency surgery (OR 1.41; 95% CI 1.04-1.92) were associated with AL. Private health insurance status (OR 0.66; 95% CI 0.50-0.88) and minimally-invasive surgery (OR 0.61; 95% CI 0.47-0.79) were protective for AL. Anastomotic technique (handsewn versus stapled) was not associated with AL (P = 0.84). Patients with higher ASA status (OR 0.47; 95% CI 0.39-0.58), advanced tumour stage (OR 0.56; 95% CI 0.50-0.63), and emergency surgery (OR 0.16; 95% CI 0.13-0.20) were less likely to have a primary anastomosis. AL-rate and year of surgery showed no association (P = 0.521).
The AL rate in Australia and New Zealand following right hemicolectomy is consistent with the published literature and was stable throughout the study period. Sex, emergency surgery, insurance status, and minimally invasive surgery are associated with AL incidence.
手术仍然是结肠癌的主要治疗方法。术后吻合口漏（AL）会带来显著的发病率和死亡率。在澳大利亚和新西兰，右半结肠切除术（right hemicolectomy）后 AL 的发生率和相关风险因素的相关数据记录仍不完善。本研究通过肠道癌症结果登记处（BCOR）来对此进行研究。
对连续接受 BCOR 注册的右半结肠切除术（2007-2021 年）治疗结肠癌的患者进行回顾性队列研究。主要观察指标是 AL 发生率。从 BCOR 中提取临床病理数据。使用逻辑回归识别与 AL 和吻合口相关的因素。通过线性回归评估 AL 率趋势。
在 13512 名接受右半结肠切除术的患者中（45.2%为男性，平均年龄 72.5±12.1 岁），有 258 名（2.0%）发生了 AL。多变量分析显示，男性（OR 1.33；95%CI 1.03-1.71）和急诊手术（OR 1.41；95%CI 1.04-1.92）与 AL 相关。私人医疗保险状况（OR 0.66；95%CI 0.50-0.88）和微创手术（OR 0.61；95%CI 0.47-0.79）对 AL 有保护作用。吻合技术（手工缝合与吻合器吻合）与 AL 无关（P=0.84）。ASA 状态较高（OR 0.47；95%CI 0.39-0.58）、肿瘤分期较晚（OR 0.56；95%CI 0.50-0.63）和急诊手术（OR 0.16；95%CI 0.13-0.20）的患者不太可能进行吻合术。AL 发生率与手术年份之间无关联（P=0.521）。
澳大利亚和新西兰右半结肠切除术后 AL 的发生率与文献报道一致，在整个研究期间保持稳定。性别、急诊手术、保险状况和微创手术与 AL 发生率相关。
