Department of General Surgery, Dokuz Eylül University Faculty of Medicine, İzmir-Türkiye.
Department of General Surgery, Medipol University Faculty of Medicine, İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2023 Mar;29(3):370-378. doi: 10.14744/tjtes.2023.52358.
Gastrointestinal anastomotic leak (GAL) is a major cause of morbidity and mortality after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study is to determine the risk factors associated with GAL in peritoneal metastases (PM) surgery.
Patients who underwent CRS and HIPEC with gastrointestinal anastomosis were included. Charlson Comorbidity Index (CCI) and Eastern Cooperative Oncology Group (ECOG) performance status were used to assess preoperative condition of the patients. GAL was recorded as gastrointestinal extralumination diagnosed clinically, radiologicaly, or during reoperation.
Among 362 patients who were analyzed, the median age was 54 years, 72.6% were female, and the most common histopathologies were ovarian cancer (37.8%) and colorectal (36.2%) cancer. The median Peritoneal Cancer Index was 11 and 80.1% of the patients underwent complete cytoreduction. A single anastomosis was performed in 293 (80.9%) patients, two anastomoses in 51 (14.1%) and three anastomoses in 18 (5%) patients. Diverting stoma was performed in 43 (11.8%) patients. GAL was seen in 38 (10.5%) patients. Smoking (p<0.001), ECOG performance status (p=0.014), CCI score (p=0.009), pre-operative albumin level (p=0.010), and number of resected organs (p=0.006) were significantly associated factors with GAL. Independent risk factors for GAL were smoking (Odds Radio [OR]: 6.223, confidence interval [CI]: 2.814-13.760; p<0.001), CCI score ≥7 (OR: 4.252, CI: 1.590-11.366; p=0.004), and pre-operative albumin level ≤3.5 g/dl (OR: 3.942, CI: 1.534-10.130; p=0.004).
Patient-related factors such as smoking, comorbidity, and pre-operative nutritional status had an impact on anasto-motic complications. Proper patient selection and prediction of an index patient requiring a prehabilitation program with a high level of care are essential prerequisites to obtaining lower anastomotic leak rates and improving outcomes in PM surgery.
胃肠道吻合口漏（GAL）是细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）后发病率和死亡率的主要原因。本研究旨在确定与腹膜转移（PM）手术中 GAL 相关的危险因素。
纳入接受 CRS 和 HIPEC 并进行胃肠道吻合的患者。Charlson 合并症指数（CCI）和东部合作肿瘤学组（ECOG）表现状态用于评估患者术前状况。GAL 是通过临床、放射学或再次手术诊断的胃肠道外渗来记录的。
在分析的 362 名患者中，中位年龄为 54 岁，72.6%为女性，最常见的组织病理学是卵巢癌（37.8%）和结直肠癌（36.2%）。中位腹膜癌指数为 11，80.1%的患者行完全肿瘤减灭术。293 名（80.9%）患者行单吻合，51 名（14.1%）患者行双吻合，18 名（5%）患者行三吻合。43 名（11.8%）患者行转流性造口术。38 名（10.5%）患者发生 GAL。吸烟（p<0.001）、ECOG 表现状态（p=0.014）、CCI 评分（p=0.009）、术前白蛋白水平（p=0.010）和切除器官数量（p=0.006）与 GAL 显著相关。GAL 的独立危险因素是吸烟（优势比 [OR]：6.223，置信区间 [CI]：2.814-13.760；p<0.001）、CCI 评分≥7（OR：4.252，CI：1.590-11.366；p=0.004）和术前白蛋白水平≤3.5 g/dl（OR：3.942，CI：1.534-10.130；p=0.004）。
患者相关因素如吸烟、合并症和术前营养状况对吻合口并发症有影响。适当的患者选择和预测需要高水平护理的康复计划的指数患者是获得较低吻合口漏率和改善 PM 手术结果的必要前提。
