Khadem Shahram, Herzberg Jonas, Honarpisheh Human, Jenner Robert Maximilian, Guraya Salman Yousuf, Strate Tim
Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, Hamburger Strasse 41, 21465, Reinbek, Germany.
Clinical Sciences Department, College of Medicine, University of Sharjah, P. O. Box 27272, Sharjah, United Arab Emirates.
Perioper Med (Lond). 2023 Mar 11;12(1):5. doi: 10.1186/s13741-023-00291-6.
Despite innovations in surgical techniques, major complications following colorectal surgery still lead to a significant morbidity and mortality. There is no standard protocol for perioperative management of patients with colorectal cancer. This study evaluates the effectiveness of a multimodal fail-safe model in minimizing severe surgical complications following colorectal resections.
We compared major complications in patients with colorectal cancers who underwent surgical resections with anastomosis during 2013-2014 (control group) with patients treated during 2015-2019 (fail-safe group). The fail-safe group had preoperative bowel preparation and a perioperative single dose of antibiotics, on-table bowel irrigation and early sigmoidoscopic assessment of anastomosis in rectal resections. A standard surgical technique for tension-free anastomosis was adapted in the fail-safe approach. The chi-square test measured relationships between categorical variables, t-test estimated the probability of differences, and the multivariate regression analysis determined the linear correlation among independent and dependent variables.
A total of 924 patients underwent colorectal operations during the study period; however, 696 patients had surgical resections with primary anastomoses. There were 427 (61.4%) laparoscopic and 230 (33.0%) open operations, while 39 (5.6%) laparoscopic procedures were converted. Overall, the rate of major complications (Dindo-Clavien grade IIIb-V) significantly reduced from 22.6% for the control group to 9.8% for the fail-safe group (p < 0.0001). Major complications mainly occurred due to non-surgical reasons such as pneumonia, heart failure, or renal dysfunction. The rates of anastomotic leakage (AL) were 11.8% (22/186) and 3.7% (n = 19/510) for the control and fail-safe groups, respectively (p < 0.0001).
We report an effective multimodal fail-safe protocol for colorectal cancer during the pre-, peri-, and postoperative period. The fail-safe model showed less postoperative complications even for low rectal anastomosis. This approach can be adapted as a structured protocol during the perioperative care of patients for colorectal surgery.
This study was registered in the German Clinical Trial Register (Study ID: DRKS00023804 ).
尽管手术技术有所创新，但结直肠手术后的严重并发症仍导致显著的发病率和死亡率。目前尚无针对结直肠癌患者围手术期管理的标准方案。本研究评估了一种多模式安全保障模型在降低结直肠切除术后严重手术并发症方面的有效性。
我们比较了2013 - 2014年接受吻合术的结直肠癌手术患者（对照组）与2015 - 2019年接受治疗的患者（安全保障组）的主要并发症情况。安全保障组进行了术前肠道准备、围手术期单剂量抗生素治疗、术中肠道灌洗以及直肠切除术中吻合口的早期乙状结肠镜评估。安全保障方法采用了无张力吻合的标准手术技术。卡方检验用于测量分类变量之间的关系，t检验估计差异概率，多变量回归分析确定自变量和因变量之间的线性相关性。
在研究期间，共有924例患者接受了结直肠手术；然而，696例患者进行了一期吻合的手术切除。其中有427例（61.4%）为腹腔镜手术，230例（33.0%）为开放手术，39例（5.6%）腹腔镜手术中转开腹。总体而言，主要并发症（Dindo-Clavien IIIb - V级）发生率从对照组的22.6%显著降至安全保障组的9.8%（p < 0.0001）。主要并发症主要由非手术原因引起，如肺炎、心力衰竭或肾功能不全。对照组和安全保障组的吻合口漏（AL）发生率分别为11.8%（22/186）和3.7%（n = 19/510）（p < 0.0001）。
我们报告了一种在结直肠癌术前、术中和术后均有效的多模式安全保障方案。即使对于低位直肠吻合，安全保障模型也显示出较少的术后并发症。这种方法可作为结直肠手术患者围手术期护理的结构化方案。
本研究已在德国临床试验注册中心注册（研究编号：DRKS00023804）。
