Colorectal Department, Eastern Health and St Vincent's Health, Melbourne, Australia.
Colorectal Department, University of Otago, Christchurch, New Zealand.
ANZ J Surg. 2024 Mar;94(3):424-428. doi: 10.1111/ans.18782. Epub 2023 Nov 21.
Anastomotic leak (AL) after colon cancer resection is feared by surgeons because of its associated morbidity and mortality. Considerable research has been directed at predictive factors for AL, but not the anatomic type of colonic resection. Anecdotally, certain types of resection are associated with higher leak rates although there remains a paucity of data on this. This study aimed to determine the AL rate for different types of colon cancer resection to inform decisions regarding the choice of operation.
Retrospective analysis of Bowel Cancer Outcome Registry (BCOR) for all colonic cancer resections with anastomosis between January 2007 and December 2020. Demographic, patient, tumour and outcome data were analysed. AL rates were compared among the different colonic procedures with both univariate and multivariate analysis.
20 191 patients who underwent resection with anastomosis for cancer were included in this study. Of these 535 (2.6%) suffered ALs. While the univariate analysis found male sex, procedure type, symptomatic cancers, emergency surgery, unsupervised registrars, conversion to open surgery, medical complications and higher TNM staging were associated with AL, multivariate analysis, found only procedure type remained a significant predictor of AL (total colectomy (OR 4.049, P<0.001), subtotal colectomy (OR 2.477, P<0.001) and extended right hemicolectomy (OR 2.171, P < 0.001)).
AL is more common in extended colonic resections. With growing evidence of similar oncological outcomes between subtotal colectomy and left hemicolectomy for splenic flexure cancers, more limited resections should be considered. The type of colonic resection should be integrated into prediction tools for AL.
结肠癌切除术后吻合口漏（AL）令外科医生感到担忧，因为其相关发病率和死亡率较高。大量研究都集中在 AL 的预测因素上，但尚未涉及结肠切除术的解剖类型。尽管有数据表明某些类型的切除术与更高的漏率相关，但目前这方面的数据仍然很少。本研究旨在确定不同类型结肠癌切除术的 AL 发生率，以便为手术选择提供信息。
对 2007 年 1 月至 2020 年 12 月间 Bowel Cancer Outcome Registry（BCOR）中所有吻合的结肠癌症切除术进行回顾性分析。分析了人口统计学、患者、肿瘤和结局数据。通过单变量和多变量分析比较了不同结肠手术的 AL 发生率。
本研究共纳入 20191 例接受癌症吻合切除术的患者。其中 535 例（2.6%）发生了 AL。虽然单变量分析发现男性、手术类型、症状性癌症、急诊手术、无人监督的登记员、转为开放手术、医疗并发症和更高的 TNM 分期与 AL 相关，但多变量分析发现只有手术类型仍然是 AL 的显著预测因素（全结肠切除术（OR 4.049，P<0.001）、次全结肠切除术（OR 2.477，P<0.001）和右半结肠切除术（OR 2.171，P<0.001））。
扩展结肠切除术更常见 AL。有越来越多的证据表明，对于脾曲癌，次全结肠切除术与左半结肠切除术的肿瘤学结局相似，应考虑更多的局限性切除术。结肠切除术的类型应纳入 AL 的预测工具中。
