Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
DKFZ Hector Cancer Institute at the University Medical Center, Mannheim, Germany.
Int J Colorectal Dis. 2024 Aug 6;39(1):126. doi: 10.1007/s00384-024-04699-4.
Anastomotic stenosis (AS) is a common complication after colorectal resection. However, the predisposing factors for stricture formation are not fully understood. Previous studies have shown anastomotic leakage (AL) to be a risk factor for the occurrence of AS. Therefore, we aim to investigate the impact of anastomotic leakage characteristics on the occurrence of anastomotic stenosis after colorectal resection.
Consecutive patients with AL following elective, sphincter preserving, colorectal resection, with or without diversion ostomy, between January 2009 and March 2023 were identified from a prospectively collected database. The characteristics of the anastomotic leakage, patient baseline and operative characteristics as well as the postoperative outcomes were analyzed using univariate and multivariate logistic regression to identify factors associated with the occurrence of post-leakage AS.
A total of 129 patients developed AL and met the inclusion criteria. Among these, 28 (21.7%) patients were diagnosed with post-leakage AS. There was a significantly higher frequency of patients with neoadjuvant radiotherapy (18% vs 3%; p = .026) and hand-sewn anastomoses (39% vs 17%; p = .011) within the AS group. Furthermore, the extent of the anastomotic defect was significantly higher in the AS group compared with the non-AS group (50%, IQR 27-71 vs. 20%, IQR 9-40, p = 0.011). Similar findings were observed between the study groups regarding age, sex, BMI, ASA score, medical comorbidities, diagnosis, surgical procedure, surgical approach (open vs. minimally invasive), and anastomotic fashioning (side-to-end vs. end-to-end). On multivariate analysis, the extent of the anastomotic defect (OR 1.01; 95% CI 1.00-1.03; p = 0.034) and hand-sewn anastomoses (OR 2.68; 95% CI 1.01-6.98; p = 0.043) were confirmed as independent risk factors for post-leakage AS. No correlation could be observed between the occurrence of post-leakage AS and the ISREC grading of AL, the anastomotic height or the management of AL. Time to ostomy reversal was significantly longer in the AS group (202d, IQR 169-275 vs. 318d IQR 192-416, p = 0.014).
The extent of the anastomotic defect and hand-sewn anastomoses were confirmed as independent risk factors for the occurrence of post-leakage AS. No correlation could be observed between the ISREC grading of AL, the anastomotic height or AL management, and the occurrence of post-leakage AS.
吻合口狭窄（AS）是结直肠切除术后的常见并发症。然而，导致狭窄形成的诱发因素尚未完全明确。既往研究表明吻合口漏（AL）是 AS 发生的危险因素。因此，我们旨在探讨 AL 的特征对结直肠切除术后吻合口狭窄发生的影响。
从 2009 年 1 月至 2023 年 3 月前瞻性收集的数据库中，连续纳入接受择期、保肛、结直肠切除术后发生 AL 且合并或不合并转流造口术的患者。采用单变量和多变量逻辑回归分析来分析 AL 的特征、患者基线和手术特征以及术后结局，以确定与术后漏后 AS 发生相关的因素。
共 129 例患者发生 AL 且符合纳入标准。其中，28 例（21.7%）患者被诊断为漏后 AS。AS 组中接受新辅助放疗的患者比例明显更高（18% vs. 3%；p=0.026），手工吻合的比例也明显更高（39% vs. 17%；p=0.011）。与非 AS 组相比，AS 组的吻合口缺损程度显著更高（50%，IQR 27-71 比 20%，IQR 9-40，p=0.011）。在年龄、性别、BMI、ASA 评分、合并症、诊断、手术方式、手术入路（开放 vs. 微创）和吻合方式（端侧吻合 vs. 端端吻合）方面，两组间也观察到相似的差异。多变量分析显示，吻合口缺损程度（OR 1.01；95%CI 1.00-1.03；p=0.034）和手工吻合（OR 2.68；95%CI 1.01-6.98；p=0.043）被确认为漏后 AS 的独立危险因素。AL 的 ISREC 分级、吻合口高度或 AL 的处理与漏后 AS 的发生之间无相关性。AS 组的造口还纳时间明显更长（202d，IQR 169-275 比 318d，IQR 192-416，p=0.014）。
吻合口缺损程度和手工吻合被确认为漏后 AS 发生的独立危险因素。AL 的 ISREC 分级、吻合口高度或 AL 的处理与漏后 AS 的发生之间无相关性。
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