Carannante Filippo, Piozzi Guglielmo Niccolò, Miacci Valentina, Bianco Gianfranco, Melone Gennaro, Schiavone Vincenzo, Costa Gianluca, Caricato Marco, Khan Jim S, Capolupo Gabriella Teresa
UOC Chirurgia Colorettale, Fondazione Policlinico Universitario Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128 Rome, Italy.
Research Unit of Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128 Rome, Italy.
J Clin Med. 2024 Aug 27;13(17):5092. doi: 10.3390/jcm13175092.
Anastomotic leakage (AL) is one of the most feared complications in colorectal surgery, with an incidence of 12-39% and associated risk of mortality of 2-24%. The causes of AL and the ways to prevent it are currently under investigation. This study aims to verify if a quadruple assessment of colorectal anastomosis could reduce AL incidence. A retrospective analysis of prospectively collected data on rectal cancer surgery performed from January 2015 to December 2017 and from January 2021 to December 2023 at a tertiary referral cancer centre was performed. Demographics, clinicopathological features, short-term outcomes, recurrences, and survival were investigated. A total of 293 patients were enrolled. AL incidence was lower in the quadruple assessment group than in the control group, reaching a statistically significant result (7.7% vs. 16%; = 0.001). This result was also confirmed after a propensity score match analysis (PSM), in which the AL rate was lower in the quadruple assessment group (5.4% vs. 12.3%; = 0.01). This study shows how the systematic implementation of a quadruple assessment when performing a colorectal anastomosis could increase awareness on anastomotic success and reduce the incidence of AL.
吻合口漏（AL）是结直肠手术中最令人担忧的并发症之一，发生率为12% - 39%，相关死亡率为2% - 24%。目前正在研究AL的病因及预防方法。本研究旨在验证对结直肠吻合口进行四重评估是否可降低AL发生率。对一家三级转诊癌症中心2015年1月至2017年12月以及2021年1月至2023年12月期间前瞻性收集的直肠癌手术数据进行回顾性分析。调查了人口统计学、临床病理特征、短期结局、复发情况和生存率。共纳入293例患者。四重评估组的AL发生率低于对照组，差异有统计学意义（7.7%对16%；P = 0.001）。倾向评分匹配分析（PSM）后该结果也得到证实，四重评估组的AL发生率更低（5.4%对12.3%；P = 0.01）。本研究表明，在进行结直肠吻合时系统地实施四重评估可提高对吻合成功的认识并降低AL发生率。
