Santullo Francesco, Vargiu Virginia, Rosati Andrea, Costantini Barbara, Gallotta Valerio, Lodoli Claudio, Abatini Carlo, Attalla El Halabieh Miriam, Ghirardi Valentina, Ferracci Federica, Quagliozzi Lorena, Naldini Angelica, Pacelli Fabio, Scambia Giovanni, Fagotti Anna
Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Department Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
Ann Surg Oncol. 2025 Apr;32(4):2620-2628. doi: 10.1245/s10434-024-16731-6. Epub 2025 Jan 4.
Anastomotic leakage (AL) is a major complication in colorectal surgery, particularly following rectal cancer surgery, necessitating effective prevention strategies. The increasing frequency of colorectal resections and anastomoses during cytoreductive surgery (CRS) for peritoneal carcinomatosis further complicates this issue owing to the diverse patient populations with varied tumor distributions and surgical complexities. This study aims to assess and compare AL incidence and associated risk factors across conventional colorectal cancer surgery (CRC), gastrointestinal CRS (GI-CRS), and ovarian CRS (OC-CRS), with a secondary focus on evaluating the role of protective ostomies.
A retrospective analysis was performed on 1324 patients undergoing CRC, GI-CRS, and OC-CRS between January 2015 and December 2022. Multivariate analysis was utilized to identify preoperative, intraoperative, and postoperative variables as potential AL risk factors.
The overall AL rate was 3.0% (40/1324), with no significant differences among the three groups. Distinct risk factors were identified for each group: CRC (preoperative chemoradiotherapy), GI-CRS (ECOG score ≥ 2, preoperative albumin < 30 mg/dL), and OC-CRS (BMI < 18 kg/m, pelvic lymphadenectomy, preoperative albumin < 30 mg/dL, anastomosis distance < 10 cm, postoperative anemia). Protective ostomies did not reduce AL incidence, and a notable discrepancy exists between AL risk factors and those influencing protective ostomy decisions.
AL, while rare, remains a serious postoperative complication in CRC and CRS. Key risk factors include preoperative nutritional status and surgical details such as blood supply and anastomosis level. Each patient group presents unique risks, which must be carefully weighed when considering protective ileostomy.
吻合口漏（AL）是结直肠手术中的主要并发症，尤其是在直肠癌手术后，因此需要有效的预防策略。在腹膜癌减瘤手术（CRS）期间，结直肠切除和吻合的频率不断增加，由于患者群体多样、肿瘤分布各异以及手术复杂性不同，这一问题变得更加复杂。本研究旨在评估和比较传统结直肠癌手术（CRC）、胃肠道CRS（GI-CRS）和卵巢CRS（OC-CRS）中的AL发生率及相关危险因素，次要目的是评估保护性造口的作用。
对2015年1月至2022年12月期间接受CRC、GI-CRS和OC-CRS的1324例患者进行回顾性分析。采用多变量分析来确定术前、术中和术后变量作为潜在的AL危险因素。
总体AL发生率为3.0%（40/1324），三组之间无显著差异。每组都确定了不同的危险因素：CRC（术前放化疗）、GI-CRS（美国东部肿瘤协作组[ECOG]评分≥2、术前白蛋白<30mg/dL）和OC-CRS（体重指数<18kg/m²、盆腔淋巴结清扫、术前白蛋白<30mg/dL、吻合口距离<10cm、术后贫血）。保护性造口并未降低AL发生率，并且AL危险因素与影响保护性造口决策的因素之间存在显著差异。
AL虽然罕见，但仍是CRC和CRS中严重的术后并发症。关键危险因素包括术前营养状况以及诸如血供和吻合水平等手术细节。每个患者群体都有独特的风险，在考虑行保护性回肠造口时必须仔细权衡。
