Ono Rika, Tominaga Tetsuro, Nonaka Takashi, Takamura Yuma, Oishi Kaido, Hashimoto Shintaro, Shiraishi Toshio, Noda Keisuke, Hisanaga Makoto, Fukuda Akiko, Moriyama Masaaki, Maruyama Keizaburo, Tei Shoko, Ishimaru Kazuhide, Matsumoto Keitaro
Department of Surgery, Sasebo City General Hospital, 9-3 Hirasemachi, Nagasaki, 857-8511, Japan.
Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Surg Today. 2025 May 29. doi: 10.1007/s00595-025-03066-2.
This study used a Japanese multicenter database to identify risk factors for anastomotic leakage (AL) and evaluate the long-term outcomes of patients who underwent laparoscopic right colectomy.
The subjects of this retrospective review were 729 patients who underwent laparoscopic right colectomy. Clinical features were compared between patients who suffered AL (n = 33) and those who did not (n = 696).
Multivariate analysis identified pulmonary disease (odds ratio [OR] 6.681, 95% confidence interval [CI] 1.495-19.864; p = 0.012), steroid use (OR 10.930, 95%CI 6.131-14.783; p < 0.001), open conversion (OR 12.648, 95%CI 5.479-15.438; p < 0.001), and blood loss ≥ 25 ml (OR 3.260, 95%CI 1.407-7.553; p = 0.005) as independent prognostic factors for AL. The five-year recurrence-free survival (RFS) rates were 43.6% in the AL group and 80.3% in the non-AL group (p = 0.016), while the 5-year overall survival (OS) rates were 71.3% in the AL group and 85.8% in the non-AL group (p = 0.027). Multivariate analysis identified AL (HR 1.519, 95%CI 1.646-3.591; p = 0.037) as the only independent predictor of OS.
Pulmonary disease, steroid use, and open conversion were identified as risk factors for AL in patients who underwent laparoscopic right colectomy. AL was associated with poor prognosis. Achievement of good short- and long-term results will require careful perioperative management of patients with these risk factors.
本研究利用日本多中心数据库确定吻合口漏（AL）的危险因素，并评估接受腹腔镜右半结肠切除术患者的长期预后。
本回顾性研究的对象为729例行腹腔镜右半结肠切除术的患者。比较发生AL的患者（n = 33）和未发生AL的患者（n = 696）的临床特征。
多因素分析确定肺部疾病（比值比[OR] 6.681，95%置信区间[CI] 1.495 - 19.864；p = 0.012）、使用类固醇（OR 10.930，95%CI 6.131 - 14.783；p < 0.001）、转为开腹手术（OR 12.648，95%CI 5.479 - 15.438；p < 0.001）和失血≥25 ml（OR 3.260，95%CI 1.407 - 7.553；p = 0.005）为AL的独立预后因素。AL组的5年无复发生存率（RFS）为43.6%，非AL组为80.3%（p = 0.016），而AL组的5年总生存率（OS）为71.3%，非AL组为85.8%（p = 0.027）。多因素分析确定AL（风险比[HR] 1.519，95%CI 1.646 - 3.591；p = 0.037）是OS的唯一独立预测因素。
肺部疾病、使用类固醇和转为开腹手术被确定为接受腹腔镜右半结肠切除术患者发生AL的危险因素。AL与预后不良相关。要取得良好的短期和长期结果，需要对有这些危险因素的患者进行仔细的围手术期管理。
