Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study.
Age Factors
Aged
Anastomosis, Surgical
/ adverse effects
Anastomotic Leak
/ etiology
Colectomy
/ adverse effects
Female
Humans
Intestine, Small
/ surgery
Middle Aged
Neoplasm Recurrence, Local
/ surgery
Ovarian Neoplasms
/ surgery
Pelvic Exenteration
/ adverse effects
Proctectomy
/ adverse effects
Retrospective Studies
Risk Factors
Serum Albumin
/ metabolism
Suture Techniques
/ adverse effects
Anastomotic leak
Ovarian cancer
Risk factors
Journal
Gynecologic oncology
ISSN: 1095-6859
Titre abrégé: Gynecol Oncol
Pays: United States
ID NLM: 0365304
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
22
02
2019
revised:
14
03
2019
accepted:
15
03
2019
pubmed:
7
4
2019
medline:
14
8
2019
entrez:
7
4
2019
Statut:
ppublish
Résumé
To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018). Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided.
Sections du résumé
OBJECTIVE
To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk.
BACKGROUND
In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak.
METHODS
Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient.
RESULTS
The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018).
CONCLUSIONS
Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided.
Identifiants
pubmed: 30952369
pii: S0090-8258(19)30434-2
doi: 10.1016/j.ygyno.2019.03.241
pii:
doi:
Substances chimiques
Serum Albumin
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Pagination
549-554Informations de copyright
Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.