Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients.

Autor: Pellino G; Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.; Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Università della Campania 'Luigi Vanvitelli', Naples, Italy., Frasson M; Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain., García-Granero A; Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.; Human Anatomy and Embryology Department, University of Valencia, Valencia, Spain., Granero-Castro P; Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain., Ramos Rodríguez JL; Hospital Universitario de Getafe, Madrid, Spain., Flor-Lorente B; Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain., Bargallo Berzosa J; Hospital de Terrassa, Barcelona, Spain., Alonso Hernández N; Hospital Universitario Son Espases, Palma, Spain., Labrador Vallverdú FJ; Hospital Universitario SESCAM, Guadalajara, Spain., Parra Baños PA; HGU Reina Sofía, Murcia, Spain., Ais Conde G; Hospital General de Segovia, Segovia, Spain., Garcia-Granero E; Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2018 Nov; Vol. 20 (11), pp. 986-995. Date of Electronic Publication: 2018 Jul 11.
DOI: 10.1111/codi.14309
Abstrakt: Aim: Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies.
Method: We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method.
Results: We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001).
Conclusion: Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.
(Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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