Is Delaying a Coloanal Anastomosis the Ideal Solution for Rectal Surgery?: Analysis of a Multicentric Cohort of 564 Patients From the GRECCAR.

Autor:	Collard MK; Department of Colorectal Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne University, Paris, France., Rullier E; Department of General and Digestive Surgery, Saint André Hospital, Bordeaux, France., Tuech JJ; Department of General and Digestive Surgery, Hospital Charles Nicole, Rouen, France., Sabbagh C; Department of General and Digestive surgery, Amiens Hospital, France., Souadka A; Department of General and Digestive surgery, National Institute of Oncology, Rabat, Marocco., Loriau J; Department of Digestive Surgery, Saint-Joseph Hospital, Paris, France., Faucheron JL; Department of Colorectal Surgery, Hôpital Unversitaire de Grenoble, France., Benoist S; Department of General and Digestive surgery, Hôpital du Kremlin-Bicêtre, Kremlin-Bicêtre, France., Dubois A; Department of General and Digestive surgery, CHU Clermont-Ferrand Site Estaing, Clermont-Ferrand, France., Dumont F; Department of General and Digestive Surgery, Institut de cancérologie de l'ouest, Saint-Herblain, France., Germain A; Department of General and Digestive Surgery, Hôpital Universitaire de Nancy, France., Manceau G; Department of General and Digestive Surgery, Hôpital Européen Georges Pompidou, Paris, France., Marchal F; Department of Surgical Oncology, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandoeuvre-les-Nancy, France., Sourrouille I; Department of Anesthesiology, Surgery and Interventional, Villejuif, France., Lakkis Z; Department of Digestive Surgery, University Hospital of Besancon, Besancon, France., Lelong B; Department of General and Digestive Surgery, Institute Paoli-Calmettes, Marseille, France., Derieux S; Department of General and Digestive Surgery, Groupe Hospitalier Diaconesses-Croix Saint Simon, Paris, France., Piessen G; Department of General and Digestive Surgery, Hôpital Huriez, Lille, France., Laforest A; Department of General and Digestive Surgery, Institute Monsouris, Paris, France., Venara A; Department of General and Digestive Surgery, Hôpital Universitaire d'Angers, France., Prudhomme M; Department of General and Digestive Surgery, Hôpital Universitaire de Nîmes, France., Brigand C; Department of General and Digestive Surgery, Hôpital de Hautepierre-Hôpitaux Universitaires, Strasbourg, France., Duchalais E; Department of General and Digestive Surgery, Centre Hospitalier Universitaire de Nantes, France., Ouaissi M; Department of General and Digestive Surgery, Hôpital Trousseau - CHRU Hôpitaux de Tours, Chambray-lès-Tours, France., Lebreton G; Department of General and Digestive Surgery, CHU côte de Nâcre, Caen, France., Rouanet P; Department of General and Digestive Surgery, Institut du Cancer de Montpellier, Montpellier, France., Mège D; Department of General and Digestive Surgery, Hôpital de la Timone, Marseille, France., Pautrat K; Department of General and Digestive Surgery, Hôpital Lariboisière, Paris, France., Reynolds IS; Department of Colorectal Surgery, Mater Misericordiae University Hospital, Dublin, Ireland., Pocard M; Department of General and Digestive Surgery, Hôpital Pitié-Salpêtrère, Paris, France., Parc Y; Department of Colorectal Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne University, Paris, France., Denost Q; Department of General and Digestive Surgery, Bordeaux Colorectal Institute, Bordeaux, France., Lefevre JH; Department of Colorectal Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne University, Paris, France.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 Nov 01; Vol. 278 (5), pp. 781-789. Date of Electronic Publication: 2023 Jul 31.
DOI:	10.1097/SLA.0000000000006025
Abstrakt:	Objectives: To assess the specific results of delayed coloanal anastomosis (DCAA) in light of its 2 main indications. Background: DCAA can be proposed either immediately after a low anterior resection (primary DCAA) or after the failure of a primary pelvic surgery as a salvage procedure (salvage DCAA). Methods: All patients who underwent DCAA intervention at 30 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included. Results: Five hundred sixty-four patients (male: 63%; median age: 62 years; interquartile range: 53-69) underwent a DCAA: 66% for primary DCAA and 34% for salvage DCAA. Overall morbidity, major morbidity, and mortality were 57%, 30%, and 1.1%, respectively, without any significant differences between primary DCAA and salvage DCAA ( P = 0.933; P = 0.238, and P = 0.410, respectively). Anastomotic leakage was more frequent after salvage DCAA (23%) than after primary DCAA (15%), ( P = 0.016).Fifty-five patients (10%) developed necrosis of the intra-abdominal colon. In multivariate analysis, intra-abdominal colon necrosis was significantly associated with male sex [odds ratio (OR) = 2.67 95% CI: 1.22-6.49; P = 0.020], body mass index >25 (OR = 2.78 95% CI: 1.37-6.00; P = 0.006), and peripheral artery disease (OR = 4.68 95% CI: 1.12-19.1; P = 0.030). The occurrence of this complication was similar between primary DCAA (11%) and salvage DCAA (8%), ( P = 0.289).Preservation of bowel continuity was reached 3 years after DCAA in 74% of the cohort (primary DCAA: 77% vs salvage DCAA: 68%, P = 0.031). Among patients with a DCAA mannered without diverting stoma, 75% (301/403) have never required a stoma at the last follow-up. Conclusions: DCAA makes it possible to definitively avoid a stoma in 75% of patients when mannered initially without a stoma and to save bowel continuity in 68% of the patients in the setting of failure of primary pelvic surgery. Competing Interests: The authors report no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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