Management and 1-year outcomes of anastomotic leakage after elective colorectal surgery

Autor: Marcello Ceccaroni, Stefano Scabini, Lorenzo Pandolfini, Simone Santoni, Gabriella Teresa Capolupo, Elisa Arici, Andrea Sagnotta, Paolo Delrio, Marco Scatizzi, Alberto Patriti, Roberto Campagnacci, Pietro Maria Amodio, Elisa Bertocchi, Raffaele Macarone Palmieri, Graziano Longo, Marco Migliore, Ugo Pace, Stefano Mancini, Michele Benedetti, Paolo Ciano, P. Marsanic, Marco Caricato, Giacomo Martorelli, Nereo Vettoretto, Angela Maurizi, Andrea Muratore, Gian Luca Baiocchi, Giacomo Ruffo, Sarah Molfino, Andrea Lucchi, Michele Motter, Vincenzo Alagna, Irene Marziali, Felice Borghi, Marco Catarci, Felice Pirozzi, Alessandro Carrara, Gianluca Garulli, Desiree Cianflocca, Antonio Sciuto, Andrea Liverani, Gianluca Guercioni, Basilio Pirrera, G. Tirone, Simone Cicconi, Federico Tomassini, Antonio Martino, Andrea Scarinci
Rok vydání: 2020
Předmět:
Zdroj: International Journal of Colorectal Disease. 36:929-939
ISSN: 1432-1262
0179-1958
DOI: 10.1007/s00384-020-03777-7
Popis: To analyze different types of management and one-year outcomes of anastomotic leakage (AL) after elective colorectal resection. All patients with anastomotic leakage after elective colorectal surgery with anastomosis (76/1,546; 4.9%), with the exclusion of cases with proximal diverting stoma, were followed-up for at least one year. Primary endpoints were as follows: composite outcome of one-year mortality and/or unplanned intensive care unit (ICU) admission and additional morbidity rates. Secondary endpoints were as follows: length of stay (LOS), one-year persistent stoma rate, and rate of return to intended oncologic therapy (RIOT). One-year mortality rate was 10.5% and unplanned ICU admission rate was 30.3%. Risk factors of the composite outcome included age (aOR = 1.08 per 1-year increase, p = 0.002) and anastomotic breakdown with end stoma at reoperation (aOR = 2.77, p = 0.007). Additional morbidity rate was 52.6%: risk factors included open versus laparoscopic reoperation (aOR = 4.38, p = 0.03) and ICU admission (aOR = 3.63, p = 0.05). Median (IQR) overall LOS was 20 days (14–26), higher in the subgroup of patients reoperated without stoma. At 1 year, a stoma persisted in 32.0% of patients, higher in the open (41.2%) versus laparoscopic (12.5%) reoperation group (p = 0.04). Only 4 out of 18 patients (22.2%) were able to RIOT. Mortality and/or unplanned ICU admission rates after AL are influenced by increasing age and by anastomotic breakdown at reoperation; additional morbidity rates are influenced by unplanned ICU admission and by laparoscopic approach to reoperation, the latter also reducing permanent stoma and failure to RIOT rates. ClinicalTrials.gov # NCT03560180
Databáze: OpenAIRE
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