Published in:
01-05-2021 | Enterostomy | Original Article
Management and 1-year outcomes of anastomotic leakage after elective colorectal surgery
Authors:
Felice Borghi, Marco Migliore, Desirée Cianflocca, Giacomo Ruffo, Alberto Patriti, Paolo Delrio, Marco Scatizzi, Stefano Mancini, Gianluca Garulli, Andrea Lucchi, Alessandro Carrara, Felice Pirozzi, Stefano Scabini, Andrea Liverani, Gianluca Baiocchi, Roberto Campagnacci, Andrea Muratore, Graziano Longo, Marco Caricato, Raffaele Macarone Palmieri, Nereo Vettoretto, Paolo Ciano, Michele Benedetti, Elisa Bertocchi, Marcello Ceccaroni, Ugo Pace, Lorenzo Pandolfini, Andrea Sagnotta, Basilio Pirrera, Vincenzo Alagna, Giacomo Martorelli, Giuseppe Tirone, Michele Motter, Antonio Sciuto, Antonio Martino, Andrea Scarinci, Sarah Molfino, Angela Maurizi, Patrizia Marsanic, Federico Tomassini, Simone Santoni, Gabriella Teresa Capolupo, Pietro Amodio, Elisa Arici, Simone Cicconi, Irene Marziali, Gianluca Guercioni, Marco Catarci, The Italian ColoRectal Anastomotic Leakage (iCral) study group
Published in:
International Journal of Colorectal Disease
|
Issue 5/2021
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Abstract
Purpose
To analyze different types of management and one-year outcomes of anastomotic leakage (AL) after elective colorectal resection.
Methods
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).
Results
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.
Conclusion
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.