Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study

Buchs, Nicolas; Gervaz, Pascal; Secic, Michelle; Bucher, Pascal Alain Robert; Mugnier-Konrad, Béatrice; Morel, Philippe

doi:10.1007/s00384-007-0399-3

Cited by 393 publications

(342 citation statements)

References 32 publications

(39 reference statements)

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“…The reason for this non-inclusion is that operator selection is a potential risk of bias because difficult cases tended to be operated by experts and some of the relatively easy cases are done by trainees, particularly in this cohort. ASA-PS classification is a reported predictive factor of postoperative complications after major abdominal surgeries for colorectal and pancreatic disease [36][37][38]. ASA-PS class 2 defines ''a patient with mild systemic disease'' such as controlled hypertension, diabetes without systemic effects, and cigarette smoking without chronic obstructive pulmonary disease [39].…”

Section: Discussionmentioning

confidence: 99%

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

et al. 2013

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Background The safety of surgery for gastric cancer in the elderly has been shown previously. However, potentially fatal complications based on an established severity grading system were not well described, and associated risk factors have not been assessed. The present study sought to examine severity-dependent postoperative complications after laparoscopy-assisted distal gastrectomy (LADG) in elderly patients and risk factors of potentially fatal postoperative complications. Methods The study included 189 patients aged 70 years or older and who underwent LADG for early gastric cancer. Patient characteristics, perioperative outcomes, postoperative complications including severity assessment using the Clavien-Dindo classification, and risk factors related to postoperative complications were analyzed. Results The overall complication rate was 24.9 % (47/189). The most frequent complication was abdominal fluid collection (9 cases, 4.8 %). Severe complications classified as grade III or above in the Clavien-Dindo grading system were found in 20 (10.6 %) patients. Multivariate analysis identified preoperative serum albumin concentration (odds ratio, 5.200; 95 % CI, 1.706-15.850), Roux-en-Y reconstruction (odds ratio, 3.611; 95 % CI, 1.103-11.817), and simultaneous cholecystectomy (odds ratio, 5.008; 95 % CI, 1.378-18.201) as independent predictors of a higher rate of severe postoperative complications after LADG in elderly patients. Conclusion The incidence of severe complications after LADG in the elderly was quite acceptable considering the risks associated with radical surgery with extensive lymphadenectomy. Preoperative serum concentrations of albumin (\4.0 g/dl), Roux-en-Y reconstruction, and simultaneous cholecystectomy are independent risk factors for severe postoperative complications in these patients.

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Section: Discussionmentioning

confidence: 99%

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

et al. 2013

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“…4 With current screening and diagnostic methods, the interval between construction of the colorectal anastomosis and diagnosis of leakage varies between 6 and 13 days. [5][6][7] Several studies have suggested that delay of diagnosis of CAL is associated with higher mortality rates and that only early management improves clinical outcome. [8][9][10] Therefore, new screening methods allowing detection of CAL in the early postoperative phase are needed.…”

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confidence: 99%

Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage

Komen

Slieker

Willemsen

et al. 2014

The American Journal of Surgery

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BACKGROUND: We aim to determine if C-reactive protein (CRP), lipopolysaccharide-binding protein (LBP), and procalcitonin (PCT) in drain fluid can serve as screening tools for colorectal anastomotic leakage (CAL).METHODS: Patients included in this multicenter prospective observational study underwent left hemicolectomy, sigmoid resection, high anterior resection, low anterior resection, or subtotal colectomy. During the first 5 postoperative days, CRP, LBP, and PCT were determined on drain fluid. RESULTS: In total 243 patients were included, of whom 19 (8%) developed CAL. CRP levels were higher in patients with leakage on day 3 and day 5, levels of LBP were higher on days 2, 3, and 4, and PCT levels were higher on day 5. Multivariate analysis showed LBP to be significantly related to CAL. An increase in the average initial value at the first postoperative day with 1 standard deviation increased the risk of leakage by 1.6 times.This research was made possible by grant from ''Stichting Technische Wetenschappen'' (STW), Utrecht, The Netherlands. STW had no role in the study design, in collection, analysis and interpretation of the data, in writing of this manuscript or in the decision to submit.

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“…Komen et al(2009) encontraram 8,7% de fístulas em 739 anastomoses colorretais, identificando o tempo cirúrgico prolongado e o índice de massa corporal (IMC) maior que 30 kg/m² como fatores de risco independentes para a ocorrência de fístulas 10 . Outros fatores de risco identificados são: presença de doença inflamatória intestinal, operações retais, risco cirúr-gico aumentado (classificação da ASA), hipoalbuminemia, perda sanguínea intraoperatória aumentada e hemotransfusão 8,9 .…”

Section: Sumário Dos Resultadosunclassified

“…Swanson et al (2003) A presença de comorbidades associadas à doença de base pode ser esperada na faixa etária mais acometida pelos tumores colorretais. Dentre as complicações decorrentes das operações colorretais, a deiscência e fístula anastomóticas costumam ser consideradas as mais graves [8][9][10] . A incidência das fístulas anastomóticas em 63 cirurgias colorretais envolvendo anastomoses foi de cinco casos (7,9%).…”

Section: Sumário Dos Resultadosunclassified

“…Estudos mostram incidência de fístulas em torno de 6% após os procedimentos colônicos e 19%, após procedimentos retais 11,12 10 . Outros fatores de risco identificados são: presença de doença inflamatória intestinal, operações retais, risco cirúr-gico aumentado (classificação da ASA), hipoalbuminemia, perda sanguínea intraoperatória aumentada e hemotransfusão 8,9 .…”

Section: Sumário Dos Resultadosunclassified

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Cirurgia no câncer colorretal: abordagem cirúrgica de 74 pacientes do SUS portadores de câncer colorretal em programa de pós-graduação lato sensu em coloproctologia

Oliveira¹,

Faria²,

Lima³

et al. 2011

Rev bras. colo-proctol.

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SILVA IGD, CRUZ GMGD. Cirurgia no câncer colorretal -abordagem cirúrgica de 74 pacientes do SUS portadores de câncer colorretal em programa de pós-graduação lato sensu em coloproctologia. Rev bras Coloproct, 2011;31(1): 44-57. RESUMO: A análise retrospectiva de 74 prontuários de pacientes do Sistema Único de Saúde (SUS), operados de câncer colorretal peloResidente R2 supervisionado e auxiliado por preceptores, permitiu as seguintes conclusões: a média etária dos pacientes foi 57,2, sendo as sexta e sétima décadas responsáveis por 51,4% dos pacientes. O câncer retal foi preponderante nas mulheres (54,1%). As localizações mais comuns dos tumores foram no sigmoide (31,1%), reto alto (24,3%) e ceco (17,6%). As cirurgias mais realizadas foram a retossigmoidectomia com anastomose colorretal (36,6%), e hemicolectomia direita com anastomose íleo-transverso (21,7%). As características anatômicas dos tumores, baseadas na classificação TNM, mais comuns foram: T3 (62,1%), N0 (59,5%) e M0 (77,0%) (p<0,05). O nú-mero médio de gânglios encontrados nas peças cirúrgicas foi de 10,4. Foram feitas 63 anastomoses (85,1%), das quais 38 (60,3%) foram mecânicas e 25, manuais (39,7%). Houve 14 comorbidades (18,9%), destacando-se a caquexia (oito casos). O índice de complicações cirúrgicas foi de 12,2% (nove casos), sendo as cirurgias que mais causaram complicações as colectomias totais com anastomose íleo-retal (40,0%) e as retossigmoidectomias abdominais, com duplo grampeamento (20%), sendo as complicações mais comuns as fístulas anastomóticas (cinco casos). As complicações (nove) decorreram mais das comorbidades (sete) que do ato cirúrgico (duas). As cirurgias que demandaram menos tempo foram: as laparotomias com ileostomia (média de 75 minutos) e as com colostomia (média de 95 minutos), sendo os maiores tempos ocupados pela proctocolectomia total com ileostomia definitiva (240 minutos) e as hemicolectomias esquerdas com anastomose transverso-retal (240 minutos), sendo o tempo médio equivalente a 160 minutos. As menores peças cirúrgicas foram as decorrentes da cirurgia de Hartmann (29 cm) e de retossigmoidectomia abdominal (32 cm); e as mais extensas, as peças de colectomia total com anastomose íleo-retal (120 cm) e proctocolectomia total com ileostomia definitiva (150 cm), ficando a média em 34,5. Houve 12 óbitos (16,2%), dois dos quais diretamente relacionados à cirurgia (um caso de deiscência de anastomose e um de evisceração); três relacionados à complicações de ordem clínica (dois casos de TEP e um de broncopneumonia); e sete comorbidades.Palavras-chave: câncer colorretal; cirurgia colorretal; câncer; SUS. Cirurgia no câncer colorretal -abordagem OBJETIVOProceder a uma revisão criteriosa de uma casuís-tica de 11 meses (2009), de 74 pacientes operados do câncer colorretal, sendo todos os pacientes do SUS e operados pelo Residente R2, sempre auxiliado por um ou dois preceptores. MATERIAIS E MÉTODOSOs prontuários dos pacientes foram minuciosamente revisados, dando-se absoluta atenção aos seguintes dados: idade; gênero; nome do cir...

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Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study

Cited by 393 publications

References 32 publications

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage

Cirurgia no câncer colorretal: abordagem cirúrgica de 74 pacientes do SUS portadores de câncer colorretal em programa de pós-graduação lato sensu em coloproctologia

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