Timuçin EROL, Salih SÜER, Mustafa ORUÇ, Kaya YORGANCI

Kanser nedeni ile yapılan sağ hemikolektomi sonrası anastomoz kaçağına etki eden faktörler: Tek merkez deneyimi

Amaç: Sağ hemikolektomi sonrasında anastomoz kaçağı diğer gastrointestinal sistem anastomozlarına oranla göreceli olarak daha az olsa da hayatı tehdit edici önemli bir komplikasyondur. Bu çalışmanın amacı sağ hemikolektomi sonrasında anastomoz kaçağına ve mortaliteye etki eden faktörleri araştırmaktır. Gereç ve Yöntemler: 1-1-2016 / 31-12-2020 tarihleri arasında sağ kolon tümörü ön tanısı ile ameliyat edilen 18 yaş üzerindeki tüm hastalar çalışmaya dahil edildi. Hastaların demografik verileri, eşlik eden hastalıkları, ameliyat öncesi laboratuar tetkikleri, perioperatif transfüzyon durumu, ameliyatı yapan sorumlu cerrah, ameliyat zamanlaması, anastomoz tekniği ve tümör evresi değişkenleri retrospektif olarak değerlendirildi. Bulgular: Toplam 141 hasta çalışmaya dahil edildi. Ortanca yaş 62 ( min 30—max 92) idi. Anastomoz kaçağı oranı % 9.2 ( n= 13) , mortalite oranı % 5 ( n=7) idi. Anastomoz kaçağına etki eden başlıca faktörün ameliyat zamanlaması olduğu ve acil şartlarda ameliyat edilen hastalarda anastomoz kaçağı riskinin anlamlı şekilde arttığı tespit edildi. İleri yaş ve düşük albümin düzeyi anastomoz kaçağı ve mortalite üzerine etki eden diğer risk faktörleri olarak tespit edildi. Sonuç: Bu çalışma sonucunda ameliyat zamanlaması, hasta yaşı ve düşük albümin düzeyi sağ hemikolektomi sonrasında anastomoz kaçağına etki eden faktörler olarak tespit edilmiştir. Acil ameliyat gerektiren ileri yaştaki, beslenme bozukluğu olan hastalarda sağ hemikolektomi sonrası anastomoz yapılması yerine diversiyonun tercih edilmesi uygun bir yaklaşım olacaktır.

Anahtar Kelimeler:

Anastomoz kaçağı, Kolon kanseri, Sağ hemikolektomi

Factors affecting anastomotic leakage after right hemicolectomy for cancer: a single center experience

Aim Although anastomotic leakage after right hemicolectomy is relatively low, it is the most important life thereathening complication. Aim of this study is to investigate the factors affecting anastomotic leakage and mortality after right hemicolectomy. Material and Methods: All patients > = 18 years of age, undergoing right hemicolectomy for a diagnosis of adenocarcinoma in the right colon between 2016 and 2020 included to study. Patient demographics, comorbidities, preoperative labaoratory tests, perioperative transfusion status , performing surgeon, anastomotic technique, tumor stage, and timing of surgery (elective v.s emergent) are the variables investigated retrospectively. Results: Total 141 patient included to study. Mean age was 62 ( min 30—max 92). Total anastomotic leakage rate was % 9.2 (n = 13) and overall mortality rate was % 5 (n = 7).Timing of the surgery found to be the major determinant of anastomotic leakage and emergent surgery significantly increased the leakage risk. Advanced age and low albumin levels were the other factors which affect on anastomotic leakage and mortality rate. Conclusion: Age of the patient, low albumin levels and timing of the operation are found to be the risk factors affecting anastomotic leakage after right hemicolectomy. Diversion can be a feasible option after right hemicolectomy for the elderly patients’ with malnutrition who neccesitates emergent operation.

Keywords:

Anastomotic leakage, colon cancer, right hemicolectomy,

PDF

___

1. Marley AR, Nan H. Epidemiology of colorectal cancer. Int J Mol Epidemiol Genet 2016; 7: 105-14.
2. Sung H, Ferlay J, Siegel RL et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians 2021; 71: 209-49.
3. van Westreenen HL, Ijpma FF, Wevers KP et al. Reoperation after colorectal surgery is an independent predictor of the 1-year mortality rate. Diseases of the colon and rectum. 2011; 54: 1438-42.
4. Turrentine FE, Denlinger CE, Simpson VB et al. Morbidity, Mortality, Cost, and Survival Estimates of Gastrointestinal Anastomotic Leaks. Journal of the American College of Surgeons 2015; 220: 195-206.
5. Suding P, Jensen E, Abramson MA et al. Definitive Risk Factors for Anastomotic Leaks in Elective Open Colorectal Resection. Archives of Surgery 2008; 143: 907-12.
6. Krarup PM, Jorgensen LN, Andreasen AH et al. A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis 2012; 14: 661-7.
7. Golub R, Golub RW, Cantu R et al. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 1997; 184:364-72.
8. Masoomi H, Buchberg B, Dang P et al. Outcomes of right vs. left colectomy for colon cancer. J Gastrointest Surg 2011; 15: 2023-8.
9. Élthes E, Sala D, Neagoe RM et al. Safety of anastomotic techniques and consequences of anastomotic leakage in patients with colorectal cancer: a single surgeon experience. Med Pharm Rep 2020; 93: 384-9.
10. Veyrie N, Ata T, Muscari F et al. Anastomotic Leakage after Elective Right Versus Left Colectomy for Cancer: Prevalence and Independent Risk Factors. Journal of the American College of Surgeons 2007; 205: 785-93.
11. Jessen M, Nerstrøm M, Wilbek TE et al. Risk factors for clinical anastomotic leakage after right hemicolectomy. Int J Colorectal Dis 2016; 31: 1619-24.
12. Group* ESoCC. Predictors for Anastomotic Leak, Postoperative Complications, and Mortality After Right Colectomy for Cancer: Results From an International Snapshot Audit. Diseases of the Colon & Rectum 2020; 63: 606-18.
13. Sánchez-Guillén L, Frasson M, García-Granero Á et al. Risk factors for leak, complications and mortality after ileocolic anastomosis: comparison of two anastomotic techniques. Ann R Coll Surg Engl 2019; 101: 571-8.
14. Kolfschoten NE, Wouters MWJM, Gooiker GA et al. Nonelective Colon Cancer Resections in Elderly Patients: Results from the Dutch Surgical Colorectal Audit. Digestive Surgery 2012; 29: 412-9.
15. Choi HK, Law WL, Ho JW. Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum 2006; 49: 1719-25.
16. Frasson M, Granero-Castro P, Ramos Rodríguez JL et al. Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients. International Journal of Colorectal Disease 2016; 31: 105-14.
17. Hyman N, Manchester TL, Osler T et al. Anastomotic leaks after intestinal anastomosis: it's later than you think. Annals of surgery 2007; 245: 254-8.
18. Sjo OH, Larsen S, Lunde OC et al. Short term outcome after emergency and elective surgery for colon cancer. Colorectal Dis 2009; 11: 733-9.
19. Leung E, McArdle K, Wong LS. Risk-adjusted scoring systems in colorectal surgery. Int J Surg 2011; 9: 130-5.
20. Telem DA, Chin EH, Nguyen SQ et al. Risk Factors for Anastomotic Leak Following Colorectal Surgery: A Case-Control Study. Archives of Surgery 2010; 145: 371-6.
21. Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg 2009; 208: 269-78.
22. Weimann A, Braga M, Carli F et al. ESPEN practical guideline: Clinical nutrition in surgery. Clinical Nutrition. 2021; 40: 4745-61.
23. Choy PY, Bissett IP, Docherty JG et al. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev 2007: 4320.
24. Nordholm-Carstensen A, Schnack Rasmussen M, Krarup P-M. Increased Leak Rates Following Stapled Versus Handsewn Ileocolic Anastomosis in Patients with Right-Sided Colon Cancer: A Nationwide Cohort Study. Diseases of the Colon & Rectum 2019; 62.
25. The relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit. Colorectal Dis 2017
26. Borowski DW, Bradburn DM, Mills SJ et al. Volume–outcome analysis of colorectal cancer-related outcomes. British Journal of Surgery 2010; 97: 1416-30.
27. Group tESoCC. The impact of stapling technique and surgeon specialism on anastomotic failure after right-sided colorectal resection: an international multicentre, prospective audit. Colorectal Disease. 2018; 20: 1028-40.