6533b7cffe1ef96bd12586ba
RESEARCH PRODUCT
Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients
G. PellinoM. FrassonA. García-graneroP. Granero-castroJ. L. Ramos RodríguezB. Flor-lorenteJ. Bargallo BerzosaN. Alonso HernándezF. J. Labrador VallverdúP. A. Parra BañosG. Ais CondeE. Garcia-graneroMiguel Angel Alvarez RicoMaria Jesus García BraoJuan Manuel Sanchez GonzalezMariela BraithwaiteEva Martí MartínezJose Antonio ÁLvarez PérezAlejandro EspíA. TralleroMónica Millán ScheidingOlga Maseda DíazPaula Dujovne LindenbaumAndrés Monzón AbadManuel Romero SimóJordi Escoll RufinoMarta Santamaría OlabarrietaJosé Viñas MartínezManolo López BañeresIsabel Blesa SierraFrancesc Feliú VillaróJavier Aguiló LucíaAntonio Codina CazadorJuan Hernandis VillalbaCarlos ÁLvarez LasoSonia Martínez AlcaideMaria Nieves Cáceres AlvaradoIgnacio Rey SimóJosep Montero GarcíaAlfonso García FadriqueVicente Aguilella DiagoJavier García SeptiemJacinto García GarcíaLuca PonchiettiMaria Soledad Carceller NavarroMaría Ramos FernándezRaquel Conde MuiñoDaniel Huerga ÁLvarezPablo Menéndez SánchezCarlos Maristany BienertMaria Teresa García MartínezCelia Moreno MuzasCarlos Pastor IdoateAdolfo Pedro Alonso CasadoJose Vicente Roig VilaIgnacio Goded BrotoPablo ColleraAntonio Arroyo Sebastiánsubject
Malemedicine.medical_specialtyColectomiesDatabases FactualColorectal cancerColonanastomotic leak030230 surgeryLower risk03 medical and health sciencesLiver disease0302 clinical medicineRisk FactorsSurgical StaplingmedicineHumansstapled anastomosipostoperative complicationProspective Studiesleft colectomyColectomyAgedbusiness.industryAnastomosis SurgicalGastroenterologyPostoperative complicationPerioperativeMiddle Agedmedicine.diseaseSurgeryColon cancerParenteral nutritionTreatment Outcome030220 oncology & carcinogenesisColonic NeoplasmsFemalebusinessComplicationdescription
Aim Reports detailing the morbidity-mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. Method We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the 'least absolute shrinkage and selection operator' (LASSO) method. Results We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00-7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58-8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18-0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03-8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8-40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). Conclusion Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2018-07-11 |