The Evaluation of Our Anastomosic Leakages Developed on Colorectal Surgery in Two Different Times and in Two Separate Centers Across the Literature

Year 2022, , 254 - 262, 30.12.2022

Okay Nazlı

https://doi.org/10.47572/muskutd.1089564

Abstract

One of the most important and feared complications in colorectal surgery is anastomotic leakage and associated pelviperitoneal sepsis. Anastomotic leaks are responsible for 30-50% of the mortality in colorectal surgery. Early detection of leakage and co-morbidities determine the mortality rate. With the unpublished data of colon and rectum cancer cases operated between 2000 and 2008 in the 3rd General Surgery Clinic of İzmir Atatürk Training and Research Hospital (İAEAH); The data of the colon and rectum cases who underwent surgical treatment between 2012-2021 in Muğla Sıtkı Koçman University Training and Research Hospital (MSKÜEAH) General Surgery Clinic, where I am still working, were analyzed retrospectively. Within the specified periods, 216 cases of colorectal cancer in the IAEAH study and 251 surgically treated colorectal cancer cases in MSKUEAH were detected. In this retrospective study, anastomotic leaks developed after colorectal surgery were evaluated. By always remembering the negative consequences of anastomotic leaks such as reoperation possibilities, surgical morbidity and mortality, length of hospital stay and hospital readmission, increased risk of leucoregional recurrence, reduced five-year overall survival, decreased quality of life and cost of patients, leak prevention measures should be increased and for this, further clinical studies need to be done. The aim of this study is to investigate the effects of advances in surgical technique, important fields such as radiology and intensive care on anastomotic leaks in patients who underwent colorectal surgery at different study periods in two different centers.

Keywords

Colorectal Carcinoma, Anastomotic Leak, Risk Factors, Surgical Morbidity, Mortality

İki Farklı Zaman Aralığı ve İki Ayrı Merkezdeki Kolorektal Cerrahide Anastomoz Kaçaklarımızın Literatür Eşliğinde Değerlendirilmesi

Abstract

Kolorektal cerrahide en önemli ve korkulan komplikasyonlardan biri anastomoz kaçakları ve buna bağlı pelviperitoneal sepsistir. Kolorektal cerrahide mortalitenin %30-50’sinden anastomoz kaçakları sorumludur. Mortalite oranını, kaçağın erken tanınması ve yandaş hastalıklar belirler. İzmir Atatürk Eğitim ve Araştırma Hastanesi 3.Genel Cerrahi Kliniği’nde (İAEAH) 2000-2008 yılları arasında opere edilen kolon ve rektum kanseri olgularının yayınlanmamış olan verileri ile halen çalışmakta olduğum Muğla Sıtkı Koçman Üniversitesi Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’nde (MSKÜEAH) 2012-2021 yılları arasında cerrahi tedavi gören kolon ve rektum olgularının verileri retrospektif olarak incelenmiştir. Belirtilen dönemler içerisinde, İAEAH çalışmasında 216, MSKÜEAH’de ise 251 cerrahi tedavi uygulanan kolorektal kanser olgusu saptanmıştır. Bu retrospektif çalışmada uygulanmış olan kolorektal cerrahi sonrası gelişen anastomoz kaçakları değerlendirilmiştir. Anastomoz kaçaklarının, reoperasyon olasılıkları, cerrahi morbidite ve mortalitenin, hastanede yatış süresinin ve hastaneye tekrar gelişin, lökorejyonel nüks riskinin artışı, beş yıllık genel sağ kalımın azalması ve hastaların yaşam kalitesinin düşmesi ve maliyet gibi olumsuz sonuçlarının daima hatırlanarak, kaçak önleyici tedbirlerin artırılması ve bunun için de yeni klinik çalışmaların yapılması gerekmektedir. Bu çalışmanın amacı cerrahi teknik, radyoloji, yoğun bakım gibi önemli alanlarda ilerlemelerin, iki ayrı merkezde farklı çalışma dönemlerinde kolorektal cerrahi uygulanan olgularda anastomoz kaçaklarına olan etkilerini araştırmaktır. 

Keywords

Kolorektal Karsinom, Anastomoz Kaçağı, Risk Faktörleri, Cerrahi Morbidite, Mortalite

References

• 1. Koperna T, Schulz F. Relaparotomy in peritonitis: Prognosis and treatment of patients with persisting intraabdominal infection. World J Surg. 2000;24:32-7.
• 2. Radenovski D, Georgiev A. Relaparatomy in middle aged and elderly patients with peritonitis following a primary operation for digestive pathology. Khirurgia (Sofiia). 1998;51:29-32.
• 3. Bokey EL, Chapuis P, Fung C, et al. Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum. 1995;38:480-6.
• 4. Soeters PB, de Zoete JPJGM, Dejong CHC, et al. Colorectal surgery and anastomotic leakage. Dig Surg. 2002;19:150-5.
• 5. Audisio RA, Papamichael D. Treatment of colorectal cancer in older patients. Nat Rev Gastroenterol Hepatol. 2012;9:716–25.
• 6. Krarup PM, Jorgensen LN, Andreasen AH, et al, Danish Colorectal Cancer Group. A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis. 2012;14(10):661-7.
• 7. Hennessey DB, Burke JP, Ni-Dhonochu T, et al. Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery: a multi-institutional study. Ann Surg. 2010;252:325–9.
• 8. Makela JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum. 2003;46:653–60.
• 9. Bertelsen CA, Andreasen AH, Jorgensen T, et al. Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis. 2010;12(1):37-43.
• 10. Platell C, Barwood N, Dorfmann G, et al. The incidence of anastomotic leaks in patients undergoing colorectal surgery. Colorectal Dis. 2006;9:71–9.
• 11. Gessler B, Eriksson O, Angenete E. Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32:549–56.
• 12. Mc Dermott FD, Heeney A, Kelly ME, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102(5):462-79.
• 13. Nikolian VC, Kamdar NS, Regenbogen SE, et al. Anastomotic Leak after Colorectal Resection: A Population-Based Study of Risk Factors and Hospital Variation. Surgery. 2017;161(6):1619–27.
• 14. Vasiliu EC, Zarnescu NO, Costea R, et al. Review of Risk Factorsfor Anastomotic Leakage in Colorectal Surgery. Chirurgia (Bucur). 2015;110:319-26.
• 15. Bakker IS, Grossmann I, Henneman D ,et al. Risk factors for anastomotic leak age and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg. 2014;101:424-43.
• 16. Rudinskaite G, Tamelis A, Saladzinskas Z, et al. Risk factors for clinical anastomotic leakage following the resection of sigmoid and rectal cancer. Medicina. 2005;41(9):741-6.
• 17. Golub R, Golub RW, Cantu R, et al. A multivariate analysis of factors cuntributing to leakage of intestinal anastomosis. J Am Coll Surg. 1997;184:364-72.
• 18. Guenaga KF, Matos D, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. The Cochrane database of systematic reviews 2011;2011(9): CD001544
• 19. Stumpf M, Klinge U, Wilms A, et al. Changes of the extracellular matrix as a risk factor for anastomotic leakage after large bowel surgery. Surgery. 2005;137:229-4.
• 20. Johansson K, Ahn H, Lindhagen J, et al. Effect of epidural anaesthesia on intestinal blood flow. Br J Surg. 1988;75:73-6.
• 21. Kwon S, Morris A, Billingham R, et al. Routine leak testing in colorectal surgery in the surgical care and outcomes assessment program. Arch Surg. 2012;147:345-51.
• 22. Branagan G, Finnis D, Wessex Colorektal Cancer Audit Working Group. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum. 2005;48(5):1021-6.
• 23. Fouda E, El Nakeeb A, Magdy A, et al. Early detection of anastomotic leakage after elective low anterior resection. J Gastrointest Surg. 2011;15:137-44.
• 24. Bellows CF, Webber LS, Albo D, et al. Early predictors of anastomotic leaks after colectomy. Tech Coloproctol. 2009;13:41-7.
• 25. Murrell ZA, Stamos MJ. Reoperation for anastomotic failure. Clin Colon Rectal Surg. 2006;19:213-6.
• 26. Walker KG, Bell SW, Rickard MJ, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg. 2004;240:255-9.
• 27. Petersen S, Freitag M, Hellmich G, et al. Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis. 1998;13:160-3.