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.

BACKGROUND: Studies focused on postoperative outcome after oncologic right colectomy are lacking. The main objective was to determine pre-/intraoperative risk factors for anastomotic leak after elective right colon resection for cancer. Secondary objectives were to determine risk factors for postoperative morbidity and mortality. METHODS: Fifty-two hospitals participated in this prospective, observational study (September 2011-September 2012), including 1102 patients that underwent elective right colectomy. Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak and postoperative morbidity and mortality. RESULTS: Anastomotic leak was diagnosed in 93 patients (8.4 %), and 72 (6.5 %) of them needed radiological or surgical intervention. Morbidity, mortality, and wound infection rates were 29.0, 2.6, and 13.4 %, respectively. Preoperative serum protein concentration was the only independent risk factor for anastomotic leak (p < 0.0001, OR 0.6 per g/dL). When considering only clinically relevant anastomotic leaks, stapled technique (p = 0.03, OR 2.1) and preoperative serum protein concentration (p = 0.004, OR 0.6 g/dL) were identified as the only two independent risk factors. Age and preoperative serum albumin concentration resulted to be risk factors for postoperative mortality. Male gender, pulmonary or hepatic disease, and open surgical approach were identified as risk factors for postoperative morbidity, while male gender, obesity, intraoperative complication, and end-to-end anastomosis were risk factors for wound infection. CONCLUSIONS: Preoperative nutritional status and the stapled anastomotic technique were the only independent risk factors for clinically relevant anastomotic leak after elective right colectomy for cancer. Age and preoperative nutritional status determined the mortality risk, while laparoscopic approach reduced postoperative morbidity.

Reconstrucción diferida del esófago tras su interrupción para el tratamiento de una patología benigna / Staged oesophageal reconstruction for benign disease

Objetivos Evaluar las complicaciones, la mortalidad y la calidad de vida tras la reconstrucción esofágica diferida en pacientes que han precisado desconexión esofágica (esofagostomía cervical) por causas de etiología benigna. Pacientes y métodos Durante el periodo 2002 a 2011, a 20 de 24 pacientes con una exclusión esofágica por patología benigna, se les realizó la reconstrucción diferida. Se analizaron las complicaciones de la reconstrucción y se evaluó la calidad de vida mediante el Cuestionario de la Salud SF-36 antes y después de la cirugía. Resultados Se intervinieron 20 pacientes (16 varones y 4 mujeres) con una edad media de 54,5±10,5 años. Las causas de desconexión esofágica fueron: 10 por ingesta de cáusticos, 3 perforaciones iatrogénicas, 4 dehiscencia de anastomosis y 3 casos con síndrome de Boerhaave. Se realizaron 14 coloplastias (60%) y 6 interposiciones gástricas (25%) en un tiempo medio de 212,2±23,5 días tras la desconexión esofágica. Las complicaciones postoperatorias más frecuentes fueron las respiratorias (55% de los pacientes) y según la clasificación modificada de Clavien se dividieron en: grado 1 (10%), grado 2 (15%), grado 3a (40%), grado 3b (10%) y grado 4a (10%). La mortalidad (grado 5) a los 30 días de la serie fue del 10%. La calidad de vida tras la reconstrucción mejoró de forma significativa en todos los dominios analizados del cuestionario SF-36.ConclusionesLa reconstrucción esofágica en un segundo tiempo se asocia a una elevada morbilidad, con una mortalidad del 10%. Tras la reconstrucción, la calidad de vida mejora en todos los parámetros evaluados (AU)

Objectives To assess morbidity, mortality and quality of life after oesophageal reconstruction in patients with oesophageal exclusion for benign diseases. Patients and methods From 2002 to 2011, 20 of 24 patients with esophageal exclusion due to benign disease underwent a delayed reconstruction. We analyzed morbidity, mortality and health-related quality of life using the SF-36 questionnaire, before and after reconstruction. Results Twenty patients were operated (16 men and 4 women) with an average age of 54.5±10.5 years. Main causes of oesophageal disconnection were: 10 cases of caustics ingestion, 3 iatrogenic perforations, 4 anastomotic leaks and 3 cases with Boerhaave syndrome. Fourteen (60%) coloplasties and 6 (25%) gastric interpositions were performed with an average time of 212,2±23.5 days after oesophageal exclusion. Pulmonary complications were the most common postoperative complications (55% patients) and according to the modified Clavien classification were divided into: grade 1 (10%), grade 2 (15%), grade 3a (40%), grade 3b (10%), and grade 4a (10%). The 30-day mortality (grade 5) of the series was 10%. Quality of life after reconstruction improved significantly in all analyzed domains of the SF-36 questionnaire. Conclusions Deferred oesophageal reconstruction is associated with a high morbidity and a mortality rate of 10%. After reconstruction, the quality of life improved in all the parameters evaluated (AU)

[Staged oesophageal reconstruction for benign disease]. / Reconstrucción diferida del esófago tras su interrupción para el tratamiento de una patología benigna.

OBJECTIVES: To assess morbidity, mortality and quality of life after oesophageal reconstruction in patients with oesophageal exclusion for benign diseases. PATIENTS AND METHODS: From 2002 to 2011, 20 of 24 patients with esophageal exclusion due to benign disease underwent a delayed reconstruction. We analyzed morbidity, mortality and health-related quality of life using the SF-36 questionnaire, before and after reconstruction. RESULTS: Twenty patients were operated (16 men and 4 women) with an average age of 54.5 ± 10.5 years. Main causes of oesophageal disconnection were: 10 cases of caustics ingestion, 3 iatrogenic perforations, 4 anastomotic leaks and 3 cases with Boerhaave syndrome. Fourteen (60%) coloplasties and 6 (25%) gastric interpositions were performed with an average time of 212,2 ± 23.5 days after oesophageal exclusion. Pulmonary complications were the most common postoperative complications (55% patients) and according to the modified Clavien classification were divided into: grade 1 (10%), grade 2 (15%), grade 3a (40%), grade 3b (10%), and grade 4a (10%). The 30-day mortality (grade 5) of the series was 10%. Quality of life after reconstruction improved significantly in all analyzed domains of the SF-36 questionnaire. CONCLUSIONS: Deferred oesophageal reconstruction is associated with a high morbidity and a mortality rate of 10%. After reconstruction, the quality of life improved in all the parameters evaluated.