Risks factors for anastomotic leakage in advanced ovarian cancer: A systematic review and meta-analysis. (February 2022)

• Record Type: Journal Article
• Authors: Valenti, Gaetano; Vitagliano, Amerigo; Morotti, Matteo; Giorda, Giorgio; Sopracordevole, Francesco; Sapia, Fabrizio; Lo presti, Viviana; Chiofalo, Benito; Forte, Sara; Lo presti, Lucia; Tozzi, Roberto
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 269(2022)
• Page Start: 3
• Page End: 15
• Publication Date: 2022-02
• Subjects: Anastomotic leakage -- Bowel surgery -- Colorectal anastomosis -- Ovarian cancer -- Rectosigmoid resection; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2021.12.007
• Languages: English
• ISSNs: 0301-2115

Abstract

Highlights: Albumin level <3 gr/dl, PDS and multiple bowel resections are risk factors for AL. ASA, ascites, protective stoma, optimal debulking surgery are not protective factors. Detecting risk factors for AL has a paramount significance in AOC surgery. Abstract: Objective: This systematic review and meta-analysis aimed to summarise the available evidence on the pre- and intra-operative risk factors for anastomotic leakage (AL) after bowel resection and anastomosis for ovarian cancer (OC). Study design: We searched online databases from Pubmed, Scopus, ScienceDirect, and Cochrane Library from inception to October 2020. Pre- and intra-operative risk factors for AL were considered as the primary outcomes. Research heterogeneity and bias were evaluated by I 2 and by the Newcastle Ottawa scale, respectively. The study was registered with PROSPERO, CRD42018095225. Results: The overall AL rate after OC surgery (median ± SD) was 5.3 ± 12% (277 AL on 5178 anastomoses). Thirteen non-randomised studies were included in the meta-analysis enrolling a total of 3274 patients. Pre albumin level ≤ 3 gr/dl, multiple bowel resections and primary cytoreductive surgery were associated with a significantly high risk of AL with a pooled OR of 5.29 (95% CI: 1.51–18.59), OR = 4.4 (95% CI: 1.19–16.66) and OR = 1.71 (95% CI: 1.05–2.77), respectively. Optimal cytoreduction, ASA score, ascites, and protective stoma were not associated with an increased risk of AL. Conclusion: Based on the best available evidence, preoperative albumin level <3 gr/dl, multiple bowel resections and primary cytoreductive surgery were associated with an increased risk for AL after bowel surgery for OC.