Risk factors for anastomotic leakage and postoperative outcomes after total and subtotal colectomy: A nationwide retrospective cohort study (RIALTCOT Study Collaborative Group). (9th November 2022)

• Record Type: Journal Article
• Authors: Ocaña, Juan; Pastor, Paula; Timoteo, Ander; Diez‐Alonso, Manuel Mariano; de la Portilla, Fernando; Cagigas, Carmen; Labalde‐Martínez, María; Espin, Eloy; Dujovne, Paula; Nieto, Marta; González, Manuel; Sanz, Rodrigo; Pascual, Marta; Aguirre‐Allende, Ignacio; Cervera, Jorge; Jiménez‐Carneros, Virginia; Guadalajara, Hector; García‐Granero, Alvaro; Fernández‐Cebrián, José María; Die‐Trill, Javier
• Other Names: García‐Pérez Juan Carlos investigator.; Pino Oriol investigator.; Vigorita Vincenzo investigator.; Serralta Daniel investigator.; Peña Emilio investigator.; Pascual Isabel investigator.; Blanco‐Antonia Francisco investigator.; Cortina‐Oliva Francisco Javier investigator.; Rodríguez‐Sánchez Anra investigator.; de Quirós Jaiver Morales‐Bernaldo investigator.; Cornejo Lidia investigator.; Vera Cristina investigator.; Pintor‐Tortolero José investigator.; Gómez Marcos investigator.; Vivas Alfredo investigator.; Ferrero‐Herrero Eduardo investigator.; Kraft Miquel investigator.; Pellino Gianluca investigator.; Rodríguez‐Martín Marcos investigator.; Sancho‐Muriel Jorge investigator.; Frasson Matteo investigator.; Noguera José investigator.; Camarero Enrique investigator.; Guerrero María Alejandra investigator.; Etxart Ane investigator.; González José María investigator.; Gacía‐Olmo Damián investigator.; Leon Miguel investigator.; Fernandez Laura investigator.; Coll Magdalena investigator.; Gonzalez Anna investigator.; Serra‐Aracil Xavier investigator.; Garrido Lucía investigator.; Ramírez‐Faracao María investigator.; Gortázar Sara investigator.; Diego‐Alonso Elisa Angela investigator.; la Serna Gabriela Rojas‐De investigator.; Gacía‐Septiem Javier investigator.;
• Is Part Of: Colorectal disease. Volume 25:Number 3(2023)
• Page Start: 420
• Page End: 430
• Publication Date: 2022-11-09
• Subjects: anastomotic leakage -- ileorectal anastomosis -- ileosigmoid anastomosis -- risk factors -- subtotal colectomy -- total colectomy; Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.16384
• Languages: English
• ISSNs: 1462-8910

Abstract

Abstract: Aim: Anastomotic leakage (AL) following ileorectal (IRA) or ileosigmoid (ISA) anastomosis is associated with a high morbidity. The identification of potential risk factors for AL could change operative planning and reduce further complications. This study assesses the rate, potential risk factors and management of AL after total colectomy (TC) and subtotal colectomy (STC). Methods: A nationwide, multicentre, retrospective cohort study involved 26 Spanish referral centres. It included TC and STC with IRA or ISA patients between January 2013 and December 2020. Clinical data, primary surgery and complications were collected. Univariate and multivariate analysis to identify risk factors for AL were performed. Management of Grade B–C AL and permanent stoma rate was assessed according to revisional surgeries. Results: The study included 1074 patients, 433 ISA group (40.3%) and 641 IRA group (59.7%). The overall incidence of AL was 14.3% with no differences between IRA and ISA (14.2% and 14.5% respectively), P = 0.871. Male sex, ASA score and lower total preoperative proteins were identified as independent risk factors for global and Grade B–C AL. Diverting ileostomy did not protect against AL ( P = 0.084). Clavien–Dindo ≥IIIA complication was found in 251 patients (23.3%). Stoma reversal was not possible in 85 patients (8.1%), being more frequent after anastomosis excision and terminal ileostomy in AL Grade C. Conclusion: Total colectomy and STC with IRA or ISA are high‐risk procedures with an increased AL rate. Male sex, ASA score and lower preoperative protein level were associated with global AL and AL Grade B and C. A lower permanent stoma rate could be obtained when diverting ileostomy is performed in revision surgery.