Abstract
Background: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. Objective: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy. Design: This was a snapshot observational prospective study. Setting: The study was conducted as a multicenter international study. Patients: The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients. Main Outcome Measures: Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method. Results: Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p ≥ 0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041). Limitations: This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors. Conclusions: Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery.
Original language | English |
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Pages (from-to) | 606-618 |
Number of pages | 13 |
Journal | Dis. Colon Rectum |
Volume | 63 |
Issue number | 5 |
DOIs | |
Publication status | Published - 2020 |
Keywords
- antibiotic agent
- adult
- aged
- anastomosis leakage
- antibiotic therapy
- blood vessel injury
- cancer mortality
- cancer surgery
- cecum
- colon cancer
- colon resection
- Conference Paper
- duodenum injury
- elective surgery
- emergency surgery
- female
- gallbladder disease
- general surgery
- hemicolectomy
- human
- ileostomy
- ileum
- kidney injury
- laparoscopic surgery
- liver injury
- major clinical study
- male
- morbidity
- mortality rate
- multicenter study
- non-smoker
- observational study
- open surgery
- operation duration
- operative blood loss
- percutaneous drainage
- peroperative complication
- postoperative complication
- prospective study
- reoperation
- sex ratio
- small intestine resection
- surgical infection
- surgical mortality
- surgical stapling
- suture technique
- ureter injury
- adverse event
- clinical audit
- clinical trial
- cohort analysis
- colon tumor
- middle aged
- mortality
- pathology
- risk factor
- survival rate
- very elderly
- Aged
- Aged, 80 and over
- Anastomotic Leak
- Cohort Studies
- Colectomy
- Colonic Neoplasms
- Female
- Humans
- Male
- Medical Audit
- Middle Aged
- Risk Factors
- Survival Rate