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 languageEnglish
Pages (from-to)606-618
Number of pages13
JournalDis. Colon Rectum
Volume63
Issue number5
DOIs
Publication statusPublished - 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

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