Abstract
Background
Anastomotic leak following colorectal surgery is associated with significant morbidity and mortality. With the widespread adoption of laparoscopy, data from initial clinical trials evaluating the efficacy of laparoscopic when compared to open surgery may not currently be generalizable. We assess the risk of anastomotic leak after laparoscopic versus open colorectal resection using a nationwide database with standardized definitions.
Methods
The 2012–2013 ACS-NSQIP targeted colectomy data were queried for all elective colorectal resections. Characteristics were compared for those patients undergoing laparoscopic versus open operations. Univariable and multivariable analyses, followed by a propensity score-matched analysis, were performed to assess the impact of laparoscopy on the development of an anastomotic leak.
Results
Of 23,568 patients, 3.4 % developed an anastomotic leak. Laparoscopic surgery was associated with a leak rate of 2.8 % (n = 425) and open surgery, 4.5 % (n = 378, p < 0.0001). Patients who developed a leak were more likely to die within 30 days of surgery (5.7 vs. 0.6 %, p < 0.0001). Patients who underwent laparoscopic surgery compared to open were younger (61 vs. 63 years, p = 0, p = 0.045) and with fewer comorbidities. On univariable analysis laparoscopic surgery was associated with reduced odds of developing an anastomotic leak (OR 0.60, p < 0.0001), and this remained after adjusting for all significant preoperative and disease-related confounders (OR 0.69, 95 % CI 0.58–0.82). A propensity score-matched analysis confirmed benefit of laparoscopic surgery over open surgery for anastomotic leak.
Conclusion
Laparoscopic colectomy is safe and associated with reduced odds of developing an anastomotic leak following colectomy when controlling for patient-, disease- and procedure-related factors.
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Authors contribution
Alice Murray and Cody Chiuzan had full access to all data. Alice Murray was responsible for data analysis, design, data interpretation and the written manuscript. Cody Chiuzan was responsible for data analysis and draft of manuscript. Professor Ravi Kiran was responsible for study conception, design and manuscript revision.
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Alice Murray, Cody Chiuzan, and Professor Ravi Kiran have no conflict of interest or financial ties to disclose.
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Murray, A.C.A., Chiuzan, C. & Kiran, R.P. Risk of anastomotic leak after laparoscopic versus open colectomy. Surg Endosc 30, 5275–5282 (2016). https://doi.org/10.1007/s00464-016-4875-0
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DOI: https://doi.org/10.1007/s00464-016-4875-0