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Short- and long-term outcomes after colorectal anastomotic leakage is affected by surgical approach at reoperation

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Anastomotic leakage is the most serious surgical complication following colorectal resection, and surgical intervention is often required. The purpose of the study was to investigate short- and long-term outcomes after reoperation for anastomotic leakage.

Method

Patients with a symptomatic anastomotic leakage following a laparoscopic colorectal cancer resection from January 2009 to December 2014 were identified from our local prospective database. Patients were grouped according to the management of anastomotic leaks: local, lap, or open approach. Primary outcomes were length of stay, chance of bowel continuity, and overall mortality.

Results

A total of 113 patients were included. The median follow-up time was 40 months (0–82 months). Overall mortality was significantly associated with UICC stage III–VI disease (vs. UICC stage I–II disease) [adj. HR 5.35 (CI 2.32–12.4), p = 0.0001] and minimal invasive reoperation compared with open approach [local: adj. HR 0.12 (CI 0.03–0.52), p = 0.004; lap: adj. HR 0.32 (CI 0.12–0.86), p = 0.024]. Chance of bowel continuity was significantly increased in younger patients below 67 years [adj. OR 6.15 (1.76–21.5), p = 0.004] and following a local procedure [adj. OR 7.45 (1.07–51.8), p = 0.043]. Patients in the open group had significantly longer length of stay and time to initiation of adjuvant chemotherapy compared with those in the lap group.

Conclusion

Our data confirms that minimal invasive reoperation for anastomotic leakage is a safe and feasible approach associated with short- and long-term advantages and can be chosen in selected cases.

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Authors and Affiliations

  1. Department of Surgery, Colorectal Cancer Unit, Zealand University Hospital, Roskilde, Sygehusvej 10, 4000, Roskilde, Denmark

    Jens Ravn Eriksen, Henrik Ovesen & Ismail Gögenur

Authors
  1. Jens Ravn Eriksen
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  2. Henrik Ovesen
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  3. Ismail Gögenur
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Correspondence to Jens Ravn Eriksen.

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The authors declare that they have no conflict of interest.

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For this type of study, formal consent is not required.

Additional information

The results from the study were presented as a poster presentation at the ASCRS meeting in Los Angeles, April 30–May 4, 2016.

All three authors meet the four ICMJE authorship criteria: (a) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting the article or revising it critically for important intellectual content; (c) final approval of the version to be published; (d) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Eriksen, J.R., Ovesen, H. & Gögenur, I. Short- and long-term outcomes after colorectal anastomotic leakage is affected by surgical approach at reoperation. Int J Colorectal Dis 33, 1097–1105 (2018). https://doi.org/10.1007/s00384-018-3079-6

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  • DOI: https://doi.org/10.1007/s00384-018-3079-6

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