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Anastomotic Location Predicts Anastomotic Leakage After Elective Colonic Resection for Cancer

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Anastomotic leakage (AL) is a potential feared complication after colorectal resection, which is associated with an increased risk of postoperative mortality and frequently requires additional surgery. The aim of this study was to assess major independent risk factors for AL after elective colonic resection for cancer, including anastomotic location.

Methods

Among 1940 consecutive patients referred to our institution for colorectal adenocarcinoma, 1025 patients had elective colonic resection with intraperitoneal anastomosis without diverting stoma. Risk factors were assessed among preoperative, operative, and histological data.

Results

Clinical AL was observed in 36 patients (3.5%) with 24 patients requiring revisional surgery (67%). In multivariate analysis, endoscopic impassable tumor and colo-colic or ileo-colic anastomosis were independent risk factors for AL. The occurrence of AL was associated with poor overall (43.1 months vs. 146.4 months; p < 0.001) and disease-free survival (40.5 months vs. 137.3 months; p = 0.003).

Conclusion

Anastomotic leakage occurs more frequently after colo-colic and ileo-colic anastomosis than after intraperitoneal colorectal anastomosis.

The right colectomy appears to be at higher risk of AL, with a greater risk of surgical intervention than after an elective left colectomy. Ileo-colic anastomosis should be avoided in cases of suboptimal conditions.

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Authors and Affiliations

  1. Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France

    Thibault Voron, Matthieu Bruzzi, Emilia Ragot, Franck Zinzindohoue, Jean-Marc Chevallier, Richard Douard & Anne Berger

  2. Faculté de Médecine Paris Descartes, Paris, France

    Thibault Voron, Matthieu Bruzzi, Franck Zinzindohoue, Jean-Marc Chevallier, Richard Douard & Anne Berger

Authors
  1. Thibault Voron
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  2. Matthieu Bruzzi
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  3. Emilia Ragot
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  4. Franck Zinzindohoue
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  5. Jean-Marc Chevallier
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  6. Richard Douard
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  7. Anne Berger
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Contributions

Study conception and design: Voron, Douard, Berger

Acquisition of data: Voron, Bruzzi, Ragot

Analysis and interpretation of data: Voron, Zinzindohoue, Chevallier, Douard, Berger

Drafting of manuscript: Voron, Douard, Berger

Critical Revision: Voron, Bruzzi, Ragot, Zinzindohoue, Chevallier, Douard, Berger

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Correspondence to Thibault Voron.

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Voron, T., Bruzzi, M., Ragot, E. et al. Anastomotic Location Predicts Anastomotic Leakage After Elective Colonic Resection for Cancer. J Gastrointest Surg 23, 339–347 (2019). https://doi.org/10.1007/s11605-018-3891-x

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  • DOI: https://doi.org/10.1007/s11605-018-3891-x

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