Does the prevalence and risk factors for anastomotic leakage differ between right and left elective colectomy for cancer in adult patients?
Anastomotic leakage is significantly less common after right colectomy compared to left colectomy, and the independent risk factors differ between the two procedures.
BACKGROUND: Anastomotic leakage in colorectal surgery remains a major challenge because of its early and late consequences. STUDY DESIGN: To determine whether prevalence and risk factors for anastomotic leakage (AL) differed between right and left elective colectomy for cancer, we conducted univariate and multivariate analyses and compared 33 variables (15 preoperative, 18 intraoperative) culled prospectively for 520 right and 1,230 left colectomies, followed by immediate anastomosis in 1,750 adult patients with or without AL. RESULTS: The overall AL rate was 4% (71 of 1,750) and was significantly lower (p 10%), odds ratio (OR)=5.62, with 95% CI 1.06 to 29.8; and intraoperative in left colectomy: palliative resection (OR=2.12; 95% CI 1.06 to 4.23), "poor" colonic cleanliness (OR=2.4; 95% CI 1.34 to 4.28), proximal colorectal anastomosis (OR=1.34; 95% CI 1 to 1.8), and distal colorectal anastomosis (OR=3.91; 95% CI 1.64 to 9.81). CONCLUSIONS: In right colectomy for cancer, preoperative nutritive support leading to regain of lost weight could reduce postoperative morbidity. Concerning left colectomy, if colonic cleanliness is poor, intraoperative colonic lavage should be done. When poor colonic cleanliness is associated with palliative resection and low distal rectal anastomosis, a protective stoma should be considered.
Veyrie et al. (Wed,) studied this question.