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Scripta Scientifica Medica

Prognostic factors for anastomotic insufficiency in elective colorectal surgery

Svilen Maslyankov, Tsvetelina Paycheva, Vasil Pavlov, Manol Sokolov, Georgi Velev, Peter Gribnev, Margarita Atanasova, Dochka Tzoneva, George Todorov, Kostadin Angelov

Abstract

Introduction: Anastomotic insufficiency is a severe, potentially fatal complication of colorectal surgery. Its frequency, according to different authors, reaches up to 20%. It is related to two main types of risk factors: associated with the patient and associated with the therapeutic approach.

Aim: The aim of the study is to determine prognostic factors for anastomotic insufficiency. The collected data from patients operated on for a period of 5 years (2013-2017) in the Second Surgery Clinic, Alexandrovska University Hospital, Sofia, were analyzed.

Materials and Methods: A total of 158 patients undergoing elective colorectal surgery have been retrospectively included. These on emergency, non-proven malignancies and with preoperative haemotransfusion were excluded from the study. All patients were evaluated by age, gender, BMI, ASA score, Charlson Comorbidity Score, localization, TNM stage and histological type. The surgical approach and the method of resection were determined. The postoperative period and complications were classified according to the Clavien-Dindo scale. The number of leukocytes, platelets, RDW, CRP and albumin were examined preoperatively, and on the day 1 and day 4, in the early postoperative period.

Results: The average age of the patients was 67 (29-87). Of these, 100 (63.3%) were men, and 58 (36.7%) are women. The mean BMI was 27.1 (23-33). A total of  78.9% of the operated patients weree in TNM stage II and III. Histologically, 77.8% were moderately differentiated adenocarcinomas. The mean Charlson Comorbidity Score for the sample was 7.1 (range: 2-13), and the ASA score was 3 (2-4). The rectum was the most common localization - 40.1%, followed by right colon 22.8%, and the sigmoid colon 20.9%. Over the review period, most resections were conventional, with only 15.2% laparoscopic approach. The operations performed were right hemicolectomy - 36 (22.8%), left hemicolectomy -15 (9.5%), segmental resection - 38 (24.1%), total colectomy - 4 (2.5%) resection of the rectum - 44 (27.9%), and other - 21 (13.3%). In 12 (7.6 %) of the patients insufficiency was reported between day 2 and day 3, postoperatively. Five of them were treated conservatively and the other six were reoperated. Seven of the insufficiencies were after anterior resection of the rectum, 2 were after left hemicolectomy, 1 after resection of the sigmoid colon, one was after right hemicolectomy, which had been treated conservatively. The mean postoperative period of patients with insufficiency was 22 days (range: 9-45). For patients without complications, the postoperative period was 9.4 days (range: 4-21) and there was a strict statistical difference (P <0.05). All patients experienced an increase in leukocyte counts postoperatively, albumin drop, increased CRP and ESR. The mean platelet counts depended on the presence of insuffiency.

Conclusion: The anterior resection, which is associated with technically more difficult anastomosis and neoadjuvant radiotherapy is a potential risk factor for anastomotic insufficiency. The use of blood parameters in the postoperative period allows early diagnosis of the complication and possible change of the therapeutic strategy.


Keywords

colorectal cancer, anastomotic insufficiency, colorectal surgery

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DOI: http://dx.doi.org/10.14748/ssm.v51i2.6025

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About The Authors

Svilen Maslyankov
Associate professor
Bulgaria

II Surgery Clinic, Alexandrovska University Hospital

Tsvetelina Paycheva
Medical Faculty
Bulgaria

Sofia University

Vasil Pavlov
Medical University of Sofia
Bulgaria

II Surgery Clinic, Alexandrovska University Hospital

Manol Sokolov
Medical University of Sofia
Bulgaria

II Surgery Clinic, Alexandrovska University Hospital

Georgi Velev
Medical University of Sofia
Bulgaria

II Surgery Clinic, Alexandrovska University Hospital

Peter Gribnev
Medical University of Sofia
Bulgaria

II Surgery Clinic, Alexandrovska University Hospital

Margarita Atanasova
Medical University of Sofia
Bulgaria

CAIC, Alexandrovska University Hospital

Dochka Tzoneva
Medical University of Sofia
Bulgaria

CAIC, Alexandrovska University Hospital

George Todorov
Medical University of Sofia
Bulgaria

II Surgery Clinic, Alexandrovska University Hospital

Kostadin Angelov
Medical University of Sofia
Bulgaria

University Hospital "Alexandrovska", Medical University - Sofia

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