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Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients

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Abstract

Background

Studies focused on postoperative outcome after oncologic right colectomy are lacking. The main objective was to determine pre-/intraoperative risk factors for anastomotic leak after elective right colon resection for cancer. Secondary objectives were to determine risk factors for postoperative morbidity and mortality.

Methods

Fifty-two hospitals participated in this prospective, observational study (September 2011–September 2012), including 1102 patients that underwent elective right colectomy. Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak and postoperative morbidity and mortality.

Results

Anastomotic leak was diagnosed in 93 patients (8.4 %), and 72 (6.5 %) of them needed radiological or surgical intervention. Morbidity, mortality, and wound infection rates were 29.0, 2.6, and 13.4 %, respectively. Preoperative serum protein concentration was the only independent risk factor for anastomotic leak (p < 0.0001, OR 0.6 per g/dL). When considering only clinically relevant anastomotic leaks, stapled technique (p = 0.03, OR 2.1) and preoperative serum protein concentration (p = 0.004, OR 0.6 g/dL) were identified as the only two independent risk factors. Age and preoperative serum albumin concentration resulted to be risk factors for postoperative mortality. Male gender, pulmonary or hepatic disease, and open surgical approach were identified as risk factors for postoperative morbidity, while male gender, obesity, intraoperative complication, and end-to-end anastomosis were risk factors for wound infection.

Conclusions

Preoperative nutritional status and the stapled anastomotic technique were the only independent risk factors for clinically relevant anastomotic leak after elective right colectomy for cancer. Age and preoperative nutritional status determined the mortality risk, while laparoscopic approach reduced postoperative morbidity.

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Acknowledgments

The study was promoted by the “Spanish Association of Surgeons” (Asociación Española de Cirujanos). Takeda sponsored the creation and maintenance of the study’s on-line database, without interfering with data collection, analysis, and conclusions of the study. The online database was created and maintained by “Oxon Epidemiology.” Dr. Granero-Castro was recipient of the FAECP-European Coloproctology Fellowship 2012, granted by Covidien. The authors thank Cirangiely Sardi Freitez for the English editing.

Collaborators

Other investigators of the ANACO (Spanish study on ANAstomotic leak after COlon resection for cancer) study group:

Alvarez Rico MA, Complejo Universitario de Burgos, Burgos; García Brao MJ, Complejo Hospitalario Universitario de A Coruña, A Coruña; Sanchez Gonzalez JM, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife; Trallero Anoro M, Hospital Universitario y Politécnico La Fe, Valencia; Millán Scheiding M, Hospital Universitario Bellvitge, Barcelona; Maseda Díaz O, Hospital Universitario Lucus Augusti, Lugo; Dujovne Lindenbaum P, Hospital Universitario Fundación Alcorcón, Alcorcón; Monzón Abad A, Hospital Universitario Miguel Servet, Zaragoza; Romero Simó M, Hospital General Universitario de Alicante, Alicante; Fermiñán Rodríguez A, Hospital Universitario Arnau de Vilanova, Lleida; Santamaría Olabarrieta M, Hospital de Cruces, Bilbao; Viñas Martínez J, Hospital Arquitecto Marcide, Ferrol; Uribe Quintana N, Hospital Arnau de Vilanova, Valencia; Blesa Sierra I, Complejo Hospitalario Torrecárdenas, Almería; Feliú Villaró F, Hospital Universitario Joan XXIII, Tarragona; Aguiló Lucía J, Hospital Lluis Alcanyis, Játiva; Bargallo Berzosa J, Hospital de Terrassa, Terrassa; Alonso Hernández N, Hospital Universitario Son Espases, Palma de Mallorca; Labrador Vallverdú FJ, Hospital Universitario de Guadalajara, Guadalajara; Parra Baños PA, HGU Reina Sofía, Murcia; Ais Conde G, Hospital General de Segovia, Segovia; Farres R, Hospital Universitario Josep Trueta, Girona; Hernandis Villalba J, Hospital General de Elda, Elda; Álvarez Laso C, Hospital de Cabueñes, Gijón; Martínez Alcaide S, Hospital de La Ribera, Alcira; Cáceres Alvarado MN, Hospital do Meixoeiro, Vigo; Rey Simó I, Complejo Hospitalario Universitario de A Coruña, A Coruña; Montero García J, Hospital General de Granollers, Granollers; García Fadrique A, Fundación Instituto Valenciano de Oncología, Valencia; Aguilella Diago V, HCU Lozano Blesa, Zaragoza; García Septiem J, Hospital Universitario de Getafe, Getafe; García García J, Hospital Universitario de Salamanca, Salamanca; Ponchietti L, Hospital de Torrevieja, Torrevieja; Carceller Navarro MS, Hospital de Manises, Valencia; Ramos Fernández M, Hospital Costa del Sol, Marbella; Conde Muiño R, Hospital Universitario Virgen de las Nieves, Granada; Huerga Álvarez D, Hospital Universitario de Fuenlabrada, Fuenlabrada; Menéndez Sánchez P, Hospital Gutiérrez Ortega, Valdepeñas; Maristany Bienert C, Hospital Universitario Mutua de Terrassa, Terrassa; García Martínez MT, Complejo Hospitalario Universitario de Vigo, Vigo; Moreno Muzas C, Hospital Obisco Polanco, Teruel; Pastor Idoate C, Fundación Jiménez-Díaz, Madrid; Andicoechea A, Hospital de Jove, Gijón; Alonso Casado AP, Hospital Universitario La Princesa, Madrid; Roig Vila JV, Consorcio Hospital General Universitario de Valencia, Valencia; Goded Broto I, Hospital San Jorge, Huesca; Collera P, Complejo Asistencial y Universitario de Manresa, Manresa; Arroyo Sebastián A, Hospital General de Elche, Elche.

Author information

Authors and Affiliations

  1. Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain

    Matteo Frasson, Pablo Granero-Castro, Blas Flor-Lorente & Eduardo Garcia-Granero

  2. Department of General Surgery, Hospital Universitario de Getafe, Madrid, Spain

    José Luis Ramos Rodríguez

  3. Department of General Surgery, Complejo Hospitalario Universitario Insular Gran Canaria, Las Palmas de Gran Canaria, Spain

    Mariela Braithwaite

  4. Department of General Surgery, Hospital Dr. Peset, Valencia, Spain

    Eva Martí Martínez

  5. Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain

    Jose Antonio Álvarez Pérez

  6. Department of General Surgery, Hospital Universitario Josep Trueta, Girona, Spain

    Antonio Codina Cazador

  7. Department of General Surgery, Hospital Clínico Universitario, Valencia, Spain

    Alejandro Espí

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  1. Matteo Frasson
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  2. Pablo Granero-Castro
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  3. José Luis Ramos Rodríguez
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  4. Blas Flor-Lorente
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  5. Mariela Braithwaite
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  7. Jose Antonio Álvarez Pérez
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  9. Alejandro Espí
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  10. Eduardo Garcia-Granero
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ANACO Study Group

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Correspondence to Matteo Frasson.

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The list of investigators is reported at the end of the paper.

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Frasson, M., Granero-Castro, P., Ramos Rodríguez, J.L. et al. Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients. Int J Colorectal Dis 31, 105–114 (2016). https://doi.org/10.1007/s00384-015-2376-6

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