V Lago1, C Fotopoulou2, V Chiantera3, L Minig4, A Gil-Moreno5, P A Cascales-Campos6, M Jurado7, A Tejerizo8, P Padilla-Iserte9, M E Malune2, M C Di Donna3, T Marina10, J L Sánchez-Iglesias5, A Olloqui8, Á García-Granero11, L Matute9, V Fornes12, S Domingo9. 1. Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain. Electronic address: victor.lago.leal@hotmail.com. 2. Department of Gynecologic Oncology, Imperial College London, London, United Kingdom. 3. Department of Gynecologic Oncology, University of Palermo, Palermo, Italy. 4. Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain. 5. Department of Obstetrics and Gynecology, Vall d'Hebron, Barcelona, Spain. 6. Department of General Surgery, Virgen de la Arrixaca Clinic and University Hospital, Murcia, Spain. 7. Department of Obstetrics and Gynecology, University Clinic of Navarra, Navarre, Spain. 8. Department of Obstetrics and Gynecology, Hospital 12 de Octubre, Madrid, Spain. 9. Department of Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain. 10. Department of Gynecology, Valencian Institute of Oncology, Valencia, Spain. 11. Department of General Surgery, University Hospital La Fe, Valencia, Spain. 12. Unit of Biostatistics, Health Research Institute Hospital La Fe, Valencia, Spain.
Abstract
OBJECTIVE: To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. BACKGROUND: In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. METHODS: Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. RESULTS: The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018). CONCLUSIONS: Due to the low incidence of AL in ovarian cancer patients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided. Crown
OBJECTIVE: To determine pre-/intraoperative risk factors for anastomotic leak after modified posterior pelvic exenteration (MPE) or colorectal resection in ovarian cancer and to create a practical instrument for predicting anastomotic leak risk. BACKGROUND: In advanced ovarian cancer surgery, there is rather limited published evidence, drawn from a small sample, providing information about risk factors for anastomotic leak. METHODS: Eight hospitals participated in this retrospective study. Data on 695 patients operated for ovarian cancer with primary anastomosis were included (January 2010-June 2018). Twelve pre-/intraoperative variables were analysed as potential independent risk factors for anastomotic leak. A predictive model was created to stablish the risk of anastomotic leak for a given patient. RESULTS: The anastomotic leak rate was 6.6% (46/695; range 1.7%-12.5%). A total of 457 patients were included in the final multivariate analysis. The following variables were found to be independently associated with anastomotic leakage: age at surgery (OR 1.046, 95% CI 1.013-1.080, p = 0.005), serum albumin level (OR 0.621, 95% CI 0.407-0.948, p = 0.027), one or more additional small bowel resections (OR 3.544, 95% CI 1.228-10.23, p = 0.019), manual anastomosis (OR 8.356, 95% CI 1.777-39.301, p = 0.007) and distance of the anastomosis from the anal verge (OR 0.839, 95% CI 0.726-0.971, p = 0.018). CONCLUSIONS: Due to the low incidence of AL in ovarian cancerpatients, a restrictive stoma policy based on the presence of risk factors should be the actual recommendation. Hand-sewn anastomosis should be avoided. Crown
Authors: Barbara Costantini; Virginia Vargiu; Francesco Santullo; Andrea Rosati; Matteo Bruno; Valerio Gallotta; Claudio Lodoli; Rossana Moroni; Fabio Pacelli; Giovanni Scambia; Anna Fagotti Journal: Ann Surg Oncol Date: 2022-04-18 Impact factor: 4.339