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Risk factors for anastomotic leakage after colorectal resection in ovarian cancer surgery: A multi-centre study

      Highlights

      • 695 patients with colorectal anastomosis were included. The anastomotic leak (AL) rate was 6.6%
      • Twelve pre-/intra-operative variables were analysed as potential independent risk factors for AL.
      • Age, albumin, additional bowel resection, manual anastomosis and distance from the anal verge were associated with AL.
      • A predictive model was created to stablish the risk of anastomotic leak for a given patient.

      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.

      Keywords

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