Predictors of Anastomotic Leak in Elderly Patients After Colectomy: Nomogram-Based Assessment From the American College of Surgeons National Surgical Quality Program Procedure-Targeted Cohort

Rencüzoğulları, Ahmet; Benlice, Çiğdem; Valente, Michael; Abbas, Maher A.; Remzi, Feza H.; Görgün, Emre

doi:10.1097/dcr.0000000000000789

Cited by 67 publications

(60 citation statements)

References 20 publications

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“…In some instances conclusive recommendations are firmly justified whereas others are still open to debate[ 1 , 10 ]. Many authors have tried to compose nomograms in order to predict the risk of AL yet, despite the significance of such scores, they are not frequently used in clinical practice[ 11 - 13 ].…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for anastomotic leakage after laparoscopic colorectal surgery

Sciuto

Merola²,

Palma

et al. 2018

WJG

254

181

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Every colorectal surgeon during his or her career is faced with anastomotic leakage (AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.

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Section: Introductionmentioning

confidence: 99%

Predictive factors for anastomotic leakage after laparoscopic colorectal surgery

Sciuto

Merola²,

Palma

et al. 2018

WJG

254

181

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“…Other studies comparing OC and MIS approaches for anastomotic leaks show inconsistent results, with one study suggesting there are fewer leaks with both RC and LC approaches compared with the OC approach. 16 …”

Section: Discussionmentioning

confidence: 99%

“…It may be that the sample size in our study is so large that the statistically significant difference in these rates is not clinically different for this complication. 3 , 4 , 8 , 16 Anastomotic leak rates are associated with several risk factors that are difficult to control for in statistical models. The reasons for inconsistent results in studies to date are not apparent at this time, and definitive conclusions based on these results would be difficult to determine.…”

Section: Discussionmentioning

confidence: 99%

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A Regional and National Database Comparison of Colorectal Outcomes

Batool¹,

Collins

Albright

et al. 2018

JSLS

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Background and Objectives:The traditional open approach is still a common option for colectomy and the most common option chosen for rectal resections for cancer. Randomized trials and large database studies have reported the merits of the minimally invasive approach, while studies comparing laparoscopic and robotic options have reported inconsistent results.Methods:This study was designed to compare open, laparoscopic, and robotic colorectal surgery outcomes in protocol-driven regional and national databases. Logistic and multiple linear regression analyses were used to compare standard 30-day colorectal outcomes in the Michigan Surgical Quality Collaborative (MSQC) and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases. The primary outcome was overall complications.Results:A total of 10,054 MSQC patients (open 37.5%, laparoscopic 48.8%, and robotic 13.6%) and 80,535 ACS-NSQIP patients (open 25.0%, laparoscopic 67.1%, and robotic 7.9%) met inclusion criteria. Overall complications and surgical site infections were significantly favorable for the laparoscopic and robotic approaches compared with the open approach. Anastomotic leaks were significantly fewer for the laparoscopic and robotic approaches compared with the open approach in ACS-NSQIP, while there was no significant difference between robotic and open approaches in MSQC. Laparoscopic complications were significantly less than robotic complications in MSQC but significantly more in ACS-NSQIP. Laparoscopic 30-day mortality was significantly less than for the robotic approach in MSQC, but there was no difference in ACS-NSQIP.Conclusion:Minimally invasive colorectal surgery is associated with fewer complications and has several other outcomes advantages compared with the traditional open approach. Individual complication comparisons vary between databases, and caution should be exercised when interpreting results in context.

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“…Thus, they concluded that in selected patients, an emergency left-colon, 1-stage resection and primary anastomosis might be performed without colonic preparation as safely as elective surgery. On the other hand, Rencuzogullari et al [5] recently reported the database review of the American College of Surgeons National Surgical Quality Improvement Program to determine predictors of anastomotic leak in elderly patients undergoing a colectomy. They found that the omission of MBP was deleterious in terms of surgical site infection, anastomotic dehiscence, ileus, length of hospitalization, and even recurrence of the neoplasm when compared to colon surgery with MBP, especially when (in the American studies) MBP was combined with oral antibiotic administration.…”

mentioning

confidence: 99%

Mechanical Bowel Preparation, Do It or Not: When Crossing a River, What Do People Do?

Kim

2017

Ann Coloproctol

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Predictors of Anastomotic Leak in Elderly Patients After Colectomy: Nomogram-Based Assessment From the American College of Surgeons National Surgical Quality Program Procedure-Targeted Cohort

Abstract: An accurate prediction of anastomotic leak affecting morbidity and mortality after colorectal surgery using the proposed nomogram may facilitate decision making in elderly patients for healthcare providers.

Cited by 67 publications

References 20 publications

Predictive factors for anastomotic leakage after laparoscopic colorectal surgery

Predictive factors for anastomotic leakage after laparoscopic colorectal surgery

A Regional and National Database Comparison of Colorectal Outcomes

Mechanical Bowel Preparation, Do It or Not: When Crossing a River, What Do People Do?

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