Safety of Anastomoses in Right Hemicolectomy for Colon Cancer

Abstract

Introducere: Cancerul colorectal este unul dintre cele mai frecvent întâlnite tumori maligne ale sistemului digestiv, incidenţa acestei boli crude crescând constant. Materiale şi Metode: 236 de pacienţi diagnosticaţi cu cancer de colon drept au fost revizuiţi retrospectiv. Pentru toţi pacienţii incluşi în acest studiu, hemicolectomie dreaptă sau hemicolectomie dreaptă extinsă cu anastomoză ileo-colonică a fost efectuată. Pacienţii au fost împărţiţi în două grupuri: grupul de studiu incluzând pacienţi care au dezvoltat fistulă de anastomoză şi grupul de control, incluzând pacienţi fără fistulă. Date clinice, chirurgicale, postoperatorii şi împrejurările apariţiei fistulelor anastomotice (AL) au fost evaluate. Studiul investighează posibilii factori de risc şi de protecţie pentru dezvoltarea fistulelor anastomotice şi nu în ultimul rând studiează relaţia dintre fistulă de anastomoză şi mortalitatea. Rezultate: factori de risc cum ar fi vârstă înaintată, tumorile 1/3 drepte ale colonului transvers, intervenţiile chirurgicale de urgenţă, sutură mecanică, anastomoza L-T, reluarea tardivă a motilităţii intestinale au fost identificate în timpul cercetării. Anastomoza L-L a fost identificată ca factor protector în dezvoltarea fistulei de anastomoză. Concluzii: Conform rezultatelor cercetării, în cazul tumorilor colonului drept, anastomoza ileo-transversă L-L ar trebui adaptată, având ceea mai scăzută rată în ceea ce priveşte dezvoltarea fistulei de anastomoză.

Value of different anastomoses in laparoscopic radical right hemicolectomy for right-sided colon cancer: retrospective study and literature review

“…In radical surgery for right hemicolectomy, anastomoses of the ileum are various, and lateral anastomosis is common [ 9 , 10 ]. After resection when performing right hemicolectomy, different anastomoses will affect anastomotic blood flow and tension and become a risk factor for postoperative anastomotic leakage [ 11 ]. Because the anastomosis is located at the level of the transverse colon in the upper abdomen, if anastomotic leakage occurs, severe infection may occur in the entire abdominal cavity and intestinal adhesions, intestinal obstruction, and other comorbidities may likely develop, which may even lead to perioperative death in serious cases.…”

Ileocolonic anastomosis–comparison of different surgical techniques: A single-center study

“…The study also confirmed better short-term outcomes including shorter hospital stay and reduction of postoperative pain. [ 20 ] Results of another study proved that in right colon tumors, SSA anastomotic technique should be used, being linked with the lowest chances of anastomotic leakage, also being considered with high probability a protective factor in the development of the fistula [ 4 ] . On the contrary, our results show, that SSA is associated with higher occurrence of anastomotic leakage in comparison to other anastomotic types.…”

“…[ 3 ] There are different types of ileocolonic anastomosis such as end-to-end anastomosis (EEA), side-to-side anastomosis (SSA), end-to-side anastomosis (ESA) and side-to-end anastomosis (SEA). [ 4 , 5 ] Due to disparity in diameters of colon and ileum, postoperative anastomotic complications are quite common. [ 6 ] Choice of the optimum variant of the anastomosis in RH depends on the understanding of pathophysiological consequences of either intestinal anastomosis.…”

C-reactive protein level on postoperative day 3 as a predictor of anastomotic leakage after elective right-sided colectomy

“…Anastomotic leakage is associated with mortality, short-and long-term morbidity, a potentially increased risk of recurrence, and poor prognosis [1,2]. The anastomotic leakage rate after right-sided colectomy is reported to range from 1.7 to 12% [3][4][5][6][7][8][9][10][11][12][13].…”

“…Several factors, including the host genetic profile, gut microbiome, inflammation, and other immune responses, have been reported to influence the occurrence of anastomotic leakage [1]. Risk factors for anastomotic leakage after right-sided colectomy include age, male sex, body mass index (BMI), diabetes, weight loss > 10%, American Society of Anesthesiologists Physical Status (ASA-PS), chronic obstructive pulmonary disease (COPD), smoking, arterial hypertension, ascites, peripheral vein disease, low protein or albumin (Alb) level, low sodium level, high CRP level, emergency surgery, long operation time, perioperative transfusion, stapled anastomosis, and delayed bowel motility [4,[7][8][9][10][11][12]. The ability to predict the risks of anastomotic leakage, preoperatively or immediately after surgery, would benefit patients scheduled to undergo elective right-sided colectomy.…”