Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients
Aim Reports detailing the morbidity–mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. Method We underto...
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| Veröffentlicht in: | Colorectal disease 2018-11, Vol.20 (11), p.986-995 |
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| creator | Pellino, G. Frasson, M. García‐Granero, A. Granero‐Castro, P. Ramos Rodríguez, J. L. Flor‐Lorente, B. Bargallo Berzosa, J. Alonso Hernández, N. Labrador Vallverdú, F. J. Parra Baños, P. A. Ais Conde, G. Garcia‐Granero, E. Alvarez Rico, Miguel Angel García Brao, Maria Jesus Sanchez Gonzalez, Juan Manuel Braithwaite, Mariela Martí Martínez, Eva Álvarez Pérez, Jose Antonio Espí, Alejandro Trallero Anoro Millán Scheiding, Mónica Maseda Díaz, Olga Dujovne Lindenbaum, Paula Monzón Abad, Andrés Romero Simó, Manuel Escoll Rufino, Jordi Santamaría Olabarrieta, Marta Viñas Martínez, José López Bañeres, Manolo Blesa Sierra, Isabel Feliú Villaró, Francesc Lucía, Javier Aguiló Codina Cazador, Antonio Villalba, Juan Hernandis Álvarez Laso, Carlos Alcaide, Sonia Martínez Cáceres Alvarado, Maria Nieves Simó, Ignacio Rey Montero García, Josep García Fadrique, Alfonso Aguilella Diago, Vicente García Septiem, Javier García, Jacinto García Ponchietti, Luca Carceller Navarro, Maria Soledad Ramos Fernández, María Conde Muiño, Raquel Huerga Álvarez, Daniel Sánchez, Pablo Menéndez Maristany Bienert, Carlos García Martínez, Maria Teresa Muzas, Celia Moreno Pastor Idoate, Carlos Alonso Casado, Adolfo Pedro Roig Vila, Jose Vicente Goded Broto, Ignacio Collera, Pablo Sebastián, Antonio Arroyo |
| description | Aim
Reports detailing the morbidity–mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies.
Method
We undertook a STROBE‐compliant analysis of left colectomies included in a national prospective online database. Forty‐two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the ‘least absolute shrinkage and selection operator’ (LASSO) method.
Results
We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00–7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58–8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18–0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03–8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8–40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001).
Conclusion
Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy. |
| doi_str_mv | 10.1111/codi.14309 |
| format | Article |
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Reports detailing the morbidity–mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies.
Method
We undertook a STROBE‐compliant analysis of left colectomies included in a national prospective online database. Forty‐two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the ‘least absolute shrinkage and selection operator’ (LASSO) method.
Results
We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00–7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58–8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18–0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03–8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8–40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001).
Conclusion
Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.</description><identifier>ISSN: 1462-8910</identifier><identifier>EISSN: 1463-1318</identifier><identifier>DOI: 10.1111/codi.14309</identifier><identifier>PMID: 29920911</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Anastomosis ; anastomotic leak ; Anticoagulants ; Cancer ; Colon cancer ; Colorectal surgery ; Complications ; Corticoids ; Corticosteroids ; Fatalities ; Hyperlipidemia ; Leakage ; left colectomy ; Liver ; Liver diseases ; Morbidity ; Mortality ; Parenteral nutrition ; postoperative complication ; Risk factors ; stapled anastomosis</subject><ispartof>Colorectal disease, 2018-11, Vol.20 (11), p.986-995</ispartof><rights>Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland</rights><rights>Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.</rights><rights>Copyright © 2018 The Association of Coloproctology of Great Britain and Ireland</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3939-eb3f3915feaa7b57a8a21fcba3894f746cab758be1e2e1cbf9d6cf4c21870a2a3</citedby><cites>FETCH-LOGICAL-c3939-eb3f3915feaa7b57a8a21fcba3894f746cab758be1e2e1cbf9d6cf4c21870a2a3</cites><orcidid>0000-0002-8322-6421</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fcodi.14309$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fcodi.14309$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29920911$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pellino, G.</creatorcontrib><creatorcontrib>Frasson, M.</creatorcontrib><creatorcontrib>García‐Granero, A.</creatorcontrib><creatorcontrib>Granero‐Castro, P.</creatorcontrib><creatorcontrib>Ramos Rodríguez, J. L.</creatorcontrib><creatorcontrib>Flor‐Lorente, B.</creatorcontrib><creatorcontrib>Bargallo Berzosa, J.</creatorcontrib><creatorcontrib>Alonso Hernández, N.</creatorcontrib><creatorcontrib>Labrador Vallverdú, F. J.</creatorcontrib><creatorcontrib>Parra Baños, P. A.</creatorcontrib><creatorcontrib>Ais Conde, G.</creatorcontrib><creatorcontrib>Garcia‐Granero, E.</creatorcontrib><creatorcontrib>Alvarez Rico, Miguel Angel</creatorcontrib><creatorcontrib>García Brao, Maria Jesus</creatorcontrib><creatorcontrib>Sanchez Gonzalez, Juan Manuel</creatorcontrib><creatorcontrib>Braithwaite, Mariela</creatorcontrib><creatorcontrib>Martí Martínez, Eva</creatorcontrib><creatorcontrib>Álvarez Pérez, Jose Antonio</creatorcontrib><creatorcontrib>Espí, Alejandro</creatorcontrib><creatorcontrib>Trallero Anoro</creatorcontrib><creatorcontrib>Millán Scheiding, Mónica</creatorcontrib><creatorcontrib>Maseda Díaz, Olga</creatorcontrib><creatorcontrib>Dujovne Lindenbaum, Paula</creatorcontrib><creatorcontrib>Monzón Abad, Andrés</creatorcontrib><creatorcontrib>Romero Simó, Manuel</creatorcontrib><creatorcontrib>Escoll Rufino, Jordi</creatorcontrib><creatorcontrib>Santamaría Olabarrieta, Marta</creatorcontrib><creatorcontrib>Viñas Martínez, José</creatorcontrib><creatorcontrib>López Bañeres, Manolo</creatorcontrib><creatorcontrib>Blesa Sierra, Isabel</creatorcontrib><creatorcontrib>Feliú Villaró, Francesc</creatorcontrib><creatorcontrib>Lucía, Javier Aguiló</creatorcontrib><creatorcontrib>Codina Cazador, Antonio</creatorcontrib><creatorcontrib>Villalba, Juan Hernandis</creatorcontrib><creatorcontrib>Álvarez Laso, Carlos</creatorcontrib><creatorcontrib>Alcaide, Sonia Martínez</creatorcontrib><creatorcontrib>Cáceres Alvarado, Maria Nieves</creatorcontrib><creatorcontrib>Simó, Ignacio Rey</creatorcontrib><creatorcontrib>Montero García, Josep</creatorcontrib><creatorcontrib>García Fadrique, Alfonso</creatorcontrib><creatorcontrib>Aguilella Diago, Vicente</creatorcontrib><creatorcontrib>García Septiem, Javier</creatorcontrib><creatorcontrib>García, Jacinto García</creatorcontrib><creatorcontrib>Ponchietti, Luca</creatorcontrib><creatorcontrib>Carceller Navarro, Maria Soledad</creatorcontrib><creatorcontrib>Ramos Fernández, María</creatorcontrib><creatorcontrib>Conde Muiño, Raquel</creatorcontrib><creatorcontrib>Huerga Álvarez, Daniel</creatorcontrib><creatorcontrib>Sánchez, Pablo Menéndez</creatorcontrib><creatorcontrib>Maristany Bienert, Carlos</creatorcontrib><creatorcontrib>García Martínez, Maria Teresa</creatorcontrib><creatorcontrib>Muzas, Celia Moreno</creatorcontrib><creatorcontrib>Pastor Idoate, Carlos</creatorcontrib><creatorcontrib>Alonso Casado, Adolfo Pedro</creatorcontrib><creatorcontrib>Roig Vila, Jose Vicente</creatorcontrib><creatorcontrib>Goded Broto, Ignacio</creatorcontrib><creatorcontrib>Collera, Pablo</creatorcontrib><creatorcontrib>Sebastián, Antonio Arroyo</creatorcontrib><creatorcontrib>ANACO Study Group</creatorcontrib><creatorcontrib>The ANACO Study Group</creatorcontrib><title>Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients</title><title>Colorectal disease</title><addtitle>Colorectal Dis</addtitle><description>Aim
Reports detailing the morbidity–mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies.
Method
We undertook a STROBE‐compliant analysis of left colectomies included in a national prospective online database. Forty‐two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the ‘least absolute shrinkage and selection operator’ (LASSO) method.
Results
We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00–7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58–8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18–0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03–8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8–40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001).
Conclusion
Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.</description><subject>Anastomosis</subject><subject>anastomotic leak</subject><subject>Anticoagulants</subject><subject>Cancer</subject><subject>Colon cancer</subject><subject>Colorectal surgery</subject><subject>Complications</subject><subject>Corticoids</subject><subject>Corticosteroids</subject><subject>Fatalities</subject><subject>Hyperlipidemia</subject><subject>Leakage</subject><subject>left colectomy</subject><subject>Liver</subject><subject>Liver diseases</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Parenteral nutrition</subject><subject>postoperative complication</subject><subject>Risk factors</subject><subject>stapled anastomosis</subject><issn>1462-8910</issn><issn>1463-1318</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9kctu1TAQhi1ERUthwwMgS2wQUlqPnXMSs0OHSytVKgtYRxNnDK6cONiOjs7r9EnxucCCBd54pPn-f26MvQJxBeVdmzC4K6iV0E_YBdRrVYGC9ukhllWrQZyz5yk9CAHrBtpn7FxqLYUGuGCPXyMNzuQQEw-WmzDO3hnMLkyJ4zTwMcSM3uUdt8H7sHXTD-7J5oJ6Krpxx7cu_-RzdCPGHU8ZZ09D0WIq2ZBcKsrIDU6G4nseKS0-H4ohH0voDE05OlOUy3Ay24_F59JFSaUX7MyiT_Ty9F-y758_fdvcVHf3X243H-4qo7TSFfXKKg0rS4hNv2qwRQnW9KhaXdumXhvsm1XbE5AkML3Vw9rY2khoG4ES1SV7e_SdY_i1UMrd6JIh73GisKROilVT16UEFPTNP-hDWOJUuuskyEYLaGtZqHdHysSQUiTbnZbUgej2I3b7y3WHyxX49cly6Uca_qJ_TlUAOAJb52n3H6tuc__x9mj6GzfKp7k</recordid><startdate>201811</startdate><enddate>201811</enddate><creator>Pellino, G.</creator><creator>Frasson, M.</creator><creator>García‐Granero, A.</creator><creator>Granero‐Castro, P.</creator><creator>Ramos Rodríguez, J. L.</creator><creator>Flor‐Lorente, B.</creator><creator>Bargallo Berzosa, J.</creator><creator>Alonso Hernández, N.</creator><creator>Labrador Vallverdú, F. J.</creator><creator>Parra Baños, P. A.</creator><creator>Ais Conde, G.</creator><creator>Garcia‐Granero, E.</creator><creator>Alvarez Rico, Miguel Angel</creator><creator>García Brao, Maria Jesus</creator><creator>Sanchez Gonzalez, Juan Manuel</creator><creator>Braithwaite, Mariela</creator><creator>Martí Martínez, Eva</creator><creator>Álvarez Pérez, Jose Antonio</creator><creator>Espí, Alejandro</creator><creator>Trallero Anoro</creator><creator>Millán Scheiding, Mónica</creator><creator>Maseda Díaz, Olga</creator><creator>Dujovne Lindenbaum, Paula</creator><creator>Monzón Abad, Andrés</creator><creator>Romero Simó, Manuel</creator><creator>Escoll Rufino, Jordi</creator><creator>Santamaría Olabarrieta, Marta</creator><creator>Viñas Martínez, José</creator><creator>López Bañeres, Manolo</creator><creator>Blesa Sierra, Isabel</creator><creator>Feliú Villaró, Francesc</creator><creator>Lucía, Javier Aguiló</creator><creator>Codina Cazador, Antonio</creator><creator>Villalba, Juan Hernandis</creator><creator>Álvarez Laso, Carlos</creator><creator>Alcaide, Sonia Martínez</creator><creator>Cáceres Alvarado, Maria Nieves</creator><creator>Simó, Ignacio Rey</creator><creator>Montero García, Josep</creator><creator>García Fadrique, Alfonso</creator><creator>Aguilella Diago, Vicente</creator><creator>García Septiem, Javier</creator><creator>García, Jacinto García</creator><creator>Ponchietti, Luca</creator><creator>Carceller Navarro, Maria Soledad</creator><creator>Ramos Fernández, María</creator><creator>Conde Muiño, Raquel</creator><creator>Huerga Álvarez, Daniel</creator><creator>Sánchez, Pablo Menéndez</creator><creator>Maristany Bienert, Carlos</creator><creator>García Martínez, Maria Teresa</creator><creator>Muzas, Celia Moreno</creator><creator>Pastor Idoate, Carlos</creator><creator>Alonso Casado, Adolfo Pedro</creator><creator>Roig Vila, Jose Vicente</creator><creator>Goded Broto, Ignacio</creator><creator>Collera, Pablo</creator><creator>Sebastián, Antonio Arroyo</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8322-6421</orcidid></search><sort><creationdate>201811</creationdate><title>Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients</title><author>Pellino, G. ; Frasson, M. ; García‐Granero, A. ; Granero‐Castro, P. ; Ramos Rodríguez, J. L. ; Flor‐Lorente, B. ; Bargallo Berzosa, J. ; Alonso Hernández, N. ; Labrador Vallverdú, F. J. ; Parra Baños, P. A. ; Ais Conde, G. ; Garcia‐Granero, E. ; Alvarez Rico, Miguel Angel ; García Brao, Maria Jesus ; Sanchez Gonzalez, Juan Manuel ; Braithwaite, Mariela ; Martí Martínez, Eva ; Álvarez Pérez, Jose Antonio ; Espí, Alejandro ; Trallero Anoro ; Millán Scheiding, Mónica ; Maseda Díaz, Olga ; Dujovne Lindenbaum, Paula ; Monzón Abad, Andrés ; Romero Simó, Manuel ; Escoll Rufino, Jordi ; Santamaría Olabarrieta, Marta ; Viñas Martínez, José ; López Bañeres, Manolo ; Blesa Sierra, Isabel ; Feliú Villaró, Francesc ; Lucía, Javier Aguiló ; Codina Cazador, Antonio ; Villalba, Juan Hernandis ; Álvarez Laso, Carlos ; Alcaide, Sonia Martínez ; Cáceres Alvarado, Maria Nieves ; Simó, Ignacio Rey ; Montero García, Josep ; García Fadrique, Alfonso ; Aguilella Diago, Vicente ; García Septiem, Javier ; García, Jacinto García ; Ponchietti, Luca ; Carceller Navarro, Maria Soledad ; Ramos Fernández, María ; Conde Muiño, Raquel ; Huerga Álvarez, Daniel ; Sánchez, Pablo Menéndez ; Maristany Bienert, Carlos ; García Martínez, Maria Teresa ; Muzas, Celia Moreno ; Pastor Idoate, Carlos ; Alonso Casado, Adolfo Pedro ; Roig Vila, Jose Vicente ; Goded Broto, Ignacio ; Collera, Pablo ; Sebastián, Antonio Arroyo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3939-eb3f3915feaa7b57a8a21fcba3894f746cab758be1e2e1cbf9d6cf4c21870a2a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Anastomosis</topic><topic>anastomotic leak</topic><topic>Anticoagulants</topic><topic>Cancer</topic><topic>Colon cancer</topic><topic>Colorectal surgery</topic><topic>Complications</topic><topic>Corticoids</topic><topic>Corticosteroids</topic><topic>Fatalities</topic><topic>Hyperlipidemia</topic><topic>Leakage</topic><topic>left colectomy</topic><topic>Liver</topic><topic>Liver diseases</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Parenteral nutrition</topic><topic>postoperative complication</topic><topic>Risk factors</topic><topic>stapled anastomosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pellino, G.</creatorcontrib><creatorcontrib>Frasson, M.</creatorcontrib><creatorcontrib>García‐Granero, A.</creatorcontrib><creatorcontrib>Granero‐Castro, P.</creatorcontrib><creatorcontrib>Ramos Rodríguez, J. L.</creatorcontrib><creatorcontrib>Flor‐Lorente, B.</creatorcontrib><creatorcontrib>Bargallo Berzosa, J.</creatorcontrib><creatorcontrib>Alonso Hernández, N.</creatorcontrib><creatorcontrib>Labrador Vallverdú, F. J.</creatorcontrib><creatorcontrib>Parra Baños, P. A.</creatorcontrib><creatorcontrib>Ais Conde, G.</creatorcontrib><creatorcontrib>Garcia‐Granero, E.</creatorcontrib><creatorcontrib>Alvarez Rico, Miguel Angel</creatorcontrib><creatorcontrib>García Brao, Maria Jesus</creatorcontrib><creatorcontrib>Sanchez Gonzalez, Juan Manuel</creatorcontrib><creatorcontrib>Braithwaite, Mariela</creatorcontrib><creatorcontrib>Martí Martínez, Eva</creatorcontrib><creatorcontrib>Álvarez Pérez, Jose Antonio</creatorcontrib><creatorcontrib>Espí, Alejandro</creatorcontrib><creatorcontrib>Trallero Anoro</creatorcontrib><creatorcontrib>Millán Scheiding, Mónica</creatorcontrib><creatorcontrib>Maseda Díaz, Olga</creatorcontrib><creatorcontrib>Dujovne Lindenbaum, Paula</creatorcontrib><creatorcontrib>Monzón Abad, Andrés</creatorcontrib><creatorcontrib>Romero Simó, Manuel</creatorcontrib><creatorcontrib>Escoll Rufino, Jordi</creatorcontrib><creatorcontrib>Santamaría Olabarrieta, Marta</creatorcontrib><creatorcontrib>Viñas Martínez, José</creatorcontrib><creatorcontrib>López Bañeres, Manolo</creatorcontrib><creatorcontrib>Blesa Sierra, Isabel</creatorcontrib><creatorcontrib>Feliú Villaró, Francesc</creatorcontrib><creatorcontrib>Lucía, Javier Aguiló</creatorcontrib><creatorcontrib>Codina Cazador, Antonio</creatorcontrib><creatorcontrib>Villalba, Juan Hernandis</creatorcontrib><creatorcontrib>Álvarez Laso, Carlos</creatorcontrib><creatorcontrib>Alcaide, Sonia Martínez</creatorcontrib><creatorcontrib>Cáceres Alvarado, Maria Nieves</creatorcontrib><creatorcontrib>Simó, Ignacio Rey</creatorcontrib><creatorcontrib>Montero García, Josep</creatorcontrib><creatorcontrib>García Fadrique, Alfonso</creatorcontrib><creatorcontrib>Aguilella Diago, Vicente</creatorcontrib><creatorcontrib>García Septiem, Javier</creatorcontrib><creatorcontrib>García, Jacinto García</creatorcontrib><creatorcontrib>Ponchietti, Luca</creatorcontrib><creatorcontrib>Carceller Navarro, Maria Soledad</creatorcontrib><creatorcontrib>Ramos Fernández, María</creatorcontrib><creatorcontrib>Conde Muiño, Raquel</creatorcontrib><creatorcontrib>Huerga Álvarez, Daniel</creatorcontrib><creatorcontrib>Sánchez, Pablo Menéndez</creatorcontrib><creatorcontrib>Maristany Bienert, Carlos</creatorcontrib><creatorcontrib>García Martínez, Maria Teresa</creatorcontrib><creatorcontrib>Muzas, Celia Moreno</creatorcontrib><creatorcontrib>Pastor Idoate, Carlos</creatorcontrib><creatorcontrib>Alonso Casado, Adolfo Pedro</creatorcontrib><creatorcontrib>Roig Vila, Jose Vicente</creatorcontrib><creatorcontrib>Goded Broto, Ignacio</creatorcontrib><creatorcontrib>Collera, Pablo</creatorcontrib><creatorcontrib>Sebastián, Antonio Arroyo</creatorcontrib><creatorcontrib>ANACO Study Group</creatorcontrib><creatorcontrib>The ANACO Study Group</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Colorectal disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pellino, G.</au><au>Frasson, M.</au><au>García‐Granero, A.</au><au>Granero‐Castro, P.</au><au>Ramos Rodríguez, J. L.</au><au>Flor‐Lorente, B.</au><au>Bargallo Berzosa, J.</au><au>Alonso Hernández, N.</au><au>Labrador Vallverdú, F. J.</au><au>Parra Baños, P. A.</au><au>Ais Conde, G.</au><au>Garcia‐Granero, E.</au><au>Alvarez Rico, Miguel Angel</au><au>García Brao, Maria Jesus</au><au>Sanchez Gonzalez, Juan Manuel</au><au>Braithwaite, Mariela</au><au>Martí Martínez, Eva</au><au>Álvarez Pérez, Jose Antonio</au><au>Espí, Alejandro</au><au>Trallero Anoro</au><au>Millán Scheiding, Mónica</au><au>Maseda Díaz, Olga</au><au>Dujovne Lindenbaum, Paula</au><au>Monzón Abad, Andrés</au><au>Romero Simó, Manuel</au><au>Escoll Rufino, Jordi</au><au>Santamaría Olabarrieta, Marta</au><au>Viñas Martínez, José</au><au>López Bañeres, Manolo</au><au>Blesa Sierra, Isabel</au><au>Feliú Villaró, Francesc</au><au>Lucía, Javier Aguiló</au><au>Codina Cazador, Antonio</au><au>Villalba, Juan Hernandis</au><au>Álvarez Laso, Carlos</au><au>Alcaide, Sonia Martínez</au><au>Cáceres Alvarado, Maria Nieves</au><au>Simó, Ignacio Rey</au><au>Montero García, Josep</au><au>García Fadrique, Alfonso</au><au>Aguilella Diago, Vicente</au><au>García Septiem, Javier</au><au>García, Jacinto García</au><au>Ponchietti, Luca</au><au>Carceller Navarro, Maria Soledad</au><au>Ramos Fernández, María</au><au>Conde Muiño, Raquel</au><au>Huerga Álvarez, Daniel</au><au>Sánchez, Pablo Menéndez</au><au>Maristany Bienert, Carlos</au><au>García Martínez, Maria Teresa</au><au>Muzas, Celia Moreno</au><au>Pastor Idoate, Carlos</au><au>Alonso Casado, Adolfo Pedro</au><au>Roig Vila, Jose Vicente</au><au>Goded Broto, Ignacio</au><au>Collera, Pablo</au><au>Sebastián, Antonio Arroyo</au><aucorp>ANACO Study Group</aucorp><aucorp>The ANACO Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients</atitle><jtitle>Colorectal disease</jtitle><addtitle>Colorectal Dis</addtitle><date>2018-11</date><risdate>2018</risdate><volume>20</volume><issue>11</issue><spage>986</spage><epage>995</epage><pages>986-995</pages><issn>1462-8910</issn><eissn>1463-1318</eissn><abstract>Aim
Reports detailing the morbidity–mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies.
Method
We undertook a STROBE‐compliant analysis of left colectomies included in a national prospective online database. Forty‐two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the ‘least absolute shrinkage and selection operator’ (LASSO) method.
Results
We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00–7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58–8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18–0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03–8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8–40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001).
Conclusion
Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29920911</pmid><doi>10.1111/codi.14309</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-8322-6421</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1462-8910 |
| ispartof | Colorectal disease, 2018-11, Vol.20 (11), p.986-995 |
| issn | 1462-8910 1463-1318 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2057443911 |
| source | Wiley Online Library - AutoHoldings Journals |
| subjects | Anastomosis anastomotic leak Anticoagulants Cancer Colon cancer Colorectal surgery Complications Corticoids Corticosteroids Fatalities Hyperlipidemia Leakage left colectomy Liver Liver diseases Morbidity Mortality Parenteral nutrition postoperative complication Risk factors stapled anastomosis |
| title | Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients |
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