Dehiscencia de anastomosis en la cirugía del cáncer de recto: incidencia, factores pronósticos y morbimortalidad asociada

Farrés Coll, Ramon
Introduction: Anastomotic leak (AL) is the most feared complication in the postoperative period for patients with rectal cancer. Objectives: To determine the real rate of AL in patients operated on for rectal cancer. To analyze the factors associated with AL. To review the consequences in terms of postoperative morbidity and mortality and oncological results. To describe the behavior, diagnosis and therapeutic management of AL cases. Hypothesis: The real incidence of AL may be underestimated. Some factors correlate with a higher rate of AL. The diagnosis and management of AL cases can have several approaches. Methods: Single-center, cohort, non-experimental, ambispective, observational clinical study. We included 331 patients operated on for rectal cancer at the University Hospital of Girona Dr. Josep Trueta between January 2010-December 2016. Clinical records were reviewed, and factors associated with AL were analyzed. Results: The actual incidence of AL in our series was 15.4%. Factors shown to be associated with higher rate of AL are male sex, tumor height below 10 cm from anal margin and tumor size. It has been shown that patients with AL in the postoperative period have an increase in complications, higher mortality, longer hospital stay, greater need for admission to the intensive care units and a higher rate of definitive stoma. In our study it has not been demonstrated that patients with AL have worse oncologic outcomes. Regarding the recommendations for the clinical management of patients with AL, early diagnosis is vital to improve prognosis and is achieved with clinical control of symptoms and signs in the postoperative period. The determination of CRP levels in blood is useful to establish suspicion. Confirmation is performed with thoracoabdominal CT. In patients requiring surgical reintervention, the laparoscopic abdominal approach, the transanal approach or a combination of both may be options that allow preservation of the anastomosis. Conclusion: Many factors interact in favoring AL in patients operated on for rectal cancer. The incidence remains high despite technical improvements and better surgical learning. There is a clear reduction in mortality in AL compared to the classic figures, which is based on a better diagnosis and an evolution in the management and approach to this complication ​
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