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Original Article

The evaluation of risk factors of anastomotic leakage in patients with colorectal cancer complicated by ileus

Yosyp Grytsenko, Anatoliy Bedeniuk, Stepan Grytsenko, Mykhaylo Horman, Hanna Boiko.

Cited by 6 Articles

Background: Obstructive ileus and peritonitis are the most frequent complication of colorectal cancer, manifested in 8-40 % cases. Anastomotic leakage (AL) is a fatal complication in colorectal surgery. In our study, we aim to analyze the safety, outcomes in patients with colon obstruction after resection with new anastomosis technique implementation and to identify prognostic value of each risk factor on development of AL.
Methods: A retrospective analysis of prospectively acquired data of 155 consecutive emergency patients with cancer of proximal rectum and sigmoid colon complicated by chronic bowel obstruction in stage of subcompensation and decompensation were included in our study and divided into 2 groups. In the basic group (n=95), primary nonfunctional anastomosis (PNA) was performed after resection of the rectum. In the comparing group (n=60), resection of the colon or rectum with primary anastomosis was performed.
Results: Postoperative complications have arisen in 5 (5,3 %) patients of group I and in 11 (18,4%) patients of group II. AL was developed only in 1 patient in the basic group (1,1%) and in 7 (11,7 %) patients of the compared group on the 5th-12th day after operation. We have worked out the rate score of risk factors of AL. А score was given for each AL factor which we had selected for elaboration of this scale.
Conclusions: Based on AL risk factors scale we highlighted 5 levels of risk which have significant clinical meaning and help surgeons decide finally how to finish operation in patient with bowel obstruction in order to avoid AL. PNA with preventive transversostoma was shown to provide adequate decompression of the colon, reliable prevention of colorectal AL, avoid complex reconstructive operations and be a good alternative for Hartman’s procedure.

Key words: colorectal cancer, bowel obstruction, anastomotic leakage.

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