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RISK FACTORS FOR ANASTOMOTIC LEAK IN PATIENTS UNDERGOING SURGERY FOR RECTAL CANCER RESECTION: A RETROSPECTIVE ANALYSIS
Daniel Doniz- Gomez Llanos
*, Amado d. Athié-Athié, Alejandra Padilla-Flores, Sara Arechavala
Medica Sur, Mexico City, CDMX, Mexico
Introduction. Colorectal cancer (CRC) is the third most common type of cancer worldwide and is the second leading cause of cancer-related death. It accounts for 10% of all new cancer diagnoses. In Mexico it represents the third most frequent cancer. Rectal cancer ranks 8th in incidence worldwide, 10th in mortality. In Mexico rectal cancer ranks sixteenth in frequency and fifteenth in deaths. 30% of all colorectal neoplasms originate in the rectum. The cornerstone of treatment for rectal cancer is surgical resection, preceded by neoadjuvant therapy or adjuvant therapy. In the surgical management of rectal cancer, the choice of one surgical approach over another will primarily depend on the tumor's location in relation to the anal margin, the involvement of adjacent structures and the sphincter complex. The main surgical procedures are LAR with colo-rectal anastomosis for patients with tumors in the upper third of the rectum, and ULAR with colo-anal anastomosis, with or without intersphincteric dissection, for patients with tumors in the middle or lower thirds of the rectum.
The most serious and feared complication is anastomotic leak. This is defined as an abnormal communication between the intraluminal and extraluminal compartments due to a defect in the integrity of the intestinal wall at the anastomosis. Its occurrence has been associated with increased local recurrence, decreased quality of life, reduced long-term survival, and poor oncological outcomes. The incidence of anastomotic leak is 3-30% with an estimated mortality rate of 6-30%. Various risk factors have been described and studied in the literature that may influence the development of AL. Depending on its impact on clinical management, anastomotic leak can be classified into three grades: Grade A, Grade B, Grade C. Treatment will depend on variables such as clinical presentation, hemodynamic stability, presence of peritonitis and/or sepsis, and may range from IV antibiotics to surgical reoperation with remodeling or dismantling of the anastomosis.
Material & Methods: We made a retrospective study including 42 patients who where treated with surgery for rectal cancer between 2017 - 2022, and analyzed possible risk factors for anastomotic leakage in this specific population
Results: In the univariate analysis 5 patients presented AL (11.9%), male sex presented more AL (80% VS 48.6%, P=0.188). Surgical time (349.0 vs. 229.5 minutes, p=0.018), surgical bleeding (800.0 vs. 210.8 mL, p=0.000) and intraoperative/postoperative blood transfussion (60.0% vs. 16.2%, p=0.025) were associated with AL. In the logistic regretion analysis, none of the previous studied variables were found to be related with AL.
Conclusions: Male sex, prolonged surgical time, elevated surgical bleeding and intraoperative/postoperative blood transfussion may be related with AL in our population.
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