RESUMO
INTRODUCTION: Anastomotic leakage (AL) is one of the most feared postoperative complications in colon cancer surgery due to an association with increased morbidity and mortality, although its impact on long-term survival is not consensual. The aim of this study was to investigate the influence of AL on long-term survival of patients undergoing curative colon cancer resection. METHODS: A single-centre retrospective cohort study was designed. Clinical records of all consecutive patients undergoing surgery at our institution between 01/01/2010 and 12/31/2019 were reviewed. Survival analysis was performed by Kaplan-Meier method to estimate overall and conditional survival and Cox regression to search for risk factors impacting survival. RESULTS: A total of 2351 patients submitted to colorectal surgery were screened for eligibility, of which 686 with colon cancer were included. AL occurred in 57 patients (8,3%) and was associated with higher postoperative morbidity and mortality, length of stay and early readmissions (P < 0,05). Overall survival was inferior in the leakage group (Hazard Ratio 2,08 [1,02-4,24]). Conditional overall survival at 30, 90 days and 6 months was also inferior in the leakage group (P < 0,05), but not at 1 year. Risk factors independently associated with reduced overall survival included AL occurrence, higher ASA classification and delayed/missed adjuvant chemotherapy. AL did not impact local and distant recurrence (P > 0,05). CONCLUSION: AL has a negative impact on survival. Its effect is more pronounced on short-term mortality. AL does not appear to be associated with disease progression.
Assuntos
Neoplasias do Colo , Procedimentos Cirúrgicos do Sistema Digestório , Humanos , Fístula Anastomótica/epidemiologia , Fístula Anastomótica/etiologia , Estudos Retrospectivos , Neoplasias do Colo/cirurgia , Neoplasias do Colo/complicações , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversosRESUMO
Introduction: Anastomotic leakage (AL) is one of the most feared postoperative complications in colon cancer surgery due to an association with increased morbidity and mortality, although its impact on long-term survival is not consensual. The aim of this study was to investigate the influence of AL on long-term survival of patients undergoing curative colon cancer resection. Methods: A single-centre retrospective cohort study was designed. Clinical records of all consecutive patients undergoing surgery at our institution between 01/01/2010 and 12/31/2019 were reviewed. Survival analysis was performed by KaplanMeier method to estimate overall and conditional survival and Cox regression to search for risk factors impacting survival. Results: A total of 2351 patients submitted to colorectal surgery were screened for eligibility, of which 686 with colon cancer were included. AL occurred in 57 patients (8,3%) and was associated with higher postoperative morbidity and mortality, length of stay and early readmissions (P < 0,05). Overall survival was inferior in the leakage group (Hazard Ratio 2,08 [1,024,24]). Conditional overall survival at 30, 90 days and 6 months was also inferior in the leakage group (P < 0,05), but not at 1 year. Risk factors independently associated with reduced overall survival included AL occurrence, higher ASA classification and delayed/missed adjuvant chemotherapy. AL did not impact local and distant recurrence (P > 0,05). Conclusion: AL has a negative impact on survival. Its effect is more pronounced on short-term mortality. AL does not appear to be associated with disease progression.(AU)
Objetivo: La fuga anastomótica (FA) es una complicación postoperatoria temida en la cirugía del cáncer de colon por asociación con mayor morbimortalidad, aunque su impacto en la supervivencia a largo plazo no es consensuado. Nuestro objetivo fue investigar el efecto de la FA en la supervivencia a largo plazo de pacientes sometidos a resección curativa del cáncer de colon. Métodos: Se realizó un estudio de cohorte retrospectivo unicéntrico de pacientes consecutivos intervenidos quirúrgicamente entre 01/01/2010 y el 31/12/2019. El análisis de supervivencia se realizó por el método de Kaplan-Meier para evaluar la supervivencia global (SG) y condicional y una regresión de Cox para evaluar los factores de riesgo con efecto en la supervivencia. Resultados: De 2351 pacientes sometidos a cirugía colorrectal, se incluyeron 686 con cáncer de colon. FA afectó 57 pacientes (8,3%) y se asoció con mayor morbimortalidad postoperatoria, duración de estancia hospitalaria y reingresos (P < 0,05). La SG fue inferior en el grupo de fuga (Hazard Ratio 2,08 [1,024,24]). La SG condicional a los 30, 90 días y 6 meses fue inferior en el grupo de fugas (P < 0,05), pero no a 1 año. Los factores de riesgo que se asociaron con SG reducida incluyeron la FA, clasificación ASA más alta y quimioterapia adyuvante retrasada/perdida. FA no afectó la recurrencia local y distante (P > 0.05). Conclusiones: FA tiene un impacto negativo en la supervivencia, con efecto más pronunciado sobre la mortalidad a corto plazo, pero no es asociado con la progresión de la enfermedad oncológica.(AU)