Anastomotic leakage after colon cancer resection: does the individual surgeon matter?

Autores de IIS La Fe

• Franco Guillermo Marinello

  Autor

• Gloria Gema Baguena Requena

  Autor

• Eli Francisco Lucas Mera

  Autor

• 

  Matteo Frasson

  Autor

• David Hervás Marín

  Autor

• Blas Flor Lorente

  Autor

• Jose Pedro Esclapez Valero

  Autor

• Alejandro Espi Macias

  Autor

• Eduardo García-Granero Ximénez

  Autor

Grupos

• Enfermedad Inflamatoria Intestinal

  

  Leader

  Pilar Nos Mateu

• Grupo de Investigación Clínica y Traslacional en Cardiología

  

  Investigador Principal

  Esther Roselló Lletí

Abstract

AimAnastomotic leakage is one of the most feared complications after colonic resection. Many risk factors for anastomotic leakage have been reported, but the impact of an individual surgeon as a risk factor has scarcely been reported. The aim of this study was to assess if the individual surgeon is an independent risk factor for anastomotic leakage in colonic cancer surgery. MethodThis was a retrospective analysis of prospectively collected data from patients who underwent elective resection for colon cancer with anastomosis at a specialized colorectal unit from January 1993 to December 2010. Anastomotic leaks were diagnosed according to standardized criteria. Patient and tumour characteristics, surgical procedure and operating surgeons were analysed. A logistic regression model was used to discriminate statistical variation and identify risk factors for anastomotic leakage. ResultsA total of 1045 patients underwent elective colon cancer resection with primary anastomosis. Anastomotic leakage occurred in 6.4% of patients. Ileocolic anastomosis had an anastomotic leakage rate of 7.2%, colo-colonic/colorectal anastomosis 5.2% and ileorectal anastomosis 12.7%, with intersurgeon variability. The independent risk factors associated with anastomotic leakage were the use of perioperative blood transfusion (OR 2.83, CI 1.59-5.06, P<0.0001) and the individual surgeon performing the procedure (OR up to 8.44, P<0.0001). ConclusionIn addition to perioperative blood transfusion, the individual surgeon was identified as an important risk factor for anastomotic leakage. Efforts should be made to reduce performance variability amongst surgeons.

Keywords

• Anastomotic leak; risk factor; colon resection; colon cancer; individual surgeon