TORNA ALL’ELENCO

Assessment of risk factors for anastomotic leak after rectal cancer surgery through an individual participant data meta-analysis: The syreal study in Surgical Endoscopy and Other Interventional Techniques

2017
AOU Città della Salute di Torino

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (7)Vedi tutti...

Arezzo A

Chiaro P

Migliore M


et alii...

Abstract

Background: Anastomotic leak (AL) after rectal cancer surgery constitutes a severe complication associated with poorer oncologic outcome and quality of life. Preoperative assessment of the risk for AL is a key component of surgical planning, during which the surgeon informs the patient about the individual risk and associated complications and can discuss the opportunity of creating an anastomosis with or without a defunctioning stoma. The aim of the SYREAL (SYstematic review of risk factors for REctal Anastomotic Leak) study was to increase the current knowledge base of the risk factors for AL in patients undergoing rectal cancer surgery. Methods: Studies on rectal cancer surgery published between 2000 and 2015 were systematically reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Individual Participant Data checklist (PRISMA-IPD) guidelines. Multiple imputation imputation by chained equations was used to fill missing data. A logistic regression model was fitted to determine the risk factors for AL. All significant variables (p<0.05) in the univariate analysis entered into the multivariable analysis. The project was registered with PROSPERO (CRD42016043053). Results: The SYREAL consortium was composed of 26 centers that provided individual data on 9742 patients. Significant preoperative risk factors were: male sex (OR=1.2206, 95%CI [1.0685, 1.3944]), short-term preoperative radiotherapy (OR=1.2021, 95%CI [1.0276, 1.4063]) and Tumor distance (OR=0.9610, 95%CI [0.9420, 0.9800]). Factors not associated with increased risk of AL were obesity, diabetes, TNM, tobacco use, American Society of Anesthesiologists (ASA) grade, operative time, blood transfusion, preoperative chemotherapy, preoperative long-course radio-therapy, time between neoadjuvant therapy and surgery, manual or stapled anastomosis, pelvic drain. Conclusions: Preoperative risk factor assessment for AL after rectal surgery can assist surgeons in decision m

DOI : 10.1007/s00464-017-5540-y

Keywords

anastomosis leakage; anesthesiologist; blood transfusion; cancer surgery; checklist; decision making; diabetic obesity; disease model; drain; female; gender; human; knowledge base; logistic regression analysis; male; meta analysis; neoadjuvant therapy; practice guideline; preoperative chemotherapy; preoperative radiotherapy; radiotherapy; rectum cancer; rectum surgery; risk factor; statistical model; stoma; surgeon; surgery; tobacco use; univariate analysis;