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Sökning: id:"swepub:oai:gup.ub.gu.se/331775" > Splenic flexure mob...

Splenic flexure mobilization and anastomotic leakage in anterior resection for rectal cancer: A multicentre cohort study.

Rutegård, Martin, 1982- (författare)
Umeå University,Umeå universitet,Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM),Institutionen för kirurgisk och perioperativ vetenskap
Svensson, Johan, 1978- (författare)
Umeå University,Umeå universitet,Statistik
Segelman, Josefin (författare)
Karolinska Institute,Karolinska Institutet,Ersta Hospital
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Matthiessen, Peter, 1957- (författare)
Örebro University,Örebro universitet,Institutionen för medicinska vetenskaper,Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
Lydrup, Marie Louise (författare)
Lund University,Lunds universitet,Kirurgi,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Surgery,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments
Park, Jennifer (författare)
Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för kirurgi,Institute of Clinical Sciences, Department of Surgery,Department of Surgery, Scandinavian Surgical Outcomes Research Group (SSORG), Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
RectoLeak study group, - (bidragsgivare)
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 (creator_code:org_t)
Sage Publications, 2023
2023
Engelska.
Ingår i: Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. - : Sage Publications. - 1457-4969 .- 1799-7267. ; 112:4, s. 246-255
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • Some colorectal surgeons advocate routine splenic flexure mobilization (SFM) when performing anterior resection for rectal cancer to ensure a tension-free anastomosis. Meta-analyses of smaller studies suggest that this approach does not influence anastomotic leakage rates, but larger multicentre studies are needed to confirm the safety of a selective strategy. The aim of this study is to evaluate the impact of SFM on anastomotic leakage.This is a retrospective multicentre cohort study, comprising 1109 patients operated with anterior resection for rectal cancer in 2014-2018. Exposure was SFM, while anastomotic leakage within a year constituted the outcome. Stratified analyses were performed for type of mesorectal excision and surgical approach, as well as sensitivity analysis considering vascular tie placement. Multivariable Cox regression with hazard ratios (HRs) and 95% confidence intervals (CIs) was employed to adjust for confounding, while multiple imputation was used for missing data.SFM was performed in 381 patients (34.4%). Anastomotic leakage occurred in 83 (21.8%) and 123 (20.3%) patients operated with and without SFM, respectively. SFM was neither clearly detrimental nor beneficial regarding anastomotic leakage (adjusted HR = 0.82; 95% CI: 0.59-1.15), with no apparent differences for total or partial mesorectal excision and minimally invasive or open surgery. Concurrent high vascular ligation did not impact these results, and there was no evidence of interaction from centers with a more common use of SFM.SFM did not seem to influence the risk of anastomotic leakage after anterior resection for rectal cancer, regardless of type of mesorectal excision, use of minimally invasive surgery, or high vascular ligation.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Nyckelord

Humans
Anastomotic Leak
epidemiology
etiology
Colon
Transverse
surgery
Cohort Studies
Rectal Neoplasms
surgery
Anastomosis
Surgical
adverse effects
methods
Retrospective Studies
Rectum
surgery
Insufficiency
adenocarcinoma
dehiscence
Insufficiency
leak
rectum
splenic flexure

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ref (ämneskategori)
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