Risk factors for anastomotic leak and postoperative morbidity after right hemicolectomy for colon cancer: results from a prospective, multi-centre, snapshot study in China

作者：Gao, Jiale; Gu, Xiaodong; Pang, Minghui; Zhang, Hong; Lian, Yugui; Zhou, Lei; Feng, Bo; Wang, Guiying; Zhang, Zhicao; Huang, He; Xiao, Gang; Han, Fanghai; Li, Xinxiang; Zhou, Xiaojun; Wang, Quan; Liu, Qian; Deng, Haijun; Wang, Zhenjun; Song, Wu; Wei, Zhengqiang; Li, Yong; Dai, Yong; Lin, Moubin; Zheng, Jianyong; Tang, Bo; He, Xianli; Wang, Hui; Liu, Fanlong; Li, Yongxiang; Zhou, Dongbing; Zhang, Wei; Ding, Kefeng; Tong, Weidong; He, Guodong; Jing, Changqing; Wu, Bin; Wu, Tao; Dong, Ming

来源：British Journal of Surgery, 2024, 111(1).

DOI：10.1093/bjs/znad316

• SHORT-TERM OUTCOMES
• MORTALITY
• COLECTOMY
• RESECTION
• SURGERY
• CLASSIFICATION
• COMPLICATIONS
• DISSECTION

Background: Right hemicolectomy is the standard treatment for right-sided colon cancer. There is variation in the technical aspects of performing right hemicolectomy as well as in short-term outcomes. It is therefore necessary to explore best clinical practice following right hemicolectomy in expert centres.Methods: This snapshot study of right hemicolectomy for colon cancer in China was a prospective, multicentre cohort study in which 52 tertiary hospitals participated. Eligible patients with stage I-III right-sided colon cancer who underwent elective right hemicolectomy were consecutively enrolled in all centres over 10 months. The primary endpoint was the incidence of postoperative 30-day anastomotic leak.Results: Of the 1854 patients, 89.9 per cent underwent laparoscopic surgery and 52.3 per cent underwent D3 lymph node dissection. The overall 30-day morbidity and mortality were 11.7 and 0.2 per cent, respectively. The 30-day anastomotic leak rate was 1.4 per cent. In multivariate analysis, ASA grade > II (P < 0.001), intraoperative blood loss > 50 ml (P = 0.044) and D3 lymph node dissection (P = 0.008) were identified as independent risk factors for postoperative morbidity. Extracorporeal side-to-side anastomosis (P = 0.031), intraoperative blood loss > 50 ml (P = 0.004) and neoadjuvant chemotherapy (P = 0.004) were identified as independent risk factors for anastomotic leak.Conclusion: In high-volume expert centres in China, laparoscopic resection with D3 lymph node dissection was performed in most patients with right-sided colon cancer, and overall postoperative morbidity and mortality was low. Further studies are needed to explore the optimal technique for right hemicolectomy in order to improve outcomes further.

• 单位
  安徽医科大学; 郑州大学; 吉林大学; 中国医学科学院北京协和医院; 同济大学; 复旦大学; 6; 中国医科大学; 浙江大学; 北京大学; 南方医科大学; 苏州大学; 西安交通大学; 河北医科大学; 电子科技大学; 山东大学; 广东省人民医院; 中山大学; 上海交通大学