Risk factors for anastomotic leak after recto-sigmoid resection for ovarian cancer

Debra L. Richardson, Andrea Mariani, William Arthur Cliby

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Objectives.: Anastomotic leak after recto-sigmoid (RS) resection for ovarian cancer (OC) is a life-threatening complication. Selection of patients for protective diverting stomas has been based on observations from the colorectal literature. Our objective was to identify primary risk factors for anastomotic leak in OC patients undergoing RS resection to better determine who would most benefit from protective diversion. Methods.: All patients with OC or primary peritoneal cancer who underwent a debulking procedure with RS resection between January 1999 and December 2004 were included. Retrospective chart review including review of operative notes, pathology reports, and medical records including follow-up visits was done. Cases with inadequate postoperative follow-up, primary end colostomies, or diverting stomas were excluded. Results.: 177 patients form our study cohort. There were a total of 12/177 anastomotic leaks (6.8%). The mean time to diagnosis of anastomotic leak was 19 days (range 4-32). The leak rate for primary debulking operations was 8.7% (10/115), whereas the leak rate in secondary debulking procedures was 3.2% (2/62) (NS, P = 0.22). In univariate analysis, only perioperative serum albumin was significantly associated with an increased risk of anastomotic leak (mean 3.4 g/dL vs. 2.4 g/dL, P = 0.002). Based on serum albumin, the leak rate was 6/29 (21%) for levels <3.0 g/dL and 2/58 (3.4%) for patients with albumin greater than or equal to 3.0 g/dL (OR 7.3, 95% CI 1.37-38.87). Conclusions.: Low serum albumin is associated with an increased risk of anastomotic leak after RS resection for OC. Patients with a low albumin level may benefit from a protective diverting colostomy/ileostomy.

Original languageEnglish (US)
Pages (from-to)667-672
Number of pages6
JournalGynecologic Oncology
Volume103
Issue number2
DOIs
StatePublished - Nov 2006

Fingerprint

Anastomotic Leak
Sigmoid Colon
Ovarian Neoplasms
Serum Albumin
Colostomy
Albumins
Ileostomy
Patient Selection
Medical Records
Cohort Studies
Pathology
Neoplasms

Keywords

  • Anastomotic leak
  • Epithelial ovarian cancer
  • Low anterior resection
  • Recto-sigmoid resection
  • Serum albumin

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Risk factors for anastomotic leak after recto-sigmoid resection for ovarian cancer. / Richardson, Debra L.; Mariani, Andrea; Cliby, William Arthur.

In: Gynecologic Oncology, Vol. 103, No. 2, 11.2006, p. 667-672.

Research output: Contribution to journalArticle

Richardson, Debra L. ; Mariani, Andrea ; Cliby, William Arthur. / Risk factors for anastomotic leak after recto-sigmoid resection for ovarian cancer. In: Gynecologic Oncology. 2006 ; Vol. 103, No. 2. pp. 667-672.
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abstract = "Objectives.: Anastomotic leak after recto-sigmoid (RS) resection for ovarian cancer (OC) is a life-threatening complication. Selection of patients for protective diverting stomas has been based on observations from the colorectal literature. Our objective was to identify primary risk factors for anastomotic leak in OC patients undergoing RS resection to better determine who would most benefit from protective diversion. Methods.: All patients with OC or primary peritoneal cancer who underwent a debulking procedure with RS resection between January 1999 and December 2004 were included. Retrospective chart review including review of operative notes, pathology reports, and medical records including follow-up visits was done. Cases with inadequate postoperative follow-up, primary end colostomies, or diverting stomas were excluded. Results.: 177 patients form our study cohort. There were a total of 12/177 anastomotic leaks (6.8{\%}). The mean time to diagnosis of anastomotic leak was 19 days (range 4-32). The leak rate for primary debulking operations was 8.7{\%} (10/115), whereas the leak rate in secondary debulking procedures was 3.2{\%} (2/62) (NS, P = 0.22). In univariate analysis, only perioperative serum albumin was significantly associated with an increased risk of anastomotic leak (mean 3.4 g/dL vs. 2.4 g/dL, P = 0.002). Based on serum albumin, the leak rate was 6/29 (21{\%}) for levels <3.0 g/dL and 2/58 (3.4{\%}) for patients with albumin greater than or equal to 3.0 g/dL (OR 7.3, 95{\%} CI 1.37-38.87). Conclusions.: Low serum albumin is associated with an increased risk of anastomotic leak after RS resection for OC. Patients with a low albumin level may benefit from a protective diverting colostomy/ileostomy.",
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N2 - Objectives.: Anastomotic leak after recto-sigmoid (RS) resection for ovarian cancer (OC) is a life-threatening complication. Selection of patients for protective diverting stomas has been based on observations from the colorectal literature. Our objective was to identify primary risk factors for anastomotic leak in OC patients undergoing RS resection to better determine who would most benefit from protective diversion. Methods.: All patients with OC or primary peritoneal cancer who underwent a debulking procedure with RS resection between January 1999 and December 2004 were included. Retrospective chart review including review of operative notes, pathology reports, and medical records including follow-up visits was done. Cases with inadequate postoperative follow-up, primary end colostomies, or diverting stomas were excluded. Results.: 177 patients form our study cohort. There were a total of 12/177 anastomotic leaks (6.8%). The mean time to diagnosis of anastomotic leak was 19 days (range 4-32). The leak rate for primary debulking operations was 8.7% (10/115), whereas the leak rate in secondary debulking procedures was 3.2% (2/62) (NS, P = 0.22). In univariate analysis, only perioperative serum albumin was significantly associated with an increased risk of anastomotic leak (mean 3.4 g/dL vs. 2.4 g/dL, P = 0.002). Based on serum albumin, the leak rate was 6/29 (21%) for levels <3.0 g/dL and 2/58 (3.4%) for patients with albumin greater than or equal to 3.0 g/dL (OR 7.3, 95% CI 1.37-38.87). Conclusions.: Low serum albumin is associated with an increased risk of anastomotic leak after RS resection for OC. Patients with a low albumin level may benefit from a protective diverting colostomy/ileostomy.

AB - Objectives.: Anastomotic leak after recto-sigmoid (RS) resection for ovarian cancer (OC) is a life-threatening complication. Selection of patients for protective diverting stomas has been based on observations from the colorectal literature. Our objective was to identify primary risk factors for anastomotic leak in OC patients undergoing RS resection to better determine who would most benefit from protective diversion. Methods.: All patients with OC or primary peritoneal cancer who underwent a debulking procedure with RS resection between January 1999 and December 2004 were included. Retrospective chart review including review of operative notes, pathology reports, and medical records including follow-up visits was done. Cases with inadequate postoperative follow-up, primary end colostomies, or diverting stomas were excluded. Results.: 177 patients form our study cohort. There were a total of 12/177 anastomotic leaks (6.8%). The mean time to diagnosis of anastomotic leak was 19 days (range 4-32). The leak rate for primary debulking operations was 8.7% (10/115), whereas the leak rate in secondary debulking procedures was 3.2% (2/62) (NS, P = 0.22). In univariate analysis, only perioperative serum albumin was significantly associated with an increased risk of anastomotic leak (mean 3.4 g/dL vs. 2.4 g/dL, P = 0.002). Based on serum albumin, the leak rate was 6/29 (21%) for levels <3.0 g/dL and 2/58 (3.4%) for patients with albumin greater than or equal to 3.0 g/dL (OR 7.3, 95% CI 1.37-38.87). Conclusions.: Low serum albumin is associated with an increased risk of anastomotic leak after RS resection for OC. Patients with a low albumin level may benefit from a protective diverting colostomy/ileostomy.

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KW - Recto-sigmoid resection

KW - Serum albumin

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