结肠癌右半结肠切除术后吻合口瘘和术后发病率的危险因素：来自中国的一项前瞻性、多中心、快照研究的结果。
Risk factors for anastomotic leak and postoperative morbidity after right hemicolectomy for colon cancer: results from a prospective, multi-centre, snapshot study in China.
发表日期：2023 Nov 07
作者：
Jiale Gao, Xiaodong Gu, Minghui Pang, Hong Zhang, Yugui Lian, Lei Zhou, Bo Feng, Guiying Wang, Zhicao Zhang, He Huang, Gang Xiao, Fanghai Han, Xinxiang Li, Xiaojun Zhou, Quan Wang, Qian Liu, Haijun Deng, Zhenjun Wang, Wu Song, Zhengqiang Wei, Yong Li, Yong Dai, Moubin Lin, Jianyong Zheng, Bo Tang, Xianli He, Hui Wang, Fanlong Liu, Yongxiang Li, Dongbing Zhou, Wei Zhang, Kefeng Ding, Weidong Tong, Guodong He, Changqing Jing, Bin Wu, Tao Wu, Ming Dong, Zhifei Li, Zhanlong Shen, Hongbo Wei, Lian Bai, Zhiqian Hu, Shiliang Tu, Jian Qiu, Xuejun Sun, Ang Li, Jing Zhuang, Su Yan, Hendrik Bonjer, Jurriaan Tuynman, Hongwei Yao, Zhongtao Zhang,
来源：
Best Pract Res Cl Ob
摘要：
右半结肠切除术是右侧结肠癌的标准治疗方法。进行右半结肠切除术的技术方面以及短期结果存在差异。因此，有必要在专家中心探索右半结肠切除术后的最佳临床实践。 这项针对中国结肠癌右半结肠切除术的快照研究是一项前瞻性、多中心队列研究，有 52 家三级医院参与。所有中心连续入组接受选择性右半结肠切除术的符合条件的 I-III 期右侧结肠癌患者超过 10 个月。主要终点是术后 30 天吻合口瘘的发生率。在 1854 名患者中，89.9% 接受了腹腔镜手术，52.3% 接受了 D3 淋巴结清扫术。 30 天的总体发病率和死亡率分别为 11.7% 和 0.2%。 30 天的吻合口漏率为 1.4%。多变量分析显示，ASA分级> II级（P < 0.001）、术中失血量> 50 ml（P = 0.044）和D3淋巴结清扫（P = 0.008）被确定为术后发病的独立危险因素。体外侧侧吻合（P = 0.031）、术中失血量> 50 ml（P = 0.004）和新辅助化疗（P = 0.004）被确定为吻合口瘘的独立危险因素。在中国高容量专家中心大多数右侧结肠癌患者均进行了腹腔镜切除加D3淋巴结清扫，总体术后发病率和死亡率较低。需要进一步研究来探索右半结肠切除术的最佳技术，以进一步改善结果。© 作者 2023。由牛津大学出版社代表 BJS Society Ltd 出版。
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.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.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.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.© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.