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Risk Factors for Anastomotic Leaks in Simultaneous Resection of Primary Colon Cancer with Synchronous Liver
Allen T Yu1, Clark Pitcher1, Sergey Khaitov1
1Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Introduction:
Anastomotic leaks (AL) are a devastating complication of simultaneous resection of primary colon cancer and liver metastases. We aimed to determine the risk factors of AL using a 10-year cohort from a nationwide database.
Patients And Methods:
The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2014 to 2023 was used. Patients who underwent simultaneous colectomy and liver resection were included. Multivariate analysis was performed with AL as the outcome variable. The 2:1 propensity score matching (PSM) was performed on preoperative and operative covariates.
Results:
A total of 1517 patients were included. Median age was 60 years and 824 (54%) were male. Most liver resections were minor hepatectomies (87%). In total, 80 (5.3%) patients developed AL. On univariate analysis, higher ASA score, chronic steroid use, and intraoperative blood transfusion were statistically significant risk factors for AL. Multivariate analysis showed that higher ASA score (ORadj 2.55), chronic steroid use (ORadj 2.39), major hepatectomy (ORadj 1.92), and blood transfusion (ORadj 2.27) were independent risk factors for AL. A 2:1 PSM cohort for blood transfusions resulted in 205 patient pairs. The rate of AL in the blood transfusion cohort was higher (10.7% versus 5.0%, p < 0.01).
Conclusions:
In this study, we found that a higher ASA score, chronic steroid use, major hepatectomies, and blood transfusions were independent predictors of AL. In matched cohorts, there was also an increased risk for AL. Thus, for high-risk patient populations undergoing simultaneous resection of primary colon cancer and liver metastasis, consideration should be given for fecal diversion or staged procedures.
