Surgery and OncologySurgery and OncologyХирургия и онкология2949-5857Publishing House ABV Press53410.17650/2686-9594-2022-12-2-17-27ORIGINAL REPORTSОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯRisk factors for colorectal anastomotic leakage and preventive measures: a retrospective cohort studyФакторы риска развития несостоятельности колоректального анастомоза и методы ее профилактики: ретроспективное когортное исследованиеLebedkoM. S.ЛебедькоМ. С.
Russian Federation

Maksim Sergeevich Lebedko

24 Kashirskoe Shosse, Moscow 115478

build. 4, 2 Bolshaya Pirogovskaya St., Moscow 119435

Максим Сергеевич Лебедько

115478 Москва, Каширское шоссе, 24

119435 Москва, Большая Пироговская ул., 2, стр. 4

lebedkomaksim@gmail.comGordeevS. S.ГордеевС. С.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 24

AlievaE. V.АлиеваЭ. В.
Russian Federation

1 Ostrovitianov St., Moscow 117997

117997 Москва, ул. Островитянова, 1

SivolobM. D.СиволобМ. Д.
Russian Federation

build. 4, 2 Bolshaya Pirogovskaya St., Moscow 119435

119435 Москва, Большая Пироговская ул., 2, стр. 4

MamedliZ. Z.МамедлиЗ. З.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 24

GaydarovS. G.ГайдаровС. Г.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

115478 Москва, Каширское шоссе, 24

KosyrevV. Yu.КосыревВ. Ю.
Russian Federation

build. 4, 2 Bolshaya Pirogovskaya St., Moscow 119435

119435 Москва, Большая Пироговская ул., 2, стр. 4

N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр онкологии им. Н. Н. Блохина» Минздрава РоссииI. M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaФГАОУ ВО «Первый Московский государственный медицинский университет им. И. М. Сеченова» Минздрава РоссииN. I. Pirogov Russian National Research Medical UniversityФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н. И. Пирогова» Минздрава России0506202212217270506202205062022Copyright ©; 2022, Lebedko M.S., Gordeev S.S., Alieva E.V., Sivolob M.D., Mamedli Z.Z., Gaydarov S.G., Kosyrev V.Y.Copyright ©; 2022, Лебедько М.С., Гордеев С.С., Алиева Э.В., Сиволоб М.Д., Мамедли З.З., Гайдаров С.Г., Косырев В.Ю.2022Lebedko M.S., Gordeev S.S., Alieva E.V., Sivolob M.D., Mamedli Z.Z., Gaydarov S.G., Kosyrev V.Y.Лебедько М.С., Гордеев С.С., Алиева Э.В., Сиволоб М.Д., Мамедли З.З., Гайдаров С.Г., Косырев В.Ю.https://creativecommons.org/licenses/by/4.0https://onco-surgery.info/jour/article/view/534

Background. Colorectal anastomotic leakage (AL) has always been one of major challenges in rectal surgery.

Objective: to perform multivariate analysis of risk factors for AL.

Materials and methods. In this retrospective cohort study, we analyzed patients that had undergone resection of the rectum with anastomosis formation between 2013 and 2020. We included patients with favorable prognostic factors (tumor located >5 cm above the anal verge, no history of chemoradiotherapy). We performed multivariate analysis using logistic regression to assess risk factors for AL.

Results. The use of more than 3 linear stapler firings to suture the rectum significantly increased the risk of AL (risk ratio 3.035; 95 % confidence interval 1.473–6.252; p = 0.003). The univariate analysis demonstrated that reinforcement of the anastomosis was significantly associated with an increased risk of AL (risk ratio 2.35; 95 % confidence interval 1.112–5.762; p = 0.027); however, this association failed to reach statistical significance (risk ratio 1,520; p = 0,066). Pelvic peritoneum suturing had no impact on the AL incidence, but in case of its development, pelvic peritoneum reconstruction prevented peritonitis (p = 0.002).

Conclusion. The number of stapler firings >3 used to suture the rectum, as well as reinforcement of the anastomosis tended to increase the risk of AL; however, these findings did not reach the level of statistical significance. Pelvic peritoneum reconstruction did not affect the incidence of AL, but significantly reduced the risk of peritonitis.

Введение. Несостоятельность колоректального анастомоза (НА) остается одной из основных проблем хирургии рака прямой кишки.

Цель исследования – провести многофакторный анализ риска развития НА.

Материалы и методы. В ретроспективном когортном исследовании за период 2013–2020 гг. Проанализированы данные историй болезни пациентов, которым по поводу рака выполнялась резекция прямой кишки с формированием анастомоза. Включали пациентов с благоприятными прогностическими факторами (локализация опухоли выше 5 см от переходной анальной складки, отсутствие предшествующей химиолучевой терапии). Оценивали влияние факторов риска на частоту развития НА на основании многофакторного анализа методом логистической регрессии.

Результаты. Использование более 3 кассет линейного степлера для прошивания и пересечения прямой кишки достоверно повышает частоту НА (отношение рисков 3,035; 95 % доверительный интервал 1,473–6,252; p = 0,003). При однофакторном анализе отмечено достоверное повышение частоты развития НА при укреплении линии аппаратного шва (отношение рисков 2,35; 95 % доверительный интервал 1,112–5,762; p = 0,027), однако при многофакторном анализе статистически значимой достоверности увеличения частоты НА не было отмечено (отношение рисков 1,520; p = 0,066). Ушивание тазовой брюшины статистически значимо не влияло на частоту НА, однако в случае ее возникновения восстановление тазовой брюшины препятствовало развитию разлитого перитонита (p = 0,002).

Выводы. Использование более 3 кассет линейного степлера для прошивания и пересечения прямой кишки, укрепление линии аппаратного анастомоза имеют тенденцию к повышению риска развития НА, но статистически значимо не влияют на него. Восстановление тазовой брюшины не влияет на частоту НА, но достоверно снижет риск развития перитонита.

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