Risk Factors for Anastomotic Leakage in Patients with Rectal Tumors Undergoing Robot-assisted Low Anterior Resection without Protective Ostomy

直腸腫瘤的病人接受達文西機械輔助性低前位切除手術且無保護性造口術後腸吻合滲漏之危險因子

Kevin A. Wang(王凱緯) ； Yen-Cheng Chen(陳彥成) ； Ching-Chun Li(李京錞) ； Po-Jung Chen(陳柏榕) ； Wei-Chih Su(蘇偉智) ； Tsung-Kun Chang(張琮琨) ； Ching-Wen Huang(黃敬文) ； Hsiang-Lin Tsai(蔡祥麟) ； Jaw-Yuan Wang(王照元)

《中華民國大腸直腸外科醫學會雜誌》 33卷4期 (2022/12) Pp. 202-211

https://doi.org/10.6312/SCRSTW.202212_33(4).11121

摘要

Purpose. To assess the risk factors for anastomotic leakage in patients undergoing robotic-assisted rectal surgery. Only a few studies have been conducted to assess the risk factors for anastomotic leakage after robotic colorectal surgery. Methods. This study retrospectively evaluated patients who underwent robot-assisted rectal surgery without protective ostomy from May 2013 to February 2022 at our institution. Univariate and multivariate analyses were performed to determine the risk factors for anastomotic leakage. Results. Anastomotic leakage was noted in 26 (9.2%) of 282 patients. Preoperative albumin level < 3.5 mg/dL (OR 9.34, CI 2.38-36.63, p = 0.001), operation time > 300 minutes (OR 3.66, CI 1.33-10.06, p = 0.012), and use of two or more linear staple firings (OR 4.45, 95% CI 1.31-15.10, p = 0.017) were independent risk factors for anastomotic leakage. Conclusions. This study identified three risk factors associated with anastomotic leakage after robotic rectal surgery. Preoperative hypoalbuminemia should be corrected for patients undergoing rectal surgery; prolonged operative times and multiple linear staple firings should warrant the potential creation of a protective ostomy.

關鍵字

Anastomotic leakage ； Robotic surgery ； Rectal surgery ； Risk factor

並列摘要

目的：評估接受達文西機械直腸輔助手術患者術後腸吻合滲漏的危險因子。很少有評估達文西機械結直腸輔助手術後發生腸吻合滲漏危險因子的研究發表。方法：本研究是回顧性分析。針對本機構從2013年5月至2022年2月接受機械輔助直腸手術，且無施行保護性腸造口的患者，進行單變異數和多變異數分析找尋出腸吻合滲漏的危險因子。結果：282名患者中有26名（9.2%）出現吻合滲漏。術前白蛋白低於3.5mg/dL（OR 9.34, CI 2.38-36.63, p=0.001），手術時間超過300分鐘（OR 3.66, CI 1.33-10.06, p=0.012）和使用多次linear staples（OR 4.45, CI 1.31-15.10, p=0.017）是腸吻合滲漏的獨立危險因子。結論：本研究找尋出三個在機械輔助直腸手術後腸吻合滲漏的危險因子。要接受直腸手術的患者，如果白蛋白過低，術前應該先補充營養。另外，手術時間過長或在截斷直腸時使用二次以上的linear staples時，術中應可能需要加做保護性造口。

並列關鍵字

腸吻合滲漏 ； 機械輔助手術 ； 直腸手術 ； 危險因子