Risikofaktoren für das Auftreten postoperativer Anastomoseninsuffizienzen nach kolorektalen Resektionen

Zusammenfassung

Hintergrund: Das Auftreten einer Anastomoseninsuffizienz ist eine der schwerwiegendsten Komplikationen in der Chirurgie mit unverändert hoher Morbidität und Letalität. Ziel der Arbeit war es, an Hand klinisch zu ermittelnder Risikofaktoren ein Risikoprofil zu erstellen, mit dem evtl. therapeutische Konsequenzen (Stomaanlage) objektiviert werden können. Methodik: In einem Zeitraum von 2 Jahren wurden 400 Patienten, welche in der Chirurgischen Universitätsklinik der RWTH Aachen eine Anastomose im Bereich des Dickdarmes erhalten haben, retrospektiv analysiert. Ausgewertet wurden mittels univariater als auch multivariater Analyse mögliche Risikofaktoren für das Auftreten einer postoperativen Nahtinsuffizienz. Ergebnisse: 23 Patienten entwickelten postoperativ eine Anastomoseninsuffizienz (5,8 %). 10 Patienten konnten konservativ behandelt werden, 13 wurden reoperiert. Sowohl in der univariaten, als auch in der multivariaten Analyse konnten eine perioperative Bestrahlung (OR = 3,76 [95 % CI 1,03–3,7]), intraoperative Bluttransfusion (OR = 2,98 [95 % CI 1,18–7,54]), regelmäßiger Alkoholkonsum (OR = 2,94 [95 % CI 1,06–8,17]) und die Einnahme von Steroiden (OR = 3,91 [95 % CI 1,17–13,07]) als Risikofaktoren für das Auftreten einer Nahtinsuffizienz identifiziert werden. Schlussfolgerung: Eine perioperative Bestrahlung und intraoperative Bluttransfusionen sind im vorliegenden Kollektiv die klinisch relevantesten Risikofaktoren für das Auftreten einer Nahtinsuffizienz. Zusammenfassend bleibt jedoch die Erstellung eines gültigen Risikoprofils aufgrund klinischer Faktoren wegen der uneinheitlichen Datenlage schwierig.

Abstract

Background: Despite improved surgical techniques, anastomotic leakage is still a serious complication in colorectal surgery, resulting in increased morbidity and mortality. This study was initiated to investigate those clinical risk factors which may influence the onset of anastomotic wound-healing complications. Methods: The postoperative courses were assessed in 400 consecutive patients who underwent colonic or rectal resection. Possible clinical risk factors were investigated by unvariate and multivariate analysis. Results: 23 patients developed an anastomotic leakage (5.8 %). 10 patients could be treated conservatively, 13 had a second operation. In the multivariate analysis significant risk factors were perioperative radiotherapy (OR = 3.76 [95 % CI 1.03–13.7]), blood transfusion (OR = 2.98 [95 % CI 1.18–7.54]), alcohol consumption (OR = 2.94 [95 % CI 1.06–8.17]), and steroid medication (OR = 3.91 [95 % CI 1.17–13.07]). Conclusion: The clinically most important risk factors for leakage were radiotherapy and blood transfusion. Further analyses with a focus on the extracellular matrix, including other clinical factors may be valuable in identifying targets for improvement.

Schlüsselwörter

Anastomoseninsuffizienz - kolorektale Chirurgie - Risikofaktoren

Key words

anastomotic leakage - colorectal resections - risk factors

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