Timing and outcome of right- vs left-sided colonic anastomotic leaks: Is there a difference?

Abstract Introduction The NUn score was created to try and predict the risk of anastomotic leak or major complications (using the Clavien- Dindo classification) from upper GI resections with an oesophageal anastomosis. A score of > 10 was used to predict an increased risk. In this study we attempt validation. Methods A database of 101 patients was studied, who underwent an Oesophagectomy for cancer between March 2017 and 2020. 72 patients had complete Post-operative day 4 bloods, needed to calculate the score. These patients were then studied for post-operative complications. Results A total of 12 patients had a NUn score of > 10 (16.67%). There was 1 death (1.37%) and 11 anastomotic leaks (15.28%). Of these the NUn score did not predict the death and predicted 8 of the 11 anastomotic leaks. From our data Conclusion From our analysis the NUNs score cannot be shown to be sensitive, specific or have useful positive predictive value. The average Nun score was not reliable, with confidence intervals crossing 10. There may be some merit in using the test for its negative predictive value, but further analysis into this is needed. The results of this audit are consistent with previous efforts at external validation.

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Management of anastomotic leaks following esophagectomy: when to intervene?

Journal of Thoracic Disease ◽

10.21037/jtd.2018.12.13 ◽

2019 ◽

Vol 11 (1) ◽

pp. 131-137 ◽

Cited By ~ 6

Author(s):

Joshua L. Manghelli ◽

DuyKhanh P. Ceppa ◽

Jason W. Greenberg ◽

David Blitzer ◽

Adam Hicks ◽

...

Keyword(s):

Anastomotic Leaks

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778 Management of Colorectal Anastomotic leaks: The East of England Experience

British Journal of Surgery ◽

10.1093/bjs/znab134.578 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Aker ◽

A Askari ◽

M Rabie ◽

M Aly ◽

S Adegbola ◽

...

Keyword(s):

High Mortality ◽

Initial Treatment ◽

Surgical Intervention ◽

Management Strategies ◽

Treatment Modalities ◽

Anastomotic Leaks ◽

Consensus Approach ◽

Multi Centre Study ◽

Population Mortality ◽

Radiological Intervention

Abstract Introduction Colorectal anastomotic leaks (AL) are an unfortunate occurrence and are associated with a high mortality. The aim of this multi-centre study is to explore the different management strategies used and compare outcomes in the management of AL. Method All patients who had an AL were included at seven hospitals across the East of England. Morbidity, mortality, and survival were compared across the different management strategies. Results A total of 247 consecutive patients were included of which 60.3% were male and the median age was 68 (IQR 57-77). Half of patients were initially managed conservatively, a further 10.5% had a radiological procedure. 39.7% required surgery as an initial treatment. Of those who initially did not have a surgical intervention (n = 149), 10.7% (n = 16/149) eventually required laparotomy. Ultimately, 42.7% (n = 106/248) required a laparotomy. The 30- and 90-day across the entire population mortality were 3.6% and 4.9% respectively. There were no significant differences in mortality or long-terms survival between the different initial treatment modalities. Conclusions Despite initial conservative, antibiotic and radiological intervention being successful in the majority of patients, two out of five patients will still require a laparotomy. A consensus approach is required to standardise management in these difficult scenarios.

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P22 Are Elderly Patients at Increased Perioperative Morbidity and Mortality from Oesophagectomy for Oesophageal Cancer? A Systematic Mapping Review and Meta-Analysis

BJS Open ◽

10.1093/bjsopen/zrab032.021 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Rohan R Gujjuri ◽

Muhammed Elhadi ◽

Hamza Umar ◽

Manjunath S Subramanya ◽

Richard P T Evans ◽

...

Keyword(s):

Elderly Population ◽

Meta Analysis ◽

Disease Free Survival ◽

The Elderly ◽

Pulmonary Complications ◽

Cardiac Complications ◽

Anastomotic Leaks ◽

Free Survival ◽

Younger Patients ◽

Disease Free

Abstract Introduction Oesophagectomy is being increasingly performed in an ageing population that is observing a concomitant growth in the life expectancy. However, the risks are poorly quantified, and this study aims to review current evidence to further quantify the postoperative of oesophagectomy in the elderly population compared to younger patients. Methods A systematic electronic search was conducted for studies reporting oesophagectomy in the elderly population. Meta-analysis was performed using random-effects modelling to compute odds ratios (OR) and 95% confidence intervals (CI). Primary outcome was overall complications and secondary outcomes included anastomotic leaks, cardiac complications, pulmonary complications, overall and disease-free survival. Meta-regression was performed to identify study-, hospital- and patient-level factors confounding study findings. Results This review included 37 eligible studies involving 61,723 patients. Increasing age was significantly associated with increased rates of overall complications (OR: 1.67, CI 95%: 1.42 – 1.97), cardiac complications (OR: 1.62, CI 95%: 1.10 – 2.40), pulmonary complications (OR: 1.44, CI 95%: 1.11 – 1.87) and decreased 5-year overall survival (OR: 1.36, CI 95%: 1.11 – 1.66) and 5-year disease-free survival (OR: 1.66, CI 95%: 1.40 – 1.97). Rates of anastomotic leaks showed no difference between elderly and younger patients (OR: 1.06, CI 95%: 0.71 – 1.59). Conclusion Postoperative outcomes such as overall complications, 5-year overall survival and disease-free survival appear to significantly worse in all age cut-offs in this meta-analysis. Sarcopenia and frailty act as better predictors of postoperative outcomes than chronological age. This study confirms the preconceived suspicions of increased risks in elderly patients following oesophagectomy and will aid future pre-operative counselling and informed consent.

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