High incidence of colic anastomotic leakage complicating upper abdominal en bloc evisceration for cancer: a 47-patient series.
OBJECTIVE
The purpose of this study was to analyze the early outcome of en bloc extended resection for upper abdominal locally advanced cancer.


METHODS
A retrospective medical chart review was performed in 47 consecutive patients who underwent an upper abdominal en bloc resection for cancer involving multiple organs or structures at Paoli-Calmettes Institute and Conception Hospital from October 1988 through April 1997. A third of patients underwent a resection of 4 sus mesocolic organs or more.


RESULTS
The postoperative morbidity and mortality rate were respectively, 57% and 19%. Despite a high number of theoretically risky procedures including pancreatic resection and pancreatojejunostomy, total gastrectomy and esophagojejunostomy, total hepatectomy and liver transplantation, the higher percentage of complication was found with colic anastomosis. Five of the 30 patients (17%) who underwent a colic anastomosis developed a colic anastomotic leakage, 4 patients were reoperated and 2 patients died.


CONCLUSIONS
Because of this unacceptably high rate of complications, we propose to systematically perform a protective stoma when an upper abdominal evisceration includes a colic anastomosis.
Department of Oncologic Surgery, Institut Paoli-Calmettes, 232 bd de Sainte Marguerite Marseille, France.
V
V
Moutardier
O
O
Turrini
B
B
Lelong
J
J
Hardwigsen
G
G
Houvenaeghel
Y P
YP
Le Treut
J R
JR
Delpero
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003110:Colonic Neoplasms / Q000601:surgery; D004067:Digestive System Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery