title: Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients.
abstract: BACKGROUND
  Studies focused on postoperative outcome after oncologic right colectomy are lacking. The main objective was to determine pre-/intraoperative risk factors for anastomotic leak after elective right colon resection for cancer. Secondary objectives were to determine risk factors for postoperative morbidity and mortality.
  
  
  METHODS
  Fifty-two hospitals participated in this prospective, observational study (September 2011-September 2012), including 1102 patients that underwent elective right colectomy. Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak and postoperative morbidity and mortality.
  
  
  RESULTS
  Anastomotic leak was diagnosed in 93 patients (8.4 %), and 72 (6.5 %) of them needed radiological or surgical intervention. Morbidity, mortality, and wound infection rates were 29.0, 2.6, and 13.4 %, respectively. Preoperative serum protein concentration was the only independent risk factor for anastomotic leak (p < 0.0001, OR 0.6 per g/dL). When considering only clinically relevant anastomotic leaks, stapled technique (p = 0.03, OR 2.1) and preoperative serum protein concentration (p = 0.004, OR 0.6 g/dL) were identified as the only two independent risk factors. Age and preoperative serum albumin concentration resulted to be risk factors for postoperative mortality. Male gender, pulmonary or hepatic disease, and open surgical approach were identified as risk factors for postoperative morbidity, while male gender, obesity, intraoperative complication, and end-to-end anastomosis were risk factors for wound infection.
  
  
  CONCLUSIONS
  Preoperative nutritional status and the stapled anastomotic technique were the only independent risk factors for clinically relevant anastomotic leak after elective right colectomy for cancer. Age and preoperative nutritional status determined the mortality risk, while laparoscopic approach reduced postoperative morbidity.
authors: Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain. dr.frasson.matteo@gmail.com.
authors: Matteo
authors: M
authors: Frasson
authors: Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.
authors: Pablo
authors: P
authors: Granero-Castro
authors: Department of General Surgery, Hospital Universitario de Getafe, Madrid, Spain.
authors: José Luis
authors: JL
authors: Ramos Rodríguez
authors: Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.
authors: Blas
authors: B
authors: Flor-Lorente
authors: Department of General Surgery, Complejo Hospitalario Universitario Insular Gran Canaria, Las Palmas de Gran Canaria, Spain.
authors: Mariela
authors: M
authors: Braithwaite
authors: Department of General Surgery, Hospital Dr. Peset, Valencia, Spain.
authors: Eva
authors: E
authors: Martí Martínez
authors: Department of General Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Jose Antonio
authors: JA
authors: Álvarez Pérez
authors: Department of General Surgery, Hospital Universitario Josep Trueta, Girona, Spain.
authors: Antonio
authors: A
authors: Codina Cazador
authors: Department of General Surgery, Hospital Clínico Universitario, Valencia, Spain.
authors: Alejandro
authors: A
authors: Espí
authors: Department of General Surgery, Digestive Surgery Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Valencia, Spain.
authors: Eduardo
authors: E
authors: Garcia-Granero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology* / Q000401:mortality*; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000601:surgery*; D003710:Demography; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D011184:Postoperative Period; D011446:Prospective Studies; D012307:Risk Factors
keywords: Anastomotic leak; Colon cancer; Colon resection; Colorectal surgery; Ileocolic anastomosis; Postoperative complication; Postoperative mortality; Primary anastomosis; Right colectomy; Wound infection