Predictors of complications and mortality following left colectomy.


eMediNexus Editorial    21 June 2018

Data relating morbidity-mortality after left colectomy is rare and are non-explanatory.

The aim of a new study published in the Colorectal Disease was to identify risk factors associated with anastomotic leak, perioperative mortality and complications following left colectomy for colonic malignancies.

The present study undertook a STROBE-compliant analysis of left colectomies included in the National prospective online database. Here, 42 variables were analyzed as potential independent risk factors for anastomotic leak, post-operative morbidity and mortality. Overall 1,111 patients were assessed.

The findings revealed that 8% of these patients developed leaks while reoperation or surgical drainage were required for 80% of the leakages. At least one minor complication was reported in 24.9% of the patients. Meanwhile, perioperative mortality was 2%, of which, 47.6% occurred due to leakage. Obesity and total parenteral nutrition (TPN) were associated with increased risk of leak, whereas female patients had a lower predisposition to leakage. Additionally, corticosteroids and oral anticoagulants doubled the risk for complications, which was lower with hyperlipidemia. Patients on TPN had more complications and higher mortality. Furthermore, liver disease and advanced age impaired survival, while corticosteroids therapy was the strongest predictor of mortality.

From the findings, it was inferred that requiring TPN was associated with more leaks, complications and mortality. Leakages were responsible for almost half of the deaths. Hyperlipidemia and female gender were associated with lower rates of complications. Thus, it was suggested that a better understanding of metabolic status on perioperative outcome after left colectomy is warranted.

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