Computed tomography in suspected anastomotic leakage after colorectal surgery: evaluating mortality rates after false-ne
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ORIGINAL ARTICLE
Computed tomography in suspected anastomotic leakage after colorectal surgery: evaluating mortality rates after false-negative imaging Nicolò Tamini1,2 · Diletta Cassini3 · Alessandro Giani1,2 · Marco Angrisani1,2 · Simone Famularo1,2 · Massimo Oldani1,2 · Mauro Montuori1,2 · Gianandrea Baldazzi3 · Luca Gianotti1,2 Received: 31 October 2018 / Accepted: 30 January 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purposes We sought to investigate the accuracy of abdominal CT scanning for anastomotic leakage and the effect of falsenegative scans on the delay in therapeutic intervention and clinical outcome. Method Data from a prospectively bi-institutionally maintained database of all patients who underwent elective colorectal surgery with primary anastomosis for malignant or benign disease between 2010 and 2017 were reviewed. Patients with confirmed anastomotic dehiscence at reintervention who underwent a postoperative CT scan for suspected leakage were identified and radiological reports were retrieved. Results Seventy-six patients with anastomotic dehiscence were included in the study. American Society of Anesthesiologists score, sex, type of surgical procedure, malignancy, and type of anastomosis do not correlate with postoperative false-negative CT imaging. Postoperative false-negative CT scan, however, led to delayed reintervention (3 vs. 6 h, p = 0.023) and increased mortality (five deaths vs. no deaths, p = 0.043). Free abdominal air (p = 0.001) and extraluminal contrast extravasation (p = 0.001) were found to be predictive of accuracy in anastomotic leakage diagnosis. Conclusion The suboptimal specificity of a postoperative CT scan in suspected anastomotic leakage after colorectal surgery can delay reintervention and increase mortality. Keywords Colorectal surgery · Computed tomography · Anastomotic leakage · Deischence
Introduction Anastomotic leakage (AL) is the most important complication after colorectal surgery, with an incidence of 3–28% and a mortality rate of 7–39% [1]. Early detection of AL followed by timely reintervention is critical to reduce mortality rates. It has been widely demonstrated in the literature that male sex, advanced age, low anastomosis, malignant disease, high American Society of Anesthesiologists (ASA) score, long operative time, emergency operation, preoperative
* Nicolò Tamini [email protected] 1
Department of Surgery, San Gerardo Hospital, Monza, Italy
2
School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
3
Policlinic of Abano Terme, Padua, Italy
radiotherapy, and perioperative loss or transfusion are the most frequent factors for AL [2–4]. At this time, the diagnostic methods that are commonly used when a leakage is suspected are computed tomography (CT) scan, contrast enema, endoscopic examination, and reoperation [5]. The preferred imaging tool for the detection of AL is abdominal CT because such provides a more precise image of the anastomosis and perianastomotic structures in
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