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TIMING AND OUTCOME OF RIGHT- VS LEFT-SIDED COLONIC ANASTOMOTIC LEAKS: IS THERE A DIFFERENCE?
L Hung, S Judeeba, I Sapci, AL Lightner, S Holubar, SR Steele, MA Valente
Cleveland Clinic Foundation

Background
Anastomotic leaks (AL) contribute to postoperative mortality, prolonged hospitalization, and increased health care costs. While left sided AL (LAL) are well described in the literature, there is a paucity of studies on outcomes and management of right-sided AL (RAL). This study aimed to compare the timing of LAL versus RAL, and the variable diagnosis, management and outcomes of LAL versus RAL. We hypothesized that the timing of RAL may be later compared to LAL and may result in worse outcomes.

Methods
Patients who underwent curative-intent surgery for neoplastic disease from January 1995 to December 2015 were included. Patients that underwent an anastomosis below the peritoneal reflection, neoadjuvant treatment, fecal diversion, previous colectomy/anastomosis, multiple anastomoses, and patients with inflammatory bowel disease or hereditary colorectal cancer syndromes were excluded. Patient demographics, neoplastic data, operative data, time to AL, methods utilized for diagnosis of AL, and management of AL were collected. The primary endpoint was timing of AL, and secondary endpoints were management and outcome based on RAL versus LAL. LAL and RAL were analyzed and compared using Chi-squared and categorical variables were expressed as number (percentage) and continuous variables expressed as median (interquartile range).

Results
A total of 2,223 patients underwent oncologic resection for colonic neoplasia (1,457 right-sided and 766 left-sided anastomoses). 67% of patients were male and the median age was 69 years (range, 34-91). There were 48 total AL events (2.16%): 22 LAL (2.87%) and 26 RAL (1.78%). There was no statistical difference in leak rates between LAL and RAL and no difference in time to diagnosis or management (Table 1). RAL had significantly decreased operative time (p=0.016), decreased intraoperative blood loss (p=0.002), and increased diagnosis by CT/radiograph (p=0.04). All patients that underwent surgery for leak had some form of fecal diversion performed. Morbidity and mortality were comparable between groups (p=0.70, p=1.0).

Conclusion
This study found overall very low AL rates with comparable timing of LAL and RAL, and no difference in management or outcome of LAL vs. RAL. These findings are informative for patient and surgeon expectations before and after surgery and when AL is suspected.


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