RESULTS
The study population consisted of 40 patients. Mean age was 52.3 ± 12.3
years. The most common type of malignancy was ovarian cancer (70.0%).
78.5% of the patients were operated for primary debulking purpose.
12.5% (5/40) of the patients suffered an AL. The clinical
characteristics of the study population were shown in Table 1.
The most common operation was rectosigmoid resection (67.5%). The mean
operation time was 367.6 ± 122.3 minutes. A protective ostomy was opened
in 7.5% (3/40) of the patients. Anastomosis was most frequently
performed with stapler devices (33/40, 82.5%). In addition to
intestinal anastomosis; peritonectomy, splenectomy, appendectomy, and
lymph node (pelvic and/or paraaortic) resection were also performed in
57.5%, 10.0%, 50.0%, 67.5% of the patients, respectively (Table 2).
In both groups, PCT values tended to decrease until POD 7. Although
the PCT values started to increase from the POD 7 through POD 8-9 in
the leak group, they remained stable in the no leak group. The albumin
decrease starting from POD 1 to POD 4 was observed in the leak group
while it remained nearly stable in the no leak group through the first
10 days postoperatively. The change of mean PCT and albumin values in
anastomotic leak and no leak groups within 10 days postoperatively was
shown in Figures 1 and 2.
Postoperative 10-day PCT, albumin and platelet values were compared in
the group with and without AL. There was a statistically significant
difference between the albumin values on POD 3 (p=0.028), on POD 4
(p=0.045) and the platelet values on POD 1 (p<0.001). The mean
albumin values on POD 3-4 and the mean platelet values on POD 1 were
lower in the AL group. Although it was not statistically significant
(p>0.05), median PCT values (ng/mL) on POD 8, 9 and 10 were
higher in the AL group compared with no leak group (Table 3). The best
cutt-off point for PCT on POD 9 was determined to be 0.11 ng/mL (AUC:
0.917, Sensitivity = %100.0, specifity = %66.7, positive predictive
value = %66.7, negative predictive value = %100.0). Postoperative
10-day CRP, leukocyte, neutrophil, leukocyte ratio neutrophil (L/N) and
fever values were also compared in the group with and without AL, and
no statistically significant difference was found (p> 0.05)
(not shown in the table).
In 4 of 5 patients with AL, peritonectomy was added to the debulking
procedure. Due to severe peritonitis, 4 patients were re-operated on POD
8-10 and the leakage was classified as major. The other patient was
discharged on POD 10 before the diagnosis of AL, and re-hospitalized on
POD 15 for a rectovaginal fistula. That patient was followed
conservatively up to 2 months untill the fistula closed on its own which
provided to classify the leakage as minor. One of the patients with AL
died of multiorgan failure on POD 20. That patient was operated for
endometrial carcinosarcoma and in the removal of omental cake,
transverse colectomy and anastomosis was performed with handsewn
technique. Clinical and surgical details of the 5 patients with AL were
detailed in Table 4.