Safety of Primary Anastomosis Following Emergency Left Sided Colorectal Resection: an International, Multi-Centre Prospective Audit

Abstract

Introduction Some evidence suggests that primary anastomosis following left sided colorectal resection in the emergency setting may be safe in selected patients, and confer favourable outcomes to permanent enterostomy. The aim of this study was to compare the major postoperative complication rate in patients undergoing end stoma vs primary anastomosis following emergency left sided colorectal resection. MethodsA pre-planned analysis of the European Soci-ety of Coloproctology 2017 audit. Adult patients(>16 years) who underwent emergency (unplanned, within 24 h of hospital admission) left sided colonic orrectal resection were included. The primary endpoint was the 30-day major complication rate (Clavien-Dindograde 3 to 5).ResultsFrom 591 patients, 455 (77%) received an end stoma, 103 a primary anastomosis (17%) and 33 primary anastomosis with defunctioning stoma (6%). Inmultivariable models, anastomosis was associated with asimilar major complication rate to end stoma (adjustedodds ratio for end stoma 1.52, 95%CI 0.83–2.79,P=0.173). Although a defunctioning stoma was notassociated with reduced anastomotic leak (12% defunc-tioned [4/33]vs13% not defunctioned [13/97],adjusted odds ratio 2.19, 95%CI 0.43–11.02,P=0.343), it was associated with less severe complica-tions (75% [3/4] with defunctioning stoma, 86.7%anastomosis only [13/15]), a lower mortality rate (0%[0/4]vs20% [3/15]), and fewer reoperations (50%[2/4]vs73% [11/15]) when a leak did occur.ConclusionsPrimary anastomosis in selected patients appears safe after left sided emergency colorectal resection. A defunctioning stoma might mitigate against risk of subsequent complications.