Dan Andras

Background: Anastomotic leakage (AL) remains one of the most feared complications after colorectal surgery. This study aimed to identify preoperative risk factors for AL using a five-year dataset from two Romanian surgical clinics. Materials and Methods: A retrospective cohort of 155 patients undergoing colorectal resection with primary anastomosis (105 from “Colentina” Hospital and 50 from “Dr. I. Cantacuzino” Hospital) was analyzed. Preoperative demographic, clinical, and laboratory data were extracted and assessed using univariate and multivariable logistic regression. Statistical analyses were performed using IBM SPSS. Results: The overall AL rate was 10.3%. Multivariable analysis identified high ASA class (OR 17.6; p = 0.001), emergency surgery (OR 32.2; p = 0.0007), and heavy alcohol use (OR 15.3; p = 0.004) as independent predictors of leakage. While low preoperative albumin and smoking were associated with leakage in a bivariate analysis, these did not remain significant after adjustment. Notably, all laboratory markers were based on preoperative values, distinguishing our approach from prior studies that commonly evaluated postoperative biomarkers. No statistically significant effect was found for neoadjuvant chemotherapy or radiotherapy after controlling for other covariates. Conclusions: High ASA score, alcohol abuse, and emergency surgery were the strongest independent predictors of AL in our cohort. The lack of predictive power of certain widely reported factors, such as low albumin, may reflect our dataset’s focus on preoperative optimization. These findings support the use of individualized risk assessment and reinforce the role of preoperative preparation in reducing leak incidence in colorectal surgery.

Background: Anastomotic leakage (AL) remains one of the most feared complications after colorectal surgery. This study aims to identify preoperative risk factors for AL using a five-year dataset from two Romanian surgical clinics. Matherial and Methods: A retrospective cohort of 155 patients undergoing colorectal resection with primary anastomosis (105 from “Colentina” Hospital and 50 from “Dr. I. Cantacuzino” Hospi-tal) was analyzed. Preoperative demographic, clinical, and laboratory data were ex-tracted and assessed using univariate and multivariable logistic regression. Statistical analyses were performed using IBM SPSS. Results: The overall AL rate was 10.3%. Multivariable analysis identified high ASA class (OR 17.6; p = 0.001), emergency sur-gery (OR 32.2; p = 0.0007), and heavy alcohol use (OR 15.3; p = 0.004) as independent predictors of leakage. While low preoperative albumin and smoking were associated with leakage in bivariate analysis, these did not remain significant after adjustment. Notably, all laboratory markers were based on preoperative values, distinguishing our approach from prior studies that commonly evaluate postoperative biomarkers. No statistically significant effect was found for neoadjuvant chemotherapy or radiother-apy after controlling for other covariates. Conclusions: High ASA score, alcohol abuse, and emergency surgery were the strongest independent predictors of AL in our cohort. The lack of predictive power of certain widely reported factors, such as low albumin, may reflect our dataset’s focus on preoperative optimization. These findings support the use of individualized risk assessment and reinforce the role of preoperative prepa-ration in reducing leak incidence in colorectal surgery.

Despite the substantial decrease in mortality rates following a pancreaticoduodenectomy to less than 5%, morbidity rates remain significant, reaching even 73%. Postoperative pancreatic fistula is one of the most frequent major complications and is significantly associated with other complications, including patient death. Currently, there is no consensus regarding the ideal type of pancreatic anastomosis, as the question of the choice between a pancreaticogastrostomy and pancreaticojejunostomy is still open. Furthermore, worldwide implementation of an ideal pancreatic fistula risk prediction score is missing. Our study found several significant predictive factors for the postoperative occurrence of fistulas, such as the soft consistency of the pancreas, non-dilated Wirsung duct, important intraoperative blood loss, other perioperative complications, preoperative patient hypoalbuminemia, and patient weight loss. Our study also revealed that for patients who exhibit fistula risk factors, pancreaticogastrostomy demonstrates a significantly lower pancreatic fistula rate than pancreaticojejunostomy. The occurrence of pancreatic fistulas has been significantly associated with the development of other postoperative major complications, and patient death. As the current pancreatic fistula risk scores proposed by various authors have not been consensually validated, we propose a simple, easy-to-use, and sensitive score for the risk prediction of postoperative pancreatic fistula occurrence based on important predictors from statistical analyses that have also been found to be significant by most of the reported studies. The new pancreatic fistula risk score proposed by us could be extremely useful for improved therapeutic management of cephalic pancreaticoduodenectomy patients.