Does Hepatic Pedicle - Clamping Increase the Risk of Colonic Anastomotic Leak after Combined Hepatectomy and Colectomy? An Analysis of the ACS-NSQIP Database

Abstract

Introduction: Hepatic pedicle clamping (HPC) is frequently used to minimize blood loss during liver parenchymal transection; this may cause intestinal hypoperfusion and is considered a possible risk factor for colonic anastomotic leak. The objective is to determine the effect of HPC on the risk of colonic anastomotic leak in patients undergoing combined hepatectomy and colectomy. Methods: Patients undergoing combined hepatectomy and colectomy for liver-only metastatic colorectal cancer from 2014 to 2018 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Organ space infection was used as a surrogate for anastomotic leak. 1:1 Coarsened exact matching for age, body mass index, ASA score, diabetes, smoking, wound class, colectomy type, hepatectomy type, and diverting stoma was performed. A multivariate logistic regression of the unmatched data was also performed. Results: 549 patients were identified, of which 130 (23%) underwent HPC. Only 34 patients (6.2%) underwent a diverting stoma. 91 patients (17%) had organ space infections. Among 218 patients in the matched cohort, there was no difference in organ space infections among patients with or without HPC (17.4% [95% CI=10.2-24.6] vs. 14.7% [95% CI=7.9-21.4], p=0.58). Likewise, there was no difference in the odds of organ space infection in patients with and without HPC on multivariate logistic regression (adjusted OR=1.1, 95% CI=0.64-1.91, p=0.72). Conclusions: HPC was not found to be associated with organ space infection, which covaries with colonic anastomotic leak, in patients undergoing combined hepatectomy and colectomy. Table: Outcome data in the unmatched cohortTabled 1No Hepatic Pedicle Clamping (n=419)Hepatic Pedicle Clamping (n=130)Superficial surgical site infection25 (6%)3 (2.3%)Deep surgical site infection4 (1%)3 (2.3%)Organ space infection65 (15.5%)26 (20%)Wound dehiscence7 (1.7%)3 (2.3%)Pneumonia18 (4.3%)7 (5.4%)Bleeding requiring transfusion107 (25.5)31 (23.8%)Infectious complication113 (27%)39 (30%)Bile leak32 (7.6%)17 (13.1)Postoperative liver failure21 (5%)10 (7.7%) Open table in a new tab