Facteurs de risque de survenue de fistules anastomotiques après resection antérieure pour adenocarcinoma du rectum
Mots-clés :
Fistule anastomotique, cancer rectal, adenocarcinoma, morbidité, radiothérapieRésumé
Prérequis : La fistule anastomotique (FA) est une cause importante de morbidité après chirurgie pour cancer rectal. But: Analyser les facteurs de risque associés à la survenue de FA après résection antérieure pour adénocarcinome du rectum.
Méthodes: Nous avons collecté les données de tous les patients qui ont eu une résection antérieure pour adénocarcinome du rectum à la Clinique Chirurgicale C (Hôpital Ibn Sina. Rabat, Maroc), entre janvier 2001 et décembre 2010. Les associations entre les variables et la FA ont été analysées en uni et multivariée.
Résultats : Notre travail a inclus 130 patients. Une FA est survenu chez 28 patients (21.5%). Les analyses uni et multivariées ont montré que le taux de FA était significativement supérieur après radiothérapie néoadjuvante (34.2% vs. 12 %, p = 0.002 – OR 3.8 – CI 95%: 1.5 – 9.4). Il n'y avait de différence significative dans le taux de FA entre les patients avec et sans stomie de protection. Dans le groupe des patients avec FA, le taux de réinterventions était significativement inférieur en cas de stomie de protection (31.8% vs. 83.3%, p = 0.04).
Conclusion : La radiothérapie est un facteur de risque de survenue de FA. La confection systématique d'une stomie de protection chez les patients recevant une radiothérapie néoajuvante est conseillée afin de réduire le taux de réinterventions associées au FA
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