Anastomotic Leak in Colorectal Surgery: Predictive Factors and Survival

Prabhakaran, S; Prabhakaran, S; Lim, WM; Guerra, G; Heriot, A; Kong, J

Author(s): Prabhakaran, S; Prabhakaran, S; Lim, WM; Guerra, G; Heriot, A; Kong, J;
Details: Publication Year 2023-09-30,Volume 95,Issue #5,Page 56-64
Journal Title: Polish Journal of Surgery
Publication Type: Research article
Abstract: IntroductionAnastomotic leak (AL) is a serious complication following colorectal surgery. This study aimed to identify factors associated with the development of AL and analyze its impact on survival.Materials and MethodsAll consecutive adult colorectal cancer resections with curative intent and anastomosis formation were included from a prospectively maintained bi-national database between 2007 and 2020. The primary outcome measure was the rate of AL. The secondary outcome measure was 5-year overall survival (OS).ResultsThere were 7566 eligible patients. The rate of AL was 2.3% and 4.4% in patients with colon and rectal cancer respectively. AL was a significant independent predictor of reduced 5-year OS in patients who underwent curative surgery for rectal cancer (Odds ratio 1.999, p = 0.017). Emergency surgery (p = 0.013), surgery at a public hospital (p < 0.01), and an open surgical approach (p = 0.002) were all significantly associated with a higher risk of AL in patients with colon cancer, with higher rates of AL noted in left colectomies as compared to right hemicolectomies (6.8% vs 1.6%, p < 0.05). In rectal cancer patients, ultra-low anterior resections had the highest risk of AL (4.6%), and associations were found with neoadjuvant chemotherapy (p = 0.011), surgery in a public hospital (p = 0.019), and an open approach (p = 0.035). Anastomosis formation technique (hand-sewn vs stapled) did not impact on rate of AL.DiscussionClinicians should be cognizant of the predictive factors for AL and consider early intervention for patients at risk of this.
Keywords: Adult; Humans; Anastomotic Leak/etiology; *Colorectal Surgery; Risk Factors; Colon/surgery; Anastomosis, Surgical/methods; *Rectal Neoplasms/surgery; Retrospective Studies; Colorectal cancer; anastomotic leak; colon cancer; predictive factors; rectal cancer
Department(s): Surgical Oncology; Laboratory Research
PubMed ID: 36808047
Publisher's Version: https://doi.org/10.5604/01.3001.0016.1602
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-08-20 06:17:46

Last Modified: 2024-08-20 06:56:39