Preoperative risk factors associated with anastomotic leakage after colectomy for colorectal cancer: a systematic review and meta-analysis

Abstract

Introduction: anastomotic leak (AL) after colectomy for colorectal cancer (CRC) is a life-threatening complication. This systematic review and meta-analysis aimed to evaluate the preoperative risk factors for AL in patients submitted to colectomy. Methods: the bibliographic search covered 15 years and 9 months, from 1st January 2005 to 19th October 2020 and was performed using PubMed, Cochrane Library, Scopus, Biblioteca Virtual em Saúde, Europe PMC and Web of Science databases. The inclusion criteria were cross-sectional, cohort and case-control studies on preoperative risk factors for AL (outcome). The Newcastle-Ottawa scale was used for bias assessment within studies. Meta-analysis involved the calculation of treatment effects for each individual study including odds ratio (OR), relative risk (RR) and 95% confidence intervals (95% CI) with construction of a random-effects model to evaluate the impact of each variable on the outcome. Statistical significance was set at p<0.05. Results: cross-sectional studies were represented by 39 articles, cohort studies by 21 articles and case-control by 4 articles. Meta-analysis identified 14 main risk factors for AL in CRC patients after colectomy, namely male sex (RR=1.56; 95% CI=1.40-1.75), smoking (RR=1.48; 95% CI=1.30-1.69), alcohol consumption (RR=1.35; 95% CI=1.21-1.52), diabetes mellitus (RR=1.97; 95% CI=1.44-2.70), lung diseases (RR=2.14; 95% CI=1.21-3.78), chronic obstructive pulmonary disease (RR=1.10; 95% IC=1.04-1.16), coronary artery disease (RR=1.61; 95% CI=1.07-2.41), chronic kidney disease (RR=1.34; 95% CI=1.22-1.47), high ASA grades (RR=1.70; 95% CI=1.37-2.09), previous abdominal surgery (RR=1.30; 95% CI=1.04-1.64), CRC-related emergency surgery (RR=1.61; 95% CI=1.26-2.07), neoadjuvant chemotherapy (RR=2.16; 95% CI=1.17-4.02), radiotherapy (RR=2.36; 95% CI=1.33-4.19) and chemoradiotherapy (RR=1.58; 95% CI=1.06-2.35). Conclusions: important preoperative risk factors for colorectal AL in CRC patients have been identified based on best evidence-based research, and such knowledge should influence decisions regarding treatment.

Urgency Index and Preoperative Index: Prediction of Anastomotic Leakage in Patients Operated For Colorectal Cancer Treatment

“…To perform the Preoperative Index, we used the result of a meta-analysis [9] that studied the preoperative RF for the occurrence of AL in patients operated on to treat CRC (Table 1). The Index, which contains [10] variables, was applied to the patients of the cohort for its validation.…”

“…The FRs from the meta-analysis [9] were used to construct the Preoperative Index. The neoadjuvant chemoradiotherapy variable was excluded since the variables neoadjuvant chemotherapy and radiotherapy in isolation achieved statistical difference.…”

“…(Source: Dias, et al[9]) ASA: American Society of Anesthesiologists, COPD: Chronic Obstructive Pulmonary Disease, CI: 95% confidence interval, RR: relative risk…”

The role of dietary prehabilitation on anastomotic healing

“…Risk factors for anastomotic leak have been identified by several groups and include radiation exposure, obesity, male gender, smoking, blood loss and the presence of diabetes [24]. Each and every one of these risk factors have been demonstrated to have a major effect on the composition and function of the gut microbiome and a major influence on the incidence of colorectal cancer (CRC) [25].…”

Development and Validation of a Mobile Application for Predicting the Risk of Anastomotic Leakage in Patients Operated for the Treatment of Colorectal Cancer

“…In the modeling stage, the content of the application was defined and the way in which it should be presented to the target audience. The contents are two indices for the prognosis of AL in patients operated on for the treatment of CRC: preoperative index derived from the metaanalysis [14] and the urgency index performed from a historical cohort [14,15]. The preoperative index contains 13 variables, while the urgency index has four, all of which are risk factors for the occurrence of AL.…”