Clinical Factors Contributing to Anastomotic Leak After Mid-to-High Colorectal Anastomosis

Abstract

Background Low colorectal anastomoses carry a high anastomotic leak (AL) rate (up to 20%) and thus are commonly diverted. Much less is known about mid-to-high colorectal anastomosis, which carries a leak rate of 2-4%. The objective of this study was to determine our AL rate after mid-to-high colorectal anastomosis and associated risk factors. Methods A single center retrospective cohort study of patients undergoing left colonic resections with mid-to-high colorectal anastomosis (≥7 cm from the anal verge) from January 2008 to October 2017 was utilized. Main outcome, AL, defined as clinical suspicion supported by radiological or intraoperative findings, was calculated and risk factors assessed using multivariable logistic regression analysis. Results 977 patients were included; 487 (49.9%) were male, with a mean age of 59.8 (+/−12.1) years. Mean BMI was 27.5 (+/−5.5) kg/m2. Diverticular disease (67.5%), malignancy (17.4%), and inflammatory bowel disease (2.2%) were the main indications for resection. Mean length of stay was 6.7 (+/−4.5) days. 455 (46.8%) colonic resections were performed by laparoscopy, 283 (29.1%) by hand assisted surgery, 219 (22.5%) by laparotomy, and 16 (1.6%) by robotics. Majority of patients had complete donuts (99.6%) and a negative air leak test (97.7%). 149 patients (15.3%) underwent construction of a diverting stoma. The overall AL rate was 2.1% (n = 20). Increased BMI (>30 kg/m2), P = .02, was an independent risk factor for AL and a trend observed for positive air leak tests ( P = .05), with other factors failing to achieve statistical significance. Conclusions Patients with mid-to-high colorectal anastomosis have a 2% AL risk. Increased BMI was a risk factor for AL.

Comprehensive abdominal composition evaluation of rectal cancer patients with anastomotic leakage compared with body mass index-matched controls

“…Related studies have demonstrated that BMI, an easily available and most commonly used index of obesity, is a risk factor for AL in rectal cancer patients who received anterior resection. However, other studies have reported contrary reports[ 24 , 25 ]. Considering that BMI cannot distinguish between the content and distribution of fat and skeletal muscle, it is imperative to explore whether fat and skeletal muscle content or distribution potentially impacts the development of AL.…”