Estimated Rate of Post-Operative Anastomotic Leak Following Colorectal Resection Surgery: A Systematic Review

Abstract

Purpose: Anastomotic leak following colorectal resection surgery is associated with short and long-term negative patient outcomes, prolonged hospitalization, and increased healthcare costs. Various patient related and surgical factors are known to contribute to the development of postoperative anastomotic leaks. This study systematically reviewed the literature to assess the incidence of post-operative leak and identify patient factors associated with the development of leaks. Methods:Articles published from 1/1/2003 -8/8/2015 reporting on post-operative anastomotic leak following colorectal resection surgery were identified in the Medline and Embase databases. The rate of post-operative leak, as well as patient and surgical characteristics, were extracted.Results: Forty-three articles met study inclusion criteria. Within the 14,102 cases, 867 patients experienced anastomotic leak, yielding an average leak rate of 6.1%. Patients were primarily male (57.0%) and had a mean age of 60.2 years. The majority of patients received a stapled anastomosis (70.9%), and most resection surgeries were performed for a diagnosis of cancer (80.7%). Comparison of patient characteristics with and without a post-operative leak revealed male gender, diabetes, open surgical procedures, and sutured anastomoses to be risk factors of anastomotic leak. Patients with anastomotic leak had a longer length of stay in the hospital and higher mortality rate than patients without a leak. Conclusions:Anastomotic leak remains a major concern in colorectal resection surgery and occurs in approximately 6.1% of cases. Both patient and surgical factors are associated with the development of post-operative anastomotic leak, which is linked to negative patient outcomes and increased mortality.

The Clinical and Economic Burden of Colorectal Anastomotic Leaks: Middle-Income Country Perspective

“…An anastomotic leak (AL) is one of the most serious surgical complications that can develop following colorectal surgery [1]. In two recent systematic reviews, the AL rate varied from 4% to 9% [2, 3]. In the review that considered only low anterior resection (LAR) studies, the pooled overall rate of AL was found to be 8.88% [3].…”

“…In two recent systematic reviews, the AL rate varied from 4% to 9% [2, 3]. In the review that considered only low anterior resection (LAR) studies, the pooled overall rate of AL was found to be 8.88% [3]. Several risk factors for the occurrence of AL have been identified, including male sex, diabetes mellitus, use of tobacco, blood loss, perioperative transfusion, operative time, preoperative chemoradiation, previous abdominal surgery, and emergency surgery [3–17].…”

“…In the review that considered only low anterior resection (LAR) studies, the pooled overall rate of AL was found to be 8.88% [3]. Several risk factors for the occurrence of AL have been identified, including male sex, diabetes mellitus, use of tobacco, blood loss, perioperative transfusion, operative time, preoperative chemoradiation, previous abdominal surgery, and emergency surgery [3–17]. On the other hand, protective stoma could reduce the occurrence of AL or reduce the severity of the AL complication [16, 17], although its routine usage shows contradictory results [18].…”

Diagnosis and Management of Intraoperative Colorectal Anastomotic Leaks: A Global Retrospective Patient Chart Review Study

“…This reflects practical experience in that most leaks are detected during the first 10 days after surgery and, thus, close monitoring of patients is required during this period in order to detect complications as early as possible [19, 28]. In this study, the intraoperative creation of a new anastomosis after a leak during surgery appeared to increase the patients' risk of a postoperative leak compared to estimates in the literature [12]. However, these findings have to be interpreted with caution owing to the inclusion criteria of the incidence of intraoperative leaks and the low overall number of subjects with postoperative leaks.…”

“…Furthermore, the evidence suggests that laparoscopic surgery may be advantageous compared to open surgery [4–10]. In particular, postoperative anastomotic leaks have been found to occur less frequently after laparoscopic surgery than after open surgery [11, 12]. However, these findings remain controversial, as other studies did not observe a significant advantage of laparoscopic versus open surgery or of stapled versus sutured anastomoses [13–18].…”