The Incidence and Mortality of Anastomotic Leakage after Colorectal Cancer Surgery

Abstract

Journal of Surgery IntroductionColorectal cancer is one of the most commonly diagnosed cancers worldwide. Its incidence increases with age and higher mortality rate is encountered in men [1]. Therapeutic approach refers to a complex surgical, chemo-and radiotherapy treatment.In spite of numerous surgical techniques developed in the last decades-including new mechanical stapler based methods-anastomotic leakage (AL) remains one of the most feared complications in colorectal surgery. Its incidence ranges from 1.5% to 16% for "per primam" anastomoses with frequent need for redo interventions, longer hospitalization and high mortality rates [2]. AL prediction and identification are still difficult due to its different clinical manifestations, varying from vague abdominal symptoms and prolonged postoperative ileus to fulminant abdominal pain in case of peritonitis and sepsis [3]. It is still a challenging task to distinguish early after surgery the developing septic process from the physiological inflammatory response; however, early diagnosis, before the appearance of clinical symptoms, remains essential for a long term survival [4]. The literature recognizes several risk factors for AL development such as diabetes, smoking, obesity, chronic kidney disease, cardiovascular diseases but facts are still contradictory [5][6][7]. According to several authors [8,9] characteristics of AL depend on many aspects: -The direction of the leakage has a major impact on the patient's symptoms; internal leakages are drained to organs such as the vagina, gallbladder or bladder and external leakages are drained through the teguments. AbstractIntroduction: Anastomotic leakage (AL) remains one of the most feared complications after colorectal surgery with high mortality rates, prolonged hospitalization, highly risk of readmission, finally generating important costs for any healthcare system. AL prediction and early detection are a considerable challenge for each surgeon as no wellestablished and reliable predictors and diagnosis protocols are currently available. Aims:To determine the incidence and mortality of AL after colorectal surgery, with identification of possible predictors and improvement points in the management of this complication. Material and methods:We included 431 patients with colorectal cancer who underwent surgical resection and restoration of the digestive tube's continuity, at the 2 nd Department of Surgery, Emergency County Clinical Hospital of Târgu-Mureș, from January 2010-December 2015. The patients have been divided in two groups: AL group including 21 patients and no leak group with 410 patients. Demographic characteristics and comorbidities were recorded with clinical and laboratory follow-up in the postoperative period.Results: There were no significant differences between the two groups in terms of demographic characteristics and comorbidities. The average age of patients with AL was 65.9 ± 11.6 vs. 65.0 ± 10.3 without AL. Male gender was predominant in both groups. No significant differences were recorde...