Trends in risk factors of anastomotic leakage after colorectal cancer surgery (2011–2019): A Dutch population‐based study

Arron, Melissa; Greijdanus, Nynke G.; Broek, Richard P. G. ten; Dekker, Jan Willem T.; Workum, Frans van; Goor, Harry van; Tanis, Pieter J.; Wilt, Johannes H. W. de

doi:10.1111/codi.15911

Cited by 25 publications

(27 citation statements)

References 41 publications

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“…Jannasch et al found in their study that leakage was 1.7 times more frequent in men [ 21 ]. Anastomosis in the narrower male pelvis results in more difficult resection for men, in both open and laparoscopic colorectal surgery [ 24 ]. In a recent study of 429 patients with rectal resections and colorectal anastomosis, the authors found male gender (OR 3.8; 95% CI 1.9−7.7; p < 0.001) to be an independent variable associated with increased AL rate [ 25 ].…”

Section: Preoperative Risk Factorsmentioning

confidence: 99%

“…The American Society of Anesthesiologists (ASA) score has been shown to be a significant risk factor for postoperative fistula in some studies [ 31 , 32 ]. An ASA grade equal or greater than 3 was reported to be an independent risk factor for anastomotic leakage [ 16 , 21 , 24 , 33 ]. The presence of comorbid conditions in patients who underwent colorectal surgery was shown to be a risk factor for leakage.…”

Section: Preoperative Risk Factorsmentioning

confidence: 99%

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Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Zarnescu

Costea

2021

Diagnostics

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Anastomotic leakage is a potentially severe complication occurring after colorectal surgery and can lead to increased morbidity and mortality, permanent stoma formation, and cancer recurrence. Multiple risk factors for anastomotic leak have been identified, and these can allow for better prevention and an earlier diagnosis of this significant complication. There are nonmodifiable factors such as male gender, comorbidities and distance of tumor from anal verge, and modifiable risk factors, including smoking and alcohol consumption, obesity, preoperative radiotherapy and preoperative use of steroids or non-steroidal anti-inflammatory drugs. Perioperative blood transfusion was shown to be an important risk factor for anastomotic failure. Recent studies on the laparoscopic approach in colorectal surgery found no statistical difference in anastomotic leakage rate compared with open surgery. A diverting stoma at the time of primary surgery does not appear to reduce the leak rate but may reduce its clinical consequences and the need for additional surgery if anastomotic leakage does occur. It is still debatable if preoperative bowel preparation should be used, especially for left colon and rectal resections, but studies have shown similar incidence of postoperative leak rate.

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Section: Preoperative Risk Factorsmentioning

confidence: 99%

Section: Preoperative Risk Factorsmentioning

confidence: 99%

Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Zarnescu

Costea

2021

Diagnostics

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“…Anastomotic leakage (AL) after LAR for rectal cancer remains a highly prevalent complication with serious consequences and leads to increased morbidity, increased risk of reinterventions, increased 90-day mortality in elderly patients, increased permanent stoma rates, and decreased quality of life. [1][2][3][4][5][6] In contrast to numerous studies on risk factors and prevention of anastomotic leakage, little is known about how to effectively treat AL after LAR.…”

Section: Introductionmentioning

confidence: 99%

International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: a case-vignette study

Talboom

Greijdanus²,

Workum³

et al. 2022

Int J Colorectal Dis

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Purpose Little is known about the optimal treatment of anastomotic leakage after low anterior resection (LAR) for rectal cancer and whether treatment strategy depends on leakage features and patient characteristics. The objective of this study was to determine which treatment principles are used by expert colorectal surgeons worldwide. Methods In this international case-vignette study, participants completed a survey on their preferred treatment for 11 clinical cases with varying leakage features and two patient scenarios depending on surgical risk (a total of 22 cases). Results In total, 42 of 64 invited surgeons completed the survey from 18 countries worldwide. The majority worked at a university training hospital (62%) and had more than 15 years of experience performing LAR for rectal cancer (52%). Early leaks in septic patients were preferably treated by major salvage surgery, to some extent depending on the patient scenario. In early leaks in non-septic patients, drainage and faecal diversion were the cornerstones of the proposed treatment. Endoscopic vacuum therapy was more often proposed than percutaneous drainage. A minority proposed anastomotic reconstruction, more often for larger defects. Treatment of late leaks ranged from watchful waiting, drainage, or transanal repair to major (non-)restorative salvage surgery, with minimal influence of the degree of symptoms on the proposed strategy. Leaks of the blind loop and rectovaginal fistulae showed high variability in the proposed treatment strategy. Conclusion This TENTACLE-Rectum case-vignette study demonstrates tailored treatment strategies depending on the clinical type of leak and patient characteristics, with variable degrees of consensus and knowledge gaps which should be addressed in future studies.

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“…Male gender has often been reported as an independent risk factor for leakage in colorectal [16,17,[20][21][22]. A multivariate analysis performed by Lipska et al in New Zealand revealed that among patients undergoing anastomoses involving the colon and rectum, male patients had a higher incidence of AL than female patients, with an OR of 3.5 [16].…”

Section: Gendermentioning

confidence: 99%

Factors Contributing to Anastomotic Leakage Following Colorectal Surgery: Why, When, and Who Leaks?

Sripathi¹,

Khan²,

Patel³

et al. 2022

Cureus

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Anastomotic leakage is a common yet one of the most feared complications following colorectal surgery. Dehiscence of the anastomosis can result in fatal complications such as peritonitis, abscess formation, and sepsis, thereby increasing morbidity and mortality, cost and length of hospital stay. Multiple factors contribute to the development of anastomotic dehiscence. Several studies have been published identifying various risk factors that may play a role in causing AL. Our study reviewed prospective and retrospective studies and summarized the risk factors into three categories: preoperative, intraoperative, and postoperative. Among these are various risk factors such as age, gender, comorbidities, American Society of Anesthesiologists (ASA) scores, operative time, smoking, alcohol use, obesity, nutritional status, mechanical bowel preparation, and steroid use. It is crucial for surgeons to have a thorough understanding of the risk factors associated with anastomotic leakage to identify patients at high risk preoperatively. It may also be relevant to intraoperative decision-making when establishing an anastomosis, such as considering proximal diversion or placing a drain if such high-risk features are present. Knowing high-risk features also helps to detect leaks as early as possible postoperatively.

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Trends in risk factors of anastomotic leakage after colorectal cancer surgery (2011–2019): A Dutch population‐based study

Cited by 25 publications

References 41 publications

Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

International expert opinion on optimal treatment of anastomotic leakage after rectal cancer resection: a case-vignette study

Factors Contributing to Anastomotic Leakage Following Colorectal Surgery: Why, When, and Who Leaks?

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