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The risk factors and predictive factors for anastomotic leakage after resection for colorectal cancer: reappraisal of the literature

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Abstract

Anastomotic leakage is a serious complication that can occur after colorectal surgery. Several risk factors for anastomotic leakage have been reported based on the findings of prospective and retrospective studies, including patient characteristics, the use of neoadjuvant therapy, the tumor location, intraoperative events, etc. However, as these risk factors affect each other, the statistical results have differed in each study. In addition, differences in surgical methods, including laparoscopy versus laparotomy or stapling anastomosis versus handsewn anastomosis, may influence the incidence of anastomotic leakage. This mini-review summarizes the results of reported papers to clarify the current evidence of risk factors for anastomotic leakage.

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References

  1. Byrn JC, Schlager A, Divino CM, Weber KJ, Baril DT, Aufses AH Jr. The management of 38 anastomotic leaks after 1,684 intestinal resections. Dis Colon Rectum. 2006;49(9):1346–53.

    Article  PubMed  Google Scholar 

  2. Hedrick TL, Sawyer RG, Foley EF, Friel CM. Anastomotic leak and the loop ileostomy: friend or foe? Dis Colon Rectum. 2006;49(8):1167–76.

    Article  PubMed  Google Scholar 

  3. Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg. 2007;245(2):254–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kanellos I, Vasiliadis K, Angelopoulos S, Tsachalis T, Pramateftakis MG, Mantzoros I, et al. Anastomotic leakage following anterior resection for rectal cancer. Tech Coloproctol. 2004;8(Suppl 1):s79–81.

    Article  PubMed  Google Scholar 

  5. Lim M, Akhtar S, Sasapu K, Harris K, Burke D, Sagar P, et al. Clinical and subclinical leaks after low colorectal anastomosis: a clinical and radiologic study. Dis Colon Rectum. 2006;49(10):1611–9.

    Article  PubMed  Google Scholar 

  6. Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6(6):462–9.

    Article  CAS  PubMed  Google Scholar 

  7. Phitayakorn R, Delaney CP, Reynolds HL, Champagne BJ, Heriot AG, Neary P, et al. Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg. 2008;32(6):1147–56.

    Article  CAS  PubMed  Google Scholar 

  8. Blumetti J, Chaudhry V, Prasad L, Abcarian H. Delayed transanal repair of persistent coloanal anastomotic leak in diverted patients after resection for rectal cancer. Colorectal Dis. 2012;14(10):1238–41.

    Article  CAS  PubMed  Google Scholar 

  9. Bertelsen CA, Andreasen AH, Jorgensen T, Harling H. Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis. 2010;12(1):37–43.

    Article  CAS  PubMed  Google Scholar 

  10. Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2005;92(2):211–6.

    Article  CAS  PubMed  Google Scholar 

  11. Krarup PM, Jorgensen LN, Andreasen AH, Harling H. A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis. 2012;14(10):661–7.

    Article  Google Scholar 

  12. Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis. 2008;23(3):265–70.

    PubMed  Google Scholar 

  13. Golub R, Golub RW, Cantu R Jr, Stein HD. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg. 1997;184(4):364–72.

    CAS  PubMed  Google Scholar 

  14. Kube R, Mroczkowski P, Granowski D, Benedix F, Sahm M, Schmidt U, et al. Anastomotic leakage after colon cancer surgery: a predictor of significant morbidity and hospital mortality, and diminished tumour-free survival. Eur J Surg Oncol. 2010;36(2):120–4.

    Article  CAS  PubMed  Google Scholar 

  15. Marra F, Steffen T, Kalak N, Warschkow R, Tarantino I, Lange J, et al. Anastomotic leakage as a risk factor for the long-term outcome after curative resection of colon cancer. Eur J Surg Oncol. 2009;35(10):1060–4.

    Article  CAS  PubMed  Google Scholar 

  16. Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T, et al. Incidence of and risk factors for anastomotic leakage after laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique anastomosis for rectal cancer. Am J Surg. 2011;202(3):259–64.

    Article  PubMed  Google Scholar 

  17. Eberl T, Jagoditsch M, Klingler A, Tschmelitsch J. Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg. 2008;196(4):592–8.

    Article  PubMed  Google Scholar 

  18. Gorissen KJ, Benning D, Berghmans T, Snoeijs MG, Sosef MN, Hulsewe KW, et al. Risk of anastomotic leakage with non-steroidal anti-inflammatory drugs in colorectal surgery. Br J Surg. 2012;99(5):721–7.

    Article  CAS  PubMed  Google Scholar 

  19. Konishi T, Watanabe T, Kishimoto J, Nagawa H. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg. 2006;202(3):439–44.

    Article  PubMed  Google Scholar 

  20. Leichtle SW, Mouawad NJ, Welch KB, Lampman RM, Cleary RK. Risk factors for anastomotic leakage after colectomy. Dis Colon Rectum. 2012;55(5):569–75.

    Article  PubMed  Google Scholar 

  21. Smith JD, Paty PB, Guillem JG, Temple LK, Weiser MR, Nash GM. Anastomotic leak is not associated with oncologic outcome in patients undergoing low anterior resection for rectal cancer. Ann Surg. 2012;256(6):1034–8.

    Article  PubMed  Google Scholar 

  22. Kobayashi M, Mohri Y, Ohi M, Inoue Y, Araki T, Okita Y, et al., Risk factors for anastomotic leakage and favorable antimicrobial treatment as empirical therapy for intra-abdominal infection in patients undergoing colorectal surgery. Surg Today, 2013.

  23. Law WI, Chu KW, Ho JW, Chan CW. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg. 2000;179(2):92–6.

    Article  CAS  PubMed  Google Scholar 

  24. Law WL, Choi HK, Lee YM, Ho JW, Seto CL. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg. 2007;11(1):8–15.

    Article  PubMed  Google Scholar 

  25. Park JS, Choi GS, Kim SH, Kim HR, Kim NK, Lee KY, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg. 2013;257(4):665–71.

    Article  PubMed  Google Scholar 

  26. Trencheva K, Morrissey KP, Wells M, Mancuso CA, Lee SW, Sonoda T, et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg. 2013;257(1):108–13.

    Article  PubMed  Google Scholar 

  27. Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg. 2002;26(4):499–502.

    Article  PubMed  Google Scholar 

  28. Schrock TR, Deveney CW, Dunphy JE. Factor contributing to leakage of colonic anastomoses. Ann Surg. 1973;177(5):513–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Piecuch J, Wiewiora M, Jopek J, Szrot M, Mazur I, Zurawinski W, et al. Mortality and anastomotic leakage after anterior resection for rectal cancer. Hepatogastroenterology. 2012;59(115):721–3.

    PubMed  Google Scholar 

  30. Makela JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum. 2003;46(5):653–60.

    Article  PubMed  Google Scholar 

  31. Boccola MA, Buettner PG, Rozen WM, Siu SK, Stevenson AR, Stitz R, et al. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg. 2011;35(1):186–95.

    Article  PubMed  Google Scholar 

  32. Telem DA, Chin EH, Nguyen SQ, Divino CM. Risk factors for anastomotic leak following colorectal surgery: a case–control study. Arch Surg. 2010;145(4):371–6 (discussion 6).

    Article  PubMed  Google Scholar 

  33. Choi HK, Law WL, Ho JW. Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon Rectum. 2006;49(11):1719–25.

    Article  PubMed  Google Scholar 

  34. Slim K, Vicaut E, Panis Y, Chipponi J. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg. 2004;91(9):1125–30.

    Article  CAS  PubMed  Google Scholar 

  35. Slim K, Vicaut E, Launay-Savary MV, Contant C, Chipponi J. Updated systematic review and meta-analysis of randomized clinical trials on the role of mechanical bowel preparation before colorectal surgery. Ann Surg. 2009;249(2):203–9.

    Article  PubMed  Google Scholar 

  36. Van’t Sant HP, Weidema WF, Hop WC, Oostvogel HJ, Contant CM. The influence of mechanical bowel preparation in elective lower colorectal surgery. Ann Surg. 2010;251(1):59–63.

    Article  PubMed  Google Scholar 

  37. Cross KL, Rees JR, Soulsby RH, Dixon AR. Primary anastomosis without colonic lavage for the obstructed left colon. Ann R Coll Surg Engl. 2008;90(4):302–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. David GG, Al-Sarira AA, Willmott S, Cade D, Corless DJ, Slavin JP. Use of Hartmann’s procedure in England. Colorectal Dis. 2009;11(3):308–12.

    Article  CAS  PubMed  Google Scholar 

  39. ReMine SG, Dozois RR. Hartmann’s procedure. Its use with complicated carcinomas of sigmoid colon and rectum. Arch Surg. 1981;116(5):630–3.

    Article  CAS  PubMed  Google Scholar 

  40. Kube R, Granowski D, Stubs P, Mroczkowski P, Ptok H, Schmidt U, et al. Surgical practices for malignant left colonic obstruction in Germany. Eur J Surg Oncol. 2010;36(1):65–71.

    Article  CAS  PubMed  Google Scholar 

  41. Grundmann RT. Primary colon resection or Hartmann’s procedure in malignant left-sided large bowel obstruction? The use of stents as a bridge to surgery. World J Gastrointest Surg. 2013;5(1):1–4.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Tan CJ, Dasari BV, Gardiner K. Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. Br J Surg. 2012;99(4):469–76.

    Article  CAS  PubMed  Google Scholar 

  43. Kapiteijn E, Kranenbarg EK, Steup WH, Taat CW, Rutten HJ, Wiggers T, et al. Total mesorectal excision (TME) with or without preoperative radiotherapy in the treatment of primary rectal cancer. Prospective randomised trial with standard operative and histopathological techniques. Dutch ColoRectal Cancer Group. Eur J Surg. 1999;165(5):410–20.

    Article  CAS  PubMed  Google Scholar 

  44. Marijnen CA, Kapiteijn E, van de Velde CJ, Martijn H, Steup WH, Wiggers T, et al. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2002;20(3):817–25.

    Article  CAS  PubMed  Google Scholar 

  45. Chang JS, Keum KC, Kim NK, Baik SH, Min BS, Huh H, et al. Preoperative chemoradiotherapy effects on anastomotic leakage after rectal cancer resection: a propensity score matching analysis. Ann Surg. 2013.

  46. Scheidbach H, Schneider C, Konradt J, Barlehner E, Kohler L, Wittekind C, et al. Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum. Surg Endosc. 2002;16(1):7–13.

    Article  CAS  PubMed  Google Scholar 

  47. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26.

    Article  PubMed  Google Scholar 

  48. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6(7):477–84.

    Article  PubMed  Google Scholar 

  49. Jayne DG, Guillou PJ, Thorpe H, Quirke P, Copeland J, Smith AM, et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol. 2007;25(21):3061–8.

    Article  PubMed  Google Scholar 

  50. Laurent C, Leblanc F, Wutrich P, Scheffler M, Rullier E. Laparoscopic versus open surgery for rectal cancer: long-term oncologic results. Ann Surg. 2009;250(1):54–61.

    Article  PubMed  Google Scholar 

  51. Kayano H, Okuda J, Tanaka K, Kondo K, Tanigawa N. Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc. 2011;25(9):2972–9.

    Article  PubMed  Google Scholar 

  52. van der Pas MH, Haglind E, Cuesta MA, Furst A, Lacy AM, Hop WC, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8.

    Article  PubMed  Google Scholar 

  53. Graffner H, Fredlund P, Olsson SA, Oscarson J, Petersson BG. Protective colostomy in low anterior resection of the rectum using the EEA stapling instrument. A randomized study. Dis Colon Rectum. 1983;26(2):87–90.

    Article  CAS  PubMed  Google Scholar 

  54. Pakkastie TE, Ovaska JT, Pekkala ES, Luukkonen PE, Jarvinen HJ. A randomised study of colostomies in low colorectal anastomoses. Eur J Surg. 1997;163(12):929–33.

    CAS  PubMed  Google Scholar 

  55. Koperna T. Cost-effectiveness of defunctioning stomas in low anterior resections for rectal cancer: a call for benchmarking. Arch Surg. 2003;138(12):1334–8 (discussion 9).

    Article  PubMed  Google Scholar 

  56. Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg. 1994;81(8):1224–6.

    Article  CAS  PubMed  Google Scholar 

  57. Puleo S, Sofia M, Trovato MA, Pesce A, Portale TR, Russello D, et al. Ileocolonic anastomosis: preferred techniques in 999 patients. A multicentric study. Surg Today 2012.

  58. Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie A, Fitzgerald A. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2011(9):CD004320.

  59. Kang J, Lee HB, Cha JH, Hur H, Min BS, Baik SH, et al. Feasibility and impact on surgical outcomes of modified double-stapling technique for patients undergoing laparoscopic anterior resection. J Gastrointest Surg. 2013;17(4):771–5.

    Article  PubMed  Google Scholar 

  60. Kim HJ, Choi GS, Park JS, Park SY. Comparison of intracorporeal single-stapled and double-stapled anastomosis in laparoscopic low anterior resection for rectal cancer: a case-control study. Int J Colorectal Dis. 2013;28(1):149–56.

    CAS  PubMed  Google Scholar 

  61. Hallbook O, Pahlman L, Krog M, Wexner SD, Sjodahl R. Randomized comparison of straight and colonic J pouch anastomosis after low anterior resection. Ann Surg. 1996;224(1):58–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Mehrvarz S, Towliat SM, Mohebbi HA, Derakhshani S, Abavisani M. Comparison of colonic J-pouch and straight coloanal anastomosis after low anterior resection. Iran Red Crescent Med J. 2013;15(1):32–5.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Steffen T, Tarantino I, Hetzer FH, Warschkow R, Lange J, Zund M. Safety and morbidity after ultra-low coloanal anastomoses: J-pouch vs end-to-end reconstruction. Int J Colorectal Dis. 2008;23(3):277–81.

    PubMed  Google Scholar 

  64. Joo JS, Latulippe JF, Alabaz O, Weiss EG, Nogueras JJ, Wexner SD. Long-term functional evaluation of straight coloanal anastomosis and colonic J-pouch: is the functional superiority of colonic J-pouch sustained? Dis Colon Rectum. 1998;41(6):740–6.

    Article  CAS  PubMed  Google Scholar 

  65. Seow-Choen F, Goh HS. Prospective randomized trial comparing J colonic pouch-anal anastomosis and straight coloanal reconstruction. Br J Surg. 1995;82(5):608–10.

    Article  CAS  PubMed  Google Scholar 

  66. Gertsch P, Baer HU, Kraft R, Maddern GJ, Altermatt HJ. Malignant cells are collected on circular staplers. Dis Colon Rectum. 1992;35(3):238–41.

    Article  CAS  PubMed  Google Scholar 

  67. Yajima K, Matsuo H, Kobayashi T, Ajioka Y, Hatakeyama K. Curative resection performed twice for circular-staple-line recurrence after colorectal carcinoma surgery: report of a case. Surg Today. 2007;37(1):61–5.

    Article  PubMed  Google Scholar 

  68. Fujii S, Yamamoto S, Ito M, Yamaguchi S, Sakamoto K, Kinugasa Y, et al. Short-term outcomes of laparoscopic intersphincteric resection from a phase II trial to evaluate laparoscopic surgery for stage 0/I rectal cancer: Japan Society of Laparoscopic Colorectal Surgery Lap RC. Surg Endosc. 2012;26(11):3067–76.

    Article  PubMed  Google Scholar 

  69. Tsujinaka S, Kawamura YJ, Tan KY, Mizokami K, Sasaki J, Maeda T, et al. Proximal bowel necrosis after high ligation of the inferior mesenteric artery in colorectal surgery. Scand J Surg. 2012;101(1):21–5.

    Article  CAS  PubMed  Google Scholar 

  70. Corder AP, Karanjia ND, Williams JD, Heald RJ. Flush aortic tie versus selective preservation of the ascending left colic artery in low anterior resection for rectal carcinoma. Br J Surg. 1992;79(7):680–2.

    Article  CAS  PubMed  Google Scholar 

  71. Hida J, Okuno K. High ligation of the inferior mesenteric artery in rectal cancer surgery. Surg Today. 2013;43(1):8–19.

    Article  PubMed  Google Scholar 

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  1. Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan

    Fumihiko Fujita, Yasuhiro Torashima, Tamotsu Kuroki & Susumu Eguchi

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  1. Fumihiko Fujita
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  2. Yasuhiro Torashima
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  3. Tamotsu Kuroki
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  4. Susumu Eguchi
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Correspondence to Fumihiko Fujita.

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Fujita, F., Torashima, Y., Kuroki, T. et al. The risk factors and predictive factors for anastomotic leakage after resection for colorectal cancer: reappraisal of the literature. Surg Today 44, 1595–1602 (2014). https://doi.org/10.1007/s00595-013-0685-3

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