scholarly journals Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2382
Author(s):  
Eugenia Claudia Zarnescu ◽  
Narcis Octavian Zarnescu ◽  
Radu Costea
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Anal Verge ◽  
Cancer Recurrence ◽  
Laparoscopic Approach ◽  
Leak Rate ◽  
Primary Surgery ◽  
Stoma Formation ◽  
Additional Surgery

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.

scholarly journals Defunctioning Protective Stoma Can Reduce the Rate of Anastomotic Leakage After Low Anterior Resection in Rectal Cancer Patients

2020 ◽  
Vol 36 (3) ◽  
pp. 192-197 ◽  
Author(s):  
Byoung Chul Lee ◽  
Seok-Byung Lim ◽  
Jong Lyul Lee ◽  
Chan Wook Kim ◽  
Yong Sik Yoon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Clinicopathological Parameters ◽  
Emergency Laparotomy ◽  
Stoma Formation ◽  
Diverting Stoma ◽  
The Impact ◽  
Protective Stoma

Purpose: This study aimed to identify risk factors for anastomotic leakage and to evaluate the impact of protective stoma on the rate of anastomotic leakage and subsequent management.Methods: This retrospective study analyzed data from 4,282 patients who underwent low anterior resection between 2007 and 2014. Among these, 1,367 (31.9%) underwent surgery to create protective diverting stoma and 232 (5.4%) experienced anastomotic leakage. At 6-month timepoints, data were evaluated to identify any correlation between the presence of diverting stoma and the incidence of anastomotic leakage. In addition, clinicopathological parameters were investigated to identify risk factors for anastomotic leakage.Results: Diverting stomas significantly reduced the rate of anastomotic leakage (hazard ratio, 0.334; 95% confidence interval, 0.212–0.525; P<0.001], which was reciprocally correlated with the rate of diverting stoma formation (P=0.039). Patients with a diverting stoma had a significantly lower incidence of generalized peritonitis (P<0.001) and therefore significantly reduced need for laparotomy (82.7% vs. 39.1%, P<0.001).Conclusion: The selective use of diverting stoma in high-risk patients decreases the rate of anastomotic leakage. Diverting stoma also affects the type of leakage and reduces the need for emergency laparotomy by approximately 40%.

Smoking and alcohol misuse are major risk factors of anastomotic leakage in colorectal surgery

1998 ◽  
Vol 114 ◽  
pp. A43 ◽  
Author(s):  
L.T. Sørensen ◽  
L.T. Kirkeby ◽  
J. Skovdal ◽  
B. Vennits ◽  
P. Wille-Jørgensen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Alcohol Misuse

Anastomotic Leakage after Anterior Resection for Rectal Cancer with Mesorectal Excision: Incidence, Risk Factors, and Management

2015 ◽  
Vol 81 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Antonio Pio Tortorelli ◽  
Sergio Alfieri ◽  
Alejandro Martin Sanchez ◽  
Fausto Rosa ◽  
Valerio Papa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Anal Verge ◽  
Univariate Analysis ◽  
Postoperative Mortality ◽  
Incidence Risk ◽  
Clinical Consequences

We investigated risk factors and prognostic implications of symptomatic anastomotic leakage after anterior resection for rectal cancer, and the influence of a diverting stoma. Our retrospective review of prospective collected data analyzed 475 patients who underwent anterior resection for rectal cancer. Uni- and multivariate analysis was made between anastomotic leakage and patient, tumor, and treatment variables, either for the overall group (n = 475) and in the midlow rectal cancer subgroup (n = 291). Overall rate of symptomatic leakage was 9 per cent (43 of 475) with no related postoperative mortality. At univariate analysis, significant factors for leak were a tumor less than 6 cm from the anal verge (13.7 vs 6.6%; P = 0.011) and intraoperative transfusions (16.9 vs 4.3%; P = 0.001). Similar results were observed in the midlow rectal cancer subgroup. At multivariate analysis, no parameter resulted in being an independent prognostic factor for risk of leakage. In patients with a leakage, a temporary enterostomy considerably reduced the need for reoperation (12.5 vs 77.8%; P < 0.0001) and the risk of a permanent stoma (18.7 vs 28.5%; P = 0.49). The incidence of anastomotic failure increases for lower tumors, whereas it is not influenced by radiotherapy. Defunctioning enterostomy does not influence the leak rate, but it mitigates clinical consequences.

scholarly journals Risk Factors of Anastomotic Leakage and Long-Term Survival After Colorectal Surgery

Medicine ◽  
2016 ◽  
Vol 95 (8) ◽  
pp. e2890 ◽  
Author(s):  
Jong Seob Park ◽  
Jung Wook Huh ◽  
Yoon Ah Park ◽  
Yong Beom Cho ◽  
Seong Hyeon Yun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Term Survival ◽  
Long Term Survival

Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery

1999 ◽  
Vol 86 (7) ◽  
pp. 927-931 ◽  
Author(s):  
L. T. Sørensen ◽  
T. Jørgensen ◽  
L. T. Kirkeby ◽  
J. Skovdal ◽  
B. Vennits ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Alcohol Abuse ◽  
Anastomotic Leakage

scholarly journals Risk Factors for Anastomotic Leakage after Colorectal Surgery with Double-staple Technique Anastomosis: Impact of the Agatston Score

2021 ◽  
Vol 5 (2) ◽  
pp. 181-187
Author(s):  
Yosuke Namba ◽  
Shoichiro Mukai ◽  
Yasufumi Saito ◽  
Toshiyuki Moriuchi ◽  
Tomoaki Bekki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Agatston Score ◽  
Staple Technique

scholarly journals Anastomotic Leak after Colorectal Surgery. Our Experience in three Years.

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Kastriot Haxhirexha ◽  
Agron Dogjani ◽  
Lutfi Zylbehari ◽  
Nehat Baftiu ◽  
Ferizat Dika – Haxhirexha
Keyword(s):  
Risk Factors ◽  
Colorectal Surgery ◽  
Anastomotic Leakage ◽  
Anastomotic Leak ◽  
Intestinal Resection ◽  
Morbidity And Mortality ◽  
Multiple Risk Factors ◽  
Four Quadrant ◽  
Emergent Surgery ◽  
Large Bowel Resection

Background: One of the most severe complication after intestinal resection, often with catastrophic consequence for the patient is leakage from the anastomosis. The severity of complications after anastomotic leak may range from a small localized peritonitis or abscess formation without sepsis, to a development of a four quadrant peritonitis with septic shock. Until now despite the seriousness of this complications, the cause of anastomotic leakage are not yet definitively clear. Aim: The aim of this study is to submit our experience in treatment of patients with anastomotic leakage after intestinal resection and their outcome. Materials and Methods: The study included 63 patients with colorectal cancer operated in the Department of Surgery at the Clinical Hospital of Tetova. In all patients intestinal resection with end to end anastomosis was performed. Conclusions: Anastomotic leak after large bowel resection is a very serious complication with a great impact on patient’s morbidity and mortality.  Multiple risk factors are associated with occurrence of this complication whereas the more suspected are: preoperative anaemia, hypoalbuminemia, emergent surgery without adequate preparation of patient, intraoperative blood loss and blood transfusion during surgery etc. Early detection of AL is very important and helpful to improve the outcome of patients and to minimize postoperative rate of morbidity and mortality. Keywords: anastomotic leaks, colorectal surgery, risk factors  

scholarly journals Reducing the incidence and managing the consequences of anastomotic leakage after rectal resection

2004 ◽  
Vol 51 (3) ◽  
pp. 19-23 ◽  
Author(s):  
B. Meade ◽  
Moran Gen
Keyword(s):  
Anal Verge ◽  
Cancer Recurrence ◽  
Anastomotic Dehiscence ◽  
Leak Rate ◽  
Cancer Trial ◽  
Colorectal Anastomoses ◽  
Increased Risk ◽  
Life Threatening ◽  
Threatening Situation ◽  
Colon Pouch

Anastomotic dehiscence is a serious, life-threatening complication of any rectal anastomosis and may be associated with an increased risk of local cancer recurrence. The leak rate following low anterior resection is in the region of 10% as reported in the recent randomised Dutch rectal cancer trial. Although accurate prediction of risk is impossible, certain factors are known to influence leak rates. There is an inverse relationship between the height of the anastomosis from the anal verge and the leak rate, with the lower anastomoses carrying the highest risk. Proximal defunctioning by a loop stoma mitigates the consequences of leakage and probably reduces, but does not abolish, the risk. There is little difference in rates of dehiscence between stapled and sutured colorectal anastomoses. A short colon pouch may reduce the chance of leakage. The highest risks are in unprotected anastomoses less than 5 cm from the anal verge in men who smoke and/or drink excessively, particularly if they have received pre-operative chemotherapy or chemo-radiotherapy. A high index of suspicion is required in detecting the early non-specific signs of a leak and urgent surgical intervention is usually required to avert a life-threatening situation. Faecal diversion should be regarded as the optimal safety measure to reduce the consequences of leakage and to mange leakage of an unprotected anastomosis.

Sign in / Sign up

Export Citation Format

Share Document