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REVIEW

Prevention of Anastomotic Leak in Colorectal Surgery: Current Knowledge and Next Steps

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Pages 11-20 | Received 08 Nov 2023, Accepted 30 Jan 2024, Published online: 08 Feb 2024

References

  • Chiarello MM, Fransvea P, Cariati M, Adams NJ, Bianchi V, Brisinda G. Anastomotic leakage in colorectal cancer surgery. Surg Oncol. 2022;40:101708. doi:10.1016/j.suronc.2022.101708
  • Ellis CT, Maykel JA. Defining anastomotic leak and the clinical relevance of leaks. Clin Colon Rectal Surg. 2021;34(6):359–365. doi:10.1055/s-0041-1735265
  • Friel C, Kin C. Anastomotic complications. In: Steele S, Hull T, Read T, Hyman N, Maykel J, Whitlow C, editors. The ASCRS Textbook of Colon and Rectal Surgery. 4th ed. Springer; 2022:189.
  • McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102(5):462–479. doi:10.1002/bjs.9697
  • He J, He M, Tang JH, Wang XH. Anastomotic leak risk factors following colon cancer resection: a systematic review and meta-analysis. Langenbecks Arch Surg. 2023;408(1):252. doi:10.1007/s00423-023-02989-z
  • Tan DJH, Yaow CYL, Mok HT, et al. The influence of diabetes on postoperative complications following colorectal surgery. Tech Coloproctol. 2021;25(3):267–278. doi:10.1007/s10151-020-02373-9
  • Huisman DE, Reudink M, van Rooijen SJ, et al. LekCheck: a prospective study to identify perioperative modifiable risk factors for anastomotic leakage in colorectal surgery. Ann Surg. 2022;275(1):e189–e197. doi:10.1097/sla.0000000000003853
  • van Rooijen SJ, Huisman D, Stuijvenberg M, et al. Intraoperative modifiable risk factors of colorectal anastomotic leakage: why surgeons and anesthesiologists should act together. Int J Surg. 2016;36(Pt A):183–200. doi:10.1016/j.ijsu.2016.09.098
  • Charalambides M, Mavrou A, Jennings T, et al. A systematic review of the literature assessing operative blood loss and postoperative outcomes after colorectal surgery. Int J Colorectal Dis. 2022;37(1):47–69. doi:10.1007/s00384-021-04015-4
  • Huisman DE, Bootsma BT, Ingwersen EW, et al. Fluid management and vasopressor use during colorectal surgery: the search for the optimal balance. Surg Endosc. 2023;37(8):6062–6070. doi:10.1007/s00464-023-09980-1
  • Adanir T, Nazli O, Kara C, et al. The relationship between vasopressor dose and anastomotic leak in colon surgery: an experimental trial. Int J Surg. 2010;8(3):221–224. doi:10.1016/j.ijsu.2010.01.004
  • Choudhuri AH, Uppal R, Kumar M. Influence of non-surgical risk factors on anastomotic leakage after major gastrointestinal surgery: audit from a tertiary care teaching institute. Int J Crit Illn Inj Sci. 2013;3(4):246–249. doi:10.4103/2229-5151.124117
  • Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jorgensen P. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg. 1999;86(7):927–931. doi:10.1046/j.1365-2168.1999.01165.x
  • Tsai KY, Huang SH, You JF, et al. Smoking cessation for less than 10 years remains a risk factor of anastomotic leakage in mid-to-low rectal cancer patients undergoing sphincter-preserving surgery. Langenbecks Arch Surg. 2022;407(3):1131–1138. doi:10.1007/s00423-021-02381-9
  • Kang CY, Halabi WJ, Chaudhry OO, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg. 2013;148(1):65–71. doi:10.1001/2013.jamasurg.2
  • Sun G, Li Y, Peng Y, et al. Can sarcopenia be a predictor of prognosis for patients with non-metastatic colorectal cancer? A systematic review and meta-analysis. Int J Colorectal Dis. 2018;33(10):1419–1427. doi:10.1007/s00384-018-3128-1
  • Herrod PJJ, Boyd-Carson H, Doleman B, et al. Quick and simple; psoas density measurement is an independent predictor of anastomotic leak and other complications after colorectal resection. Tech Coloproctol. 2019;23(2):129–134. doi:10.1007/s10151-019-1928-0
  • Margadant CC, Bruns ER, Sloothaak DA, et al. Lower muscle density is associated with major postoperative complications in older patients after surgery for colorectal cancer. Eur J Surg Oncol. 2016;42(11):1654–1659. doi:10.1016/j.ejso.2016.05.040
  • Trejo-Avila M, Bozada-Gutierrez K, Valenzuela-Salazar C, Herrera-Esquivel J, Moreno-Portillo M. Sarcopenia predicts worse postoperative outcomes and decreased survival rates in patients with colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis. 2021;36(6):1077–1096. doi:10.1007/s00384-021-03839-4
  • Eriksen TF, Lassen CB, Gögenur I. Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey. Colorectal Dis. 2014;16(5):154–160. doi:10.1111/codi.12490
  • Lake JP, Firoozmand E, Kang JC, et al. Effect of high-dose steroids on anastomotic complications after proctocolectomy with ileal pouch-anal anastomosis. J Gastrointest Surg. 2004;8(5):547–551. doi:10.1016/j.gassur.2004.01.002
  • Ziv Y, Church JM, Fazio VW, King TM, Lavery IC. Effect of systemic steroids on ileal pouch-anal anastomosis in patients with ulcerative colitis. Dis Colon Rectum. 1996;39(5):504–508. doi:10.1007/bf02058701
  • El-Hussuna A, Andersen J, Bisgaard T, et al. Biologic treatment or immunomodulation is not associated with postoperative anastomotic complications in abdominal surgery for Crohn’s disease. Scand J Gastroenterol. 2012;47(6):662–668. doi:10.3109/00365521.2012.660540
  • Moosvi Z, Duong J, Bechtold ML, Nguyen DL. Systematic review and meta-analysis: risks of postoperative complications with preoperative use of anti-tumor necrosis factor-alpha biologics in inflammatory bowel disease patients. Eur J Gastroenterol Hepatol. 2021;33(6):799–816. doi:10.1097/meg.0000000000001944
  • Cira K, Weber MC, Wilhelm D, Friess H, Reischl S, Neumann PA. The Effect of anti-tumor necrosis factor-alpha therapy within 12 weeks prior to surgery on postoperative complications in inflammatory bowel disease: a systematic review and meta-analysis. J Clin Med. 2022;11:23.
  • Law CC, Bell C, Koh D, Bao Y, Jairath V, Narula N. Risk of postoperative infectious complications from medical therapies in inflammatory bowel disease. Cochrane Database Syst Rev. 2020;10(10):Cd013256. doi:10.1002/14651858.CD013256.pub2
  • Cohen BL, Fleshner P, Kane SV, et al. Prospective cohort study to investigate the safety of preoperative tumor necrosis factor inhibitor exposure in patients with inflammatory bowel disease undergoing intra-abdominal surgery. Gastroenterology. 2022;163(1):204–221. doi:10.1053/j.gastro.2022.03.057
  • Sneider E, Davids J. Effect of chemotherapy, radiation, or immunosuppression on the integrity of the intestinal anastomosis. Semin Colon Rect Surg. 2014;25. doi:10.1053/j.scrs.2014.04.008
  • van der Vliet JA, Willems MC, de Man BM, Lomme RM, Hendriks T. Everolimus interferes with healing of experimental intestinal anastomoses. Transplantation. 2006;82(11):1477–1483. doi:10.1097/01.tp.0000246078.09845.9c
  • Jamjittrong S, Matsuda A, Matsumoto S, et al. Postoperative non-steroidal anti-inflammatory drugs and anastomotic leakage after gastrointestinal anastomoses: systematic review and meta-analysis. Ann Gastroenterol Surg. 2020;4(1):64–75. doi:10.1002/ags3.12300
  • Bhangu A, Singh P, Fitzgerald JE, Slesser A, Tekkis P. Postoperative nonsteroidal anti-inflammatory drugs and risk of anastomotic leak: meta-analysis of clinical and experimental studies. World J Surg. 2014;38(9):2247–2257. doi:10.1007/s00268-014-2531-1
  • Modasi A, Pace D, Godwin M, Smith C, Curtis B. NSAID administration post colorectal surgery increases anastomotic leak rate: systematic review/meta-analysis. Surg Endosc. 2019;33(3):879–885. doi:10.1007/s00464-018-6355-1
  • Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2011;2011(9):Cd001544. doi:10.1002/14651858.CD001544.pub4
  • Leenen JPL, Hentzen J, Ockhuijsen HDL. Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Updates Surg. 2019;71(2):227–236. doi:10.1007/s13304-018-0526-4
  • Willis MA, Toews I, Soltau SLV, Kalff JC, Meerpohl JJ, Vilz TO. Preoperative combined mechanical and oral antibiotic bowel preparation for preventing complications in elective colorectal surgery. Cochrane Database Syst Rev. 2023;2. doi:10.1002/14651858.CD014909.pub2
  • Hansen RB, Balachandran R, Valsamidis TN, Iversen LH. The role of preoperative mechanical bowel preparation and oral antibiotics in prevention of anastomotic leakage following restorative resection for primary rectal cancer - a systematic review and meta-analysis. Int J Colorectal Dis. 2023;38(1):129. doi:10.1007/s00384-023-04416-7
  • Liu Y, Li B, Wei Y. New understanding of gut microbiota and colorectal anastomosis leak: a collaborative review of the current concepts. Front Cell Infect Microbiol. 2022;12:1022603. doi:10.3389/fcimb.2022.1022603
  • Williamson AJ, Alverdy JC. Influence of the Microbiome on Anastomotic Leak. Clin Colon Rectal Surg. 2021;34(6):439–446. doi:10.1055/s-0041-1735276
  • Stumpf M, Klinge U, Wilms A, et al. Changes of the extracellular matrix as a risk factor for anastomotic leakage after large bowel surgery. Surgery. 2005;137(2):229–234. doi:10.1016/j.surg.2004.07.011
  • Edomskis P, Goudberg MR, Sparreboom CL, et al. Matrix metalloproteinase-9 in relation to patients with complications after colorectal surgery: a systematic review. Int J Colorectal Dis. 2021;36(1):1–10. doi:10.1007/s00384-020-03724-6
  • Kivirikko KI. Collagens and their abnormalities in a wide spectrum of diseases. Ann Med. 1993;25(2):113–126. doi:10.3109/07853899309164153
  • Stumpf M, Cao W, Klinge U, Klosterhalfen B, Kasperk R, Schumpelick V. Collagen distribution and expression of matrix metalloproteinases 1 and 13 in patients with anastomotic leakage after large-bowel surgery. Langenbecks Arch Surg. 2002;386(7):502–506. doi:10.1007/s00423-001-0255-9
  • Burcharth J, Rosenberg J. Gastrointestinal surgery and related complications in patients with Ehlers-Danlos syndrome: a systematic review. Dig Surg. 2012;29(4):349–357. doi:10.1159/000343738
  • Ng SC, Stupart D, Bartolo D, Watters D. Anastomotic leaks in stage IV colorectal cancer. ANZ J Surg. 2018;88(9):E649–E653. doi:10.1111/ans.14494
  • Kaser SA, Mattiello D, Maurer CA. Distant metastasis in colorectal cancer is a risk factor for anastomotic leakage. Ann Surg Oncol. 2016;23(3):888–893. doi:10.1245/s10434-015-4941-1
  • Kryzauskas M, Bausys A, Degutyte AE, et al. Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery. World J Surg Oncol. 2020;18(1):205. doi:10.1186/s12957-020-01968-8
  • Hu MH, Huang RK, Zhao RS, Yang KL, Wang H. Does neoadjuvant therapy increase the incidence of anastomotic leakage after anterior resection for mid and low rectal cancer? A systematic review and meta-analysis. Colorectal Dis. 2017;19(1):16–26. doi:10.1111/codi.13424
  • Mankarious MM, Portolese AC, Hoskins MA, et al. Neoadjuvant chemotherapy does not increase risk for anastomotic leak for simultaneous resection of primary colon cancer with synchronous liver metastasis: a NSQIP-colectomy analysis. J Surg Oncol. 2023;128(1):58–65. doi:10.1002/jso.27242
  • Cheong CK, Nistala KRY, Ng CH, et al. Neoadjuvant therapy in locally advanced colon cancer: a meta-analysis and systematic review. J Gastrointest Oncol. 2020;11(5):847–857. doi:10.21037/jgo-20-220
  • Yang J, Luo Y, Tian T, Dong P, Fu Z. Effects of neoadjuvant radiotherapy on postoperative complications in rectal cancer: a meta-analysis. J Oncol. 2022;2022:8197701. doi:10.1155/2022/8197701
  • Saif MW, Elfiky A, Salem RR. Gastrointestinal perforation due to bevacizumab in colorectal cancer. Ann Surg Oncol. 2007;14(6):1860–1869. doi:10.1245/s10434-006-9337-9
  • Kim S, Shin JK, Park Y, et al. Bevacizumab increases the risk of anastomosis site leakage in metastatic colorectal cancer. Front Oncol. 2022;12:1018458. doi:10.3389/fonc.2022.1018458
  • Benson AB, Venook AP, Al-Hawary MM, et al. Colon cancer, version 2.2021, NCCN clinical practice guidelines in oncology. J National Compr Cancer Network. 2021;19(3):329–359. doi:10.6004/jnccn.2021.0012
  • Neutzling CB, Lustosa SA, Proenca IM, da Silva EM, Matos D. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. 2012;2:CD003144. doi:10.1002/14651858.CD003144.pub2
  • 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. doi:10.1002/14651858.CD004320.pub3
  • Oliveira A, Faria S, Goncalves N, Martins A, Leao P. Surgical approaches to colonic and rectal anastomosis: systematic review and meta-analysis. Int J Colorectal Dis. 2023;38(1):52. doi:10.1007/s00384-023-04328-6
  • Abounozha S, Kheder A, Alshahri T, Ibrahim R. Best evidence topic: is ileocolic anastomotic leak rate higher in handsewn or stapler’s anastomosis? Ann Med Surg. 2020;60:619–622. doi:10.1016/j.amsu.2020.11.075
  • Balciscueta Z, Uribe N, Caubet L, et al. Impact of the number of stapler firings on anastomotic leakage in laparoscopic rectal surgery: a systematic review and meta-analysis. Tech Coloproctol. 2020;24(9):919–925. doi:10.1007/s10151-020-02240-7
  • Braunschmid T, Hartig N, Baumann L, Dauser B, Herbst F. Influence of multiple stapler firings used for rectal division on colorectal anastomotic leak rate. Surg Endosc. 2017;31(12):5318–5326. doi:10.1007/s00464-017-5611-0
  • Tejedor P, Sagias F, Nock D, et al. Advantages of using a robotic stapler in rectal cancer surgery. J Robot Surg. 2020;14(2):365–370. doi:10.1007/s11701-019-00993-4
  • Tejedor P, Sagias F, Flashman K, Kandala NL, Khan J. The use of robotic or laparoscopic stapler in rectal cancer surgery: a systematic review and meta-analysis. J Robot Surg. 2020;14(6):829–833. doi:10.1007/s11701-020-01126-y
  • SureForm Staplers. Available from: https://www.intuitive.com/en-us/products-and-services/da-vinci/stapling/sureform. Accessed October, 2023.
  • Somashekhar SP, Saldanha E, Kumar R, Pandey K, Dahiya A, Ashwin KR. Prospective analysis of 164 fires of da Vinci SureForm SmartFire stapler in oncological cases: Indian cohort of 76 consecutive cases. J Minim Access Surg. 2023;19(3):384–389. doi:10.4103/jmas.jmas_154_22
  • Pla-Marti V, Martin-Arevalo J, Moro-Valdezate D, et al. Impact of the novel powered circular stapler on risk of anastomotic leakage in colorectal anastomosis: a propensity score-matched study. Tech Coloproctol. 2021;25(3):279–284. doi:10.1007/s10151-020-02338-y
  • Sylla P, Sagar P, Johnston SS, et al. Outcomes associated with the use of a new powered circular stapler for left-sided colorectal reconstructions: a propensity score matching-adjusted indirect comparison with manual circular staplers. Surg Endosc. 2022;36(4):2541–2553. doi:10.1007/s00464-021-08542-7
  • Vignali A, Gozzini L, Gasparini G, Calef R, Rosati R, Elmore U. Impact of powered circular stapler on anastomotic leak after anastomosis to the rectum: a propensity score matched study. Int J Colorectal Dis. 2023;38(1):211. doi:10.1007/s00384-023-04506-6
  • Catarci M, Guadagni S, Masedu F, et al. Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts. Int J Surg. 2023;109(8):2312–2323. doi:10.1097/JS9.0000000000000480
  • Renna MS, Grzeda MT, Bailey J, et al. Intraoperative bowel perfusion assessment methods and their effects on anastomotic leak rates: meta-analysis. Br J Surg. 2023;110(9):1131–1142. doi:10.1093/bjs/znad154
  • Kojima S, Sakamoto T, Nagai Y, Matsui Y, Nambu K, Masamune K. Laser speckle contrast imaging for intraoperative quantitative assessment of intestinal blood perfusion during colorectal surgery: a prospective pilot study. Surg Innov. 2019;26(3):293–301. doi:10.1177/1553350618823426
  • Buxey K, Lam F, Muhlmann M, Wong S. Does indocyanine green improve the evaluation of perfusion during laparoscopic colorectal surgery with extracorporeal anastomosis? ANZ J Surg. 2019;89(11):E487–E491. doi:10.1111/ans.15320
  • Safiejko K, Tarkowski R, Kozlowski TP, et al. Safety and efficacy of indocyanine green in colorectal cancer surgery: a systematic review and meta-analysis of 11,047 patients. Cancers. 2022;14:4.
  • Xia S, Wu W, Luo L, Ma L, Yu L, Li Y. Indocyanine green fluorescence angiography decreases the risk of anastomotic leakage after rectal cancer surgery: a systematic review and meta-analysis. Front Med. 2023;10:1157389. doi:10.3389/fmed.2023.1157389
  • Phan K, Oh L, Ctercteko G, et al. Does a stoma reduce the risk of anastomotic leak and need for re-operation following low anterior resection for rectal cancer: systematic review and meta-analysis of randomized controlled trials. J Gastrointest Oncol. 2019;10(2):179–187. doi:10.21037/jgo.2018.11.07
  • Myrseth E, Nymo LS, Gjessing PF, Norderval S. Diverting stomas reduce reoperation rates for anastomotic leak but not overall reoperation rates within 30 days after anterior rectal resection: a national cohort study. Int J Colorectal Dis. 2022;37(7):1681–1688. doi:10.1007/s00384-022-04205-8
  • Hernandez PT, Paspulati RM, Shanmugan S. Diagnosis of anastomotic leak. Clin Colon Rectal Surg. 2021;34(6):391–399. doi:10.1055/s-0041-1735270
  • Mik M, Dziki L, Berut M, Trzcinski R, Dziki A. Neutrophil to lymphocyte ratio and C-reactive protein as two predictive tools of anastomotic leak in colorectal cancer open surgery. Dig Surg. 2018;35(1):77–84. doi:10.1159/000456081
  • Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101(4):339–346. doi:10.1002/bjs.9354
  • Stephensen BD, Reid F, Shaikh S, Carroll R, Smith SR, Pockney P. C-reactive protein trajectory to predict colorectal anastomotic leak: PREDICT Study. Br J Surg. 2020;107(13):1832–1837. doi:10.1002/bjs.11812
  • Paliogiannis P, Deidda S, Maslyankov S, et al. Blood cell count indexes as predictors of anastomotic leakage in elective colorectal surgery: a multicenter study on 1432 patients. World J Surg Oncol. 2020;18(1):89. doi:10.1186/s12957-020-01856-1
  • Samji KB, Kielar AZ, Connolly M, et al. Anastomotic leaks after small- and large-bowel surgery: diagnostic performance of CT and the importance of intraluminal contrast administration. AJR Am J Roentgenol. 2018;210(6):1259–1265. doi:10.2214/ajr.17.18642
  • Phitayakorn R, Delaney CP, Reynolds HL, et al. Standardized algorithms for management of anastomotic leaks and related abdominal and pelvic abscesses after colorectal surgery. World J Surg. 2008;32(6):1147–1156. doi:10.1007/s00268-008-9468-1
  • Hedrick TL, Kane W. Management of acute anastomotic leaks. Clin Colon Rectal Surg. 2021;34(6):400–405. doi:10.1055/s-0041-1735271
  • Saur NM, Paulson EC. Operative management of anastomotic leaks after colorectal surgery. Clin Colon Rectal Surg. 2019;32(3):190–195. doi:10.1055/s-0038-1677025
  • Stafford C, Francone TD, Marcello PW, Roberts PL, Ricciardi R. Is diversion with ileostomy non-inferior to Hartmann resection for left-sided colorectal anastomotic leak? J Gastrointest Surg. 2018;22(3):503–507. doi:10.1007/s11605-017-3612-x
  • Krarup PM, Jorgensen LN, Harling H. Management of anastomotic leakage in a nationwide cohort of colonic cancer patients. J Am Coll Surg. 2014;218(5):940–949. doi:10.1016/j.jamcollsurg.2014.01.051
  • Clifford RE, Fowler H, Govindarajah N, Vimalachandran D, Sutton PA. Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage. Surg Endosc. 2019;33(4):1049–1065. doi:10.1007/s00464-019-06670-9
  • Eisenstein S, Stringfield S, Holubar SD. Using the National Surgical Quality Improvement Project (NSQIP) to perform clinical research in colon and rectal surgery. Clin Colon Rectal Surg. 2019;32(1):41–53. doi:10.1055/s-0038-1673353
  • Tsai YY, Chen WT. Management of anastomotic leakage after rectal surgery: a review article. J Gastrointest Oncol. 2019;10(6):1229–1237. doi:10.21037/jgo.2019.07.07