Rectal Surgery, Male Sex Risk Factors for Anastomotic Leakage

Anastomotic leakage (AL) was associated with advanced age, presence of comorbidities, rectal surgery, and being male in patients with colorectal cancer (CRC) who elected to have colorectal surgery, according to a study published in Current Health Sciences Journal.

The safety of surgery for CRC has increased in the previous 50 years due primarily to surgical techniques improving and technology advancing to include laparoscopic and robotic surgery. Complications, however, are still possible in colorectal surgery. AL occurs in approximately 2.8% to 30% of patients; it is a complication that can lead to adverse effects on long-term outcomes, such as a decrease in survival time and increased disease recurrence. This study aimed to identify all potential risk factors for the occurrence of AL and to evaluate the therapeutic options and diagnostic methods of AL.

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The retrospective study used data from 2014 to 2022 from the 1st Surgery Clinic of Craiova in Romania. Patients were included if they were 18 years and older, had CRC with various localizations, and had a primary surgery of resection. Patients with Miles abdomino-perineal resections, Harmann resections, and colostomies were excluded. All patients had preparation before their operation.vData were collected from all patients on age, gender, occupation, comorbidities, chemotherapy, leakage, surgery, and tumors .

There were 28 incidences of AL that were registered after 315 operations for CRC between 2014 and 2022. The incidence rate of AL was 8.8%. Different values were found based on the type of primary surgery, tumor topography, presence of protective ileostomy, type of anastomosis and suture, and approach route. Resections in rectal cancer (12.38%), resections for left colon cancer (7.93%), and resections in right colon cancer (3.75%) had the highest incidence of AL. Further, AL was found in 60.71% of cases that had rectal surgery when it was their primary surgery.

The researchers found that 82.14% of patients 60 years and older had AL, making it a primary risk factor. Male patients were also more likely to have AL, as 21 men experienced AL compared with 7 women. Twenty-seven of the 28 patients with AL had 2 or more comorbidities, with the most common being cardiovascular diseases (67.85%), digestive issues (32.14%), respiratory issues (25.0%), renal disease (25%), diabetes (18.57%), and obesity (17.85%). Eating disorders were also found in numerous patients, with 17 cases of hypoproteinemia and 14 cases of anemia.

All leakage were cases of AL, 18 of which were from direct tracts. The colorectal anastomosis was the location of the leakage in 19 cases. Intestinal contents made up the contents of the leakage in 8 cases, with fecaloid being the contents in 9 cases and purulent in 11 cases.

The overall morbidity of the patient population was 64.28%, with 18 cases having progressive complications, and the overall mortality was 21.42% with 6 deaths, 3 of which came after reinterventions. Patients spent an average of 33.35 days in the hospital.

The researchers concluded that older age, presence of 2 or more comorbidities, rectal surgery, and male sex were all risk factors for AL. Mortality was prominent in patients with AL at 6 deaths and reintervention was a noted cause of death. These factors could help in addressing CRC in patients needing colorectal surgery.

Reference

Denicu MM, Cartu D, Ramboiu S, et al. Anastomotic leakage after colorectal surgery: risk factors, diagnosis and therapeutic options. Curr Health Sci J. 2023;49(3):333-342. doi:10.12865/chsj.49.03.05