Skip to main content

Anastomotic Location Predicts Anastomotic Leakage After Elective Colonic Resection for Cancer

Journal of Gastrointestinal Surgery volume 23, pages 339–347 (2019)Cite this article

Abstract

Background

Anastomotic leakage (AL) is a potential feared complication after colorectal resection, which is associated with an increased risk of postoperative mortality and frequently requires additional surgery. The aim of this study was to assess major independent risk factors for AL after elective colonic resection for cancer, including anastomotic location.

Methods

Among 1940 consecutive patients referred to our institution for colorectal adenocarcinoma, 1025 patients had elective colonic resection with intraperitoneal anastomosis without diverting stoma. Risk factors were assessed among preoperative, operative, and histological data.

Results

Clinical AL was observed in 36 patients (3.5%) with 24 patients requiring revisional surgery (67%). In multivariate analysis, endoscopic impassable tumor and colo-colic or ileo-colic anastomosis were independent risk factors for AL. The occurrence of AL was associated with poor overall (43.1 months vs. 146.4 months; p < 0.001) and disease-free survival (40.5 months vs. 137.3 months; p = 0.003).

Conclusion

Anastomotic leakage occurs more frequently after colo-colic and ileo-colic anastomosis than after intraperitoneal colorectal anastomosis.

The right colectomy appears to be at higher risk of AL, with a greater risk of surgical intervention than after an elective left colectomy. Ileo-colic anastomosis should be avoided in cases of suboptimal conditions.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359–86. https://doi.org/10.1002/ijc.29210

    Article  CAS  Google Scholar 

  2. Blumetti J, Chaudhry V, Cintron JR, et al. Management of Anastomotic Leak: Lessons Learned from a Large Colon and Rectal Surgery Training Program. World J Surg 2014;38:985–91. https://doi.org/10.1007/s00268-013-2340-y

    Article  PubMed  Google Scholar 

  3. Marinello FG, Baguena G, Lucas E, et al. Anastomotic leaks after colon cancer resections: Does the individual surgeon matter?. Colorectal Dis 2015;562–9. https://doi.org/10.1111/codi.13212

  4. Frasson M, Flor-Lorente B, Rodríguez JLR, et al. Risk Factors for Anastomotic Leak After Colon Resection for Cancer. Ann Surg 2015;262:321–30. https://doi.org/10.1097/SLA.0000000000000973

    Article  PubMed  Google Scholar 

  5. Trencheva K, Morrissey KP, Wells M, et al. Identifying Important Predictors for Anastomotic Leak After Colon and Rectal Resection. Ann Surg 2012;1. https://doi.org/10.1097/SLA.0b013e318262a6cd

  6. Kockerling F, Rose J, Schneider C, et al. Laparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group (LCSSG). Surg Endosc 1999;13:639–44.

    Article  CAS  PubMed  Google Scholar 

  7. Alves A, Panis Y, Trancart D. Factors associated with clinically anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 2002;499–502. https://doi.org/10.1007/s00268-001-0256-4

  8. Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011;253:890–9. https://doi.org/10.1097/SLA.0b013e3182128929

    Article  PubMed  Google Scholar 

  9. Marra F, Steffen T, Kalak N, et al. Anastomotic leakage as a risk factor for the long-term outcome after curative resection of colon cancer. Eur J Surg Oncol 2009;35:1060–4. https://doi.org/10.1016/j.ejso.2009.02.011

    Article  CAS  PubMed  Google Scholar 

  10. Kube R, Mroczkowski P, Granowski D, 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; 36:120–4. https://doi.org/10.1016/j.ejso.2009.08.011

    Article  CAS  PubMed  Google Scholar 

  11. Krarup P-M, Jorgensen LN, Harling H. Management of anastomotic leakage in a nationwide cohort of colonic cancer patients. J Am Coll Surg 2014; 218:940–9. https://doi.org/10.1016/j.jamcollsurg.2014.01.051

    Article  PubMed  Google Scholar 

  12. Vonlanthen R, Slankamenac K, Breitenstein S, et al. The Impact of Complications on Costs of Major Surgical Procedures. Ann Surg 2011; 254:907–13. https://doi.org/10.1097/SLA.0b013e31821d4a43

    Article  PubMed  Google Scholar 

  13. Karliczek A, Harlaar NJ, Zeebregts CJ, et al. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis 2009; 24:569–76. https://doi.org/10.1007/s00384-009-0658-6

    Article  CAS  PubMed  Google Scholar 

  14. McDermott FD, Heeney A, Kelly ME, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 2015;102:462–79. https://doi.org/10.1002/bjs.9697

    Article  CAS  PubMed  Google Scholar 

  15. Buchs NC, Gervaz P, Secic M, et al. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 2008; 23:265–70. https://doi.org/10.1007/s00384-007-0399-3

    Article  PubMed  Google Scholar 

  16. Boccola M A, Buettner PG, Rozen WM, et al. Risk factors and outcomes for anastomotic leakage in colorectal surgery: A single-institution analysis of 1576 patients. World J Surg 2011; 35:186–95. https://doi.org/10.1007/s00268-010-0831-7

    Article  PubMed  Google Scholar 

  17. Shiomi A, Ito M, Maeda K, et al. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: A propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg 2015; 220:186–94. https://doi.org/10.1016/j.jamcollsurg.2014.10.017

    Article  PubMed  Google Scholar 

  18. Peeters KCMJ, Tollenaar RAEM, Marijnen CAM, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005; 92:211–6. https://doi.org/10.1002/bjs.4806

    Article  CAS  PubMed  Google Scholar 

  19. Bakker IS, Grossmann I, Henneman D, et al. Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 2014; 101:424–32. https://doi.org/10.1002/bjs.9395

    Article  CAS  PubMed  Google Scholar 

  20. Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications. Ann Surg 2004; 240:205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed Central  PubMed  Google Scholar 

  21. Edge SD, Compton C, Fritz A, et al. Colon and Rectum. In: Springer, ed. AJCC Cancer Staging Manual. New York: 2010.173–206.

  22. Veyrie N, Ata T, Muscari F, et al. Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg 2007;205:785–93. https://doi.org/10.1016/j.jamcollsurg.2007.06.284

    Article  PubMed  Google Scholar 

  23. Bakker IS, Snijders HS, Grossmann I, et al. High mortality rates after non-elective colon cancer resection: results of a national audit. Color Dis 2016;:n/a-n/a. https://doi.org/10.1111/codi.13262

  24. Alves A, Panis Y, Mathieu P, et al. Postoperative Mortality and Morbidity in French Patients Undergoing Colorectal Surgery. Arch Surg 2005;140:278–83. https://doi.org/10.1001/archsurg.140.3.284

    Article  PubMed  Google Scholar 

  25. Kwaan MR, Al-Refaie WB, Parsons HM, et al. Are Right-Sided Colectomy Outcomes Different From Left-Sided Colectomy Outcomes? Study of Patients With Colon Cancer in the ACS NSQIP Database. JAMA Surg 2013;148:504–10. https://doi.org/10.1001/jamasurg.2013.1205

    Article  PubMed  Google Scholar 

  26. Panis Y, Maggiori L, Caranhac G, et al. Mortality After Colorectal Cancer Surgery. Ann Surg 2011;254:738–44. https://doi.org/10.1097/SLA.0b013e31823604ac

    Article  PubMed  Google Scholar 

  27. Hyman N, Manchester TL, Osler T, et al. Anastomotic leaks after intestinal anastomosis: It’s later than you think. Ann Surg 2007; 245:254–8. https://doi.org/10.1097/01.sla.0000225083.27182.85

    Article  PubMed Central  PubMed  Google Scholar 

  28. Kehlet H. Fast-track colorectal surgery Perioperative. Lancet 2008; 371:792–3. https://doi.org/10.1016/S0140-6736(08)60357-8

    Article  Google Scholar 

  29. Anderson ADG, McNaught CE, MacFie J, et al. Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg 2003; 90:1497–504. https://doi.org/10.1002/bjs.4371

    Article  CAS  PubMed  Google Scholar 

  30. Khoo CK, Vickery CJ, Forsyth N, et al. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg 2007;245:867–72. https://doi.org/10.1097/01.sla.0000259219.08209.36

    Article  PubMed Central  PubMed  Google Scholar 

  31. Gatt M, Anderson ADG, Reddy BS, et al. Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection. Br J Surg 2005;92:1354–62. https://doi.org/10.1002/bjs.5187

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of General, Digestive and Oncological Surgery, Georges Pompidou European Hospital, AP-HP, Assistance Publique-Hôpitaux de Paris, 20-40 rue Leblanc, 75908, Paris, France

    Thibault Voron, Matthieu Bruzzi, Emilia Ragot, Franck Zinzindohoue, Jean-Marc Chevallier, Richard Douard & Anne Berger

  2. Faculté de Médecine Paris Descartes, Paris, France

    Thibault Voron, Matthieu Bruzzi, Franck Zinzindohoue, Jean-Marc Chevallier, Richard Douard & Anne Berger

Authors
  1. Thibault Voron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthieu Bruzzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emilia Ragot
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Franck Zinzindohoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean-Marc Chevallier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Richard Douard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anne Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: Voron, Douard, Berger

Acquisition of data: Voron, Bruzzi, Ragot

Analysis and interpretation of data: Voron, Zinzindohoue, Chevallier, Douard, Berger

Drafting of manuscript: Voron, Douard, Berger

Critical Revision: Voron, Bruzzi, Ragot, Zinzindohoue, Chevallier, Douard, Berger

Corresponding author

Correspondence to Thibault Voron.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Voron, T., Bruzzi, M., Ragot, E. et al. Anastomotic Location Predicts Anastomotic Leakage After Elective Colonic Resection for Cancer. J Gastrointest Surg 23, 339–347 (2019). https://doi.org/10.1007/s11605-018-3891-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-018-3891-x

Keywords

  • Colonic resection
  • Colorectal cancer
  • Anastomotic leakage
  • Right colectomy
  • Prognostic factors