Skip to main content

Advertisement

SpringerLink
Log in

Risk of anastomotic leak after laparoscopic versus open colectomy

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Anastomotic leak following colorectal surgery is associated with significant morbidity and mortality. With the widespread adoption of laparoscopy, data from initial clinical trials evaluating the efficacy of laparoscopic when compared to open surgery may not currently be generalizable. We assess the risk of anastomotic leak after laparoscopic versus open colorectal resection using a nationwide database with standardized definitions.

Methods

The 2012–2013 ACS-NSQIP targeted colectomy data were queried for all elective colorectal resections. Characteristics were compared for those patients undergoing laparoscopic versus open operations. Univariable and multivariable analyses, followed by a propensity score-matched analysis, were performed to assess the impact of laparoscopy on the development of an anastomotic leak.

Results

Of 23,568 patients, 3.4 % developed an anastomotic leak. Laparoscopic surgery was associated with a leak rate of 2.8 % (n = 425) and open surgery, 4.5 % (n = 378, p < 0.0001). Patients who developed a leak were more likely to die within 30 days of surgery (5.7 vs. 0.6 %, p < 0.0001). Patients who underwent laparoscopic surgery compared to open were younger (61 vs. 63 years, p = 0, p = 0.045) and with fewer comorbidities. On univariable analysis laparoscopic surgery was associated with reduced odds of developing an anastomotic leak (OR 0.60, p < 0.0001), and this remained after adjusting for all significant preoperative and disease-related confounders (OR 0.69, 95 % CI 0.58–0.82). A propensity score-matched analysis confirmed benefit of laparoscopic surgery over open surgery for anastomotic leak.

Conclusion

Laparoscopic colectomy is safe and associated with reduced odds of developing an anastomotic leak following colectomy when controlling for patient-, disease- and procedure-related factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 147(3):339–351

    Article  PubMed  Google Scholar 

  2. Trencheva K, Morrissey KP, Wells M et al (2013) Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 257(1):108–113

    Article  PubMed  Google Scholar 

  3. Alves A, Panis Y, Trancart D et al (2002) Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 26:499

    Article  PubMed  Google Scholar 

  4. McDermott FD, Heeney A, Kelly ME et al (2015) Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 102(5):462–479

    Article  CAS  PubMed  Google Scholar 

  5. Matthiessen P, Hallböök O, Andersson M et al (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462

    Article  CAS  PubMed  Google Scholar 

  6. Docherty JG, McGregor JR, Akyol AM et al (1995) Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg 221(2):176–184

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Buchs NC, Gervaz P, Secic M et al (2008) Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis 23(3):265–270

    Article  PubMed  Google Scholar 

  8. Park JS, Choi GS, Kim SH et al (2013) Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg 257(4):665–671

    Article  PubMed  Google Scholar 

  9. Vignali A, Fazio VW, Lavery IC et al (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1014 patients. J Am Coll Surg 185:105

    Article  CAS  PubMed  Google Scholar 

  10. Khuri SF, Daley J, Henderson W et al (1998) The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 228(4):491–507

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bruce J, Krukowski ZH, Al-Khairy G et al (2001) Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 88(9):1157–1168 (Review)

    Article  CAS  PubMed  Google Scholar 

  12. Bakker IS, Grossmann I, Henneman D, Havenga K, Wiggers T (2014) Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 101(4):424–432 (discussion 432)

    Article  CAS  PubMed  Google Scholar 

  13. Frasson M, Flor-Lorente B, Ramos Rodríguez JL, Granero-Castro P, Hervás D, Alvarez Rico MA, Brao MJ, Sánchez González JM, Garcia-Granero E, ANACO Study Group (2015) Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients. Ann Surg 262(2):321–330

    Article  PubMed  Google Scholar 

  14. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350(20):2050–2059

    Article  Google Scholar 

  15. van der Pas MH, Haglind E, Cuesta MA, Colorectal Cancer Laparoscopic or Open Resection II (COLOR II) Study Group et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 14(3):210–218

    Article  PubMed  Google Scholar 

  16. Wang CL, Qu G, Xu HW (2014) The short- and long-term outcomes of laparoscopic versus open surgery for colorectal cancer: a meta-analysis. Int J Colorectal Dis 29(3):309–320

    Article  CAS  PubMed  Google Scholar 

  17. Braga M, Frasson M, Zuliani W et al (2010) Randomized clinical trial of laparoscopic versus open left colonic resection. Br J Surg 97(8):1180–1186

    Article  CAS  PubMed  Google Scholar 

  18. Fujii S, Ota M, Ichikawa Y et al (2010) Comparison of short, long-term surgical outcomes and mid-term health-related quality of life after laparoscopic and open resection for colorectal cancer: a case-matched control study. Int J Colorectal Dis 25(11):1311–1323

    Article  PubMed  Google Scholar 

  19. Antoniou SA, Antoniou GA, Koch OO et al (2015) Laparoscopic colorectal surgery confers lower mortality in the elderly: a systematic review and meta-analysis of 66,483 patients. Surg Endosc 29(2):322–333

    Article  PubMed  Google Scholar 

  20. Wilson MZ, Hollenbeak CS, Stewart DB (2014) Laparoscopic colectomy is associated with a lower incidence of postoperative complications than open colectomy: a propensity score-matched cohort analysis. Colorectal Dis 16(5):382–389

    Article  CAS  PubMed  Google Scholar 

  21. Neudecker J, Klein F, Bittner R et al (2009) LAPKON II Trialists. Short-term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer. Br J Surg 96(12):1458–1467

    Article  CAS  PubMed  Google Scholar 

  22. Lacy AM, García-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359(9325):2224–2229

    Article  PubMed  Google Scholar 

  23. Krarup PM, Jorgensen LN, Andreasen AH, Danish Colorectal Cancer Group et al (2012) A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis 14(10):e661–e667

    Article  PubMed  Google Scholar 

  24. Arezzo A, Passera R, Scozzari G et al (2013) Laparoscopy for rectal cancer reduces short-term mortality and morbidity: results of a systematic review and meta-analysis. Surg Endosc 27(5):1485–1502

    Article  PubMed  Google Scholar 

  25. Hua L, Wang C, Yao K, Zhang J, Chen J, Ma W (2014) Is the incidence of postoperative anastomotic leakage different between laparoscopic and open total mesorectal excision in patients with rectal cancer? A meta-analysis based on randomized controlled trials and controlled clinical trials. J Cancer Res Ther 10(Suppl):272–275

    PubMed  Google Scholar 

  26. Levack M, Berger D, Sylla P et al (2011) Laparoscopy decreases anastomotic leak rate in sigmoid colectomy for diverticulitis. Arch Surg 146(2):207–210

    Article  PubMed  Google Scholar 

  27. Kang CY, Halabi WJ, Chaudhry OO et al (2013) Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 148(1):65–71

    Article  PubMed  Google Scholar 

  28. Kang CY, Halabi WJ, Chaudhry OO et al (2013) A nationwide analysis of laparoscopy in high-risk colorectal surgery patients. J Gastrointest Surg 17(2):382–391

    Article  PubMed  Google Scholar 

  29. Richards CH, Campbell V, Ho C et al (2012) Smoking is a major risk factor for anastomotic leak in patients undergoing low anterior resection. Colorectal Dis 14(5):628–633

    Article  CAS  PubMed  Google Scholar 

  30. Karliczek A, Harlaar NJ, Zeebregts CJ et al (2009) Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis 24(5):569–576

    Article  CAS  PubMed  Google Scholar 

  31. Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, van der Pas MH, de Lange-de Klerk ES, Lacy AM, Bemelman WA, Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, COLOR II Study Group (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 372(14):1324–1332

    Article  CAS  PubMed  Google Scholar 

  32. Delgado S, Lacy AM, Filella X et al (2001) Acute phase response in laparoscopic and open colectomy in colon cancer: randomized study. Dis Colon Rectum 44(5):638–646

    Article  CAS  PubMed  Google Scholar 

  33. Fingerhut A, Elhadad A, Hay JM et al (1994) Infraperitoneal colorectal anastomosis: hand-sewn versus circular staples. A controlled clinical trial. French Associations for Surgical Research. Surgery 116(3):484–490

    CAS  PubMed  Google Scholar 

  34. Lawson EH, Louie R, Zingmond DS et al (2012) A comparison of clinical registry versus administrative claims data for reporting of 30-day surgical complications. Ann Surg 256(6):973–981

    Article  PubMed  Google Scholar 

  35. Agostino RB (1998) Propensity score matching for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17:2265–2281

    Article  PubMed  Google Scholar 

Download references

Authors contribution

Alice Murray and Cody Chiuzan had full access to all data. Alice Murray was responsible for data analysis, design, data interpretation and the written manuscript. Cody Chiuzan was responsible for data analysis and draft of manuscript. Professor Ravi Kiran was responsible for study conception, design and manuscript revision.

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York City, NY, 10032, USA

    Alice C. A. Murray & Ravi P. Kiran

  2. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10027, USA

    Cody Chiuzan & Ravi P. Kiran

Authors
  1. Alice C. A. Murray
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cody Chiuzan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ravi P. Kiran
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ravi P. Kiran.

Ethics declarations

Disclosures

Alice Murray, Cody Chiuzan, and Professor Ravi Kiran have no conflict of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Murray, A.C.A., Chiuzan, C. & Kiran, R.P. Risk of anastomotic leak after laparoscopic versus open colectomy. Surg Endosc 30, 5275–5282 (2016). https://doi.org/10.1007/s00464-016-4875-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-4875-0

Keywords

Search

Navigation