An Integrated Approach to Colorectal Anastomotic Leakage

Abstract

Colorectal anastomotic leakage (CAL) still remains a frequent and most dangerous complication after gastrointestinal surgery, occurring in 4-33% patients and contributing to one third of postoperative mortality. CAL substantially prolongs hospital stay ? by one to two weeks - and greatly increases medical costs by as much as $24,000 within the first period of hospitalization, thereby approximately tripling the expenditure relative to that of patients without CAL. Due to the high risk of postoperative mortality, substantial efforts have been made to investigate means of preventing and detecting CAL. In recent decades, however, even with substantial improvements in surgical technique, no clear decrease in CAL rate has been achieved. Much effort has been devoted to selecting patients with higher risks of CAL, and many risk factors have been identified, such as being male, smoking, alcohol abuse, obesity, a high American Society of Anesthesiologists (ASA) score, low level (e.g. rectal) anastomosis, tumor stage, urgent operation, increased blood loss, and prolonged duration of surgery have been revealed. Previous studies by our research group also reported several novel risk factors including after-hours surgery, and long-term and preoperative administration of corticosteroids. However, these risk factors seem to cover most patients and thus may have limited value in the preoperative selection of patients.