Risk Factors and Preventive Measures for Anastomotic Leak in Colorectal Cancer

Abstract

Anastomotic leak (AL) represents one of the most detrimental complications after colorectal surgery. The patient-related factors and surgery-related factors leading to AL have been identified in previous studies. Through early identification and timely adjustment of risk factors, preventive measures can be taken to reduce potential AL. However, there are still many problems associated with AL. The debate about preventive measures such as preoperative mechanical bowel preparation (MBP), intraoperative drainage, and surgical scope also continues. Recently, the gut microbiota has received more attention due to its important role in various diseases. Although the underlying mechanisms of gut microbiota on AL have not been validated completely, new strategies that manipulate intrinsic mechanisms are expected to prevent and treat AL. Moreover, laboratory examinations for AL prediction and methods for blood perfusion assessment are likely to be promoted in clinical practice. This review outlines possible risk factors for AL and suggests some preventive measures in terms of patient, surgery, and gut microbiota.

Keywords: anastomotic leakage; colorectal cancer; gut microbiota; prevention; risk factor.

Figure 1.

Preventive measures for anastomotic leak (AL) in terms of patient, surgery, and gut microbiota.

Figure 2.

The possible mechanisms of gut microbiota on anastomotic leak (AL). The altered phenotype makes the strain aggressive and virulent, activating MMP-9 and PLG, causing collagen degradation and AL. Besides, low microbiota diversity and decreased beneficial microbiota may reduce the proliferation and migration of ROS-mediated epithelial cells, thereby delaying anastomotic healing.