Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going?

Abstract

Anastomotic leakage (AL) remains one of the most severe complications following colorectal cancer (CRC) surgery. Indeed, leaks that may occur after any type of intestinal anastomosis are commonly associated with a higher reoperation rate and an increased risk of postoperative morbidity and mortality. At first, our review aims to identify specific preoperative, intraoperative and perioperative factors that eventually lead to the development of anastomotic dehiscence based on the current literature. We will also investigate the role of several biomarkers in predicting the presence of ALs following colorectal surgery. Despite significant improvements in perioperative care, advances in surgical techniques, and a high index of suspicion of this complication, the incidence of AL remained stable during the last decades. Thus, gaining a better knowledge of the risk factors that influence the AL rates may help identify high-risk surgical patients requiring more intensive perioperative surveillance. Furthermore, prompt diagnosis of this severe complication may help improve patient survival. To date, several studies have identified predictive biomarkers of ALs, which are most commonly associated with the inflammatory response to colorectal surgery. Interestingly, early diagnosis and evaluation of the severity of this complication may offer a significant opportunity to guide clinical judgement and decision-making.

Keywords: anastomotic leakage; anastomotic leakage prediction; colorectal cancer; colorectal surgery; risk factors.

Figure 1

Multiple risk factors have been investigated so far concerning their impact on the incidence of postoperative ALs. Gaining a better knowledge of certain preoperative, intraoperative and perioperative factors could assist the surgeons’ intraoperative judgement and decision-making.

Figure 2

Intraoperative assessment of anastomotic perfusion using ICG-FA in order to construct a well-vascularized anastomosis (white arrows) and reduce the risk of postoperative AL. ICG-FA, indocyanine green-fluorescence angiography; AL, anastomotic leakage.