Impact of Anastomotic Leakage After Colorectal Cancer Surgery on Quality of Life: A Systematic Review

Abstract

Background: Colorectal anastomotic leakage remains one of the most frequent and dreaded postoperative complications after colorectal resection. However, limited research has been conducted on the impact of this complication on the quality of life of patients who have undergone colorectal cancer surgery.

Objective: The aim of this systematic review was to identify, appraise, and synthesize the available evidence regarding the quality of life in patients with anastomotic leakage after oncological colorectal resections to inform clinical decision-making.

Data sources and study selection: PubMed, Embase, and the Cochrane Library were searched for studies reporting quality of life using validated questionnaires in patients with anastomotic leakage after oncological colorectal resections. The literature search was performed systematically and according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Outcomes: Outcomes from quality-of-life questionnaires of patients with and without anastomotic leakage were analyzed.

Results: Thirteen articles reporting on 4618 individual patients were included, among which 527 patients developed anastomotic leakage. Quality of life was evaluated using 10 distinct questionnaires administered at various postoperative time points, ranging from 1 month to 14 years. Quality-of-life outcomes differed across studies and time points, but overall scores were most negatively affected by anastomotic leakage up to 12 months postoperatively.

Limitations: There was a high heterogeneity between the included studies based on the questionnaires used and the time of assessment.

Conclusions: The published evidence suggests that anastomotic leakage after oncologic colorectal resection is associated with impaired quality of life, especially within the first postoperative year. The impact of anastomotic leakage on quality of life warrants further evaluation and discussion with patients.

FIGURE 1.

Study selection. A, PRISMA flow chart outlining study selection strategy. B, Adapted ROBINS-I tool Risk of Bias from included studies. CRC = colorectal cancer; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; QoL = quality of life; ROBINS-I = Risk of Bias in Non-randomized Studies of Interventions.

FIGURE 2.

Schematic overview of results of QOL questionnaires based on different time points. *Not statistically significant but on an individual level AL was a determinant of a clinically relevant decrease; **at least 6 mo after the restoration of bowel continuity; ***subgroup: in patients with no stoma closure, there was a difference; ****modified version of the questionnaire. AL = anastomotic leakage; CGQL = Cleveland Global QoL questionnaire; EORTC = European Organization for Research and Treatment of Cancer; EQ-VAS = the EuroQoL Visual Analog Scale; FIQL = Fecal Incontinence; GIQLI = GI QoL Index; IQR = interquartile range; IN-PATSAT32 = inpatient satisfaction; MCS = mental component summary; PCS = physical component summary; QLQ-CR29 = QoL Questionnaire colorectal cancer–specific; QLQ-CR30 = QoL Questionnaire cancer–specific; QoL= quality of life; SF-12 = 12-item Short-Form survey; SF-36 = 36-item Short-Form survey; RSCL = Rotterdam Symptoms Check List.