The Incidence and Mortality of Anastomotic Leakage after Colorectal Cancer Surgery

Abstract

Introduction: Anastomotic leakage (AL) remains one of the most feared complications after colorectal surgery with high mortality rates, prolonged hospitalization, highly risk of readmission, finally generating important costs for any healthcare system. AL prediction and early detection are a considerable challenge for each surgeon as no wellestablished and reliable predictors and diagnosis protocols are currently available. Aims: To determine the incidence and mortality of AL after colorectal surgery, with identification of possible predictors and improvement points in the management of this complication. Material and methods: We included 431 patients with colorectal cancer who underwent surgical resection and restoration of the digestive tube’s continuity, at the 2nd Department of Surgery, Emergency County Clinical Hospital of Târgu-MureE™, from January 2010-December 2015. The patients have been divided in two groups: AL group including 21 patients and no leak group with 410 patients. Demographic characteristics and comorbidities were recorded with clinical and laboratory follow-up in the postoperative period. Results: There were no significant differences between the two groups in terms of demographic characteristics and comorbidities. The average age of patients with AL was 65.9 ± 11.6 vs. 65.0 ± 10.3 without AL. Male gender was predominant in both groups. No significant differences were recorded in terms of the localization and type of intervention between the two groups. Elevated C reactive protein levels were significantly more frequent in patients with AL (p=0.03). The mortality rate in patients with AL was significantly higher compared to the no leak group 28.6% vs. 1.9% (p<0.0001). Conclusions: AL remains the most feared complication in colorectal surgery, with high mortality rates, regardless of the localization of the anastomosis and type of intervention. Elevated C reactive protein levels may predict AL being helpful for the early detection and treatment of this complication.