Anastomotic Leak in Colorectal Surgery: Predictive Factors and Survival

Introduction: Anastomotic leak (AL) is a serious complication following colorectal surgery. Aim: The aim of this study was to identify factors associated with the development of AL and to analyze its impact on survival. Materials and methods: All consecutive adult colorectal cancer resections performed between 2007 and 2020 with curative intent and anastomosis formation were included from a prospectively maintained database. The primary outcome measure was the rate of AL. The secondary outcome measure was 5-year overall survival (OS). Results: There were 6837 eligible patients. The rate of AL was 2.2% and 4.0% in patients with colon and rectal cancer, respectively. AL was a significant independent predictor of reduced 5-year OS in patients who underwent curative surgery for rectal cancer (odds ratio 2.293, p = 0.009). Emergency surgery (p = 0.015), surgery at a public hospital (p = 0.002), and an open surgical approach (p = 0.021) were all associated with a significantly higher risk of AL in patients with colon cancer, with higher rates of AL noted in left colectomies as compared to right hemicolectomies (4.4% vs. 1.3%, p < 0.001). In rectal cancer patients,AL was associated with neoadjuvant chemoradiotherapy (p = 0.038) and male gender (p = 0.002). The anastomosis formation technique (hand-sewn vs. stapled) did not impact the rate of AL (p = 0.116 and p = 0.198 with colon and rectal cancer, respectively). Discussion: Clinicians should be cognizant of the predictive factors for AL and should consider early intervention for at-risk patients.