RISK FACTORS FOR ANASTOMOTIC LEAKAGE FOLLOWING RADICAL ONE-STAGE SURGICAL INTERVENTIONS IN COLORECTAL SURGERY

Authors

DOI:

https://doi.org/10.11603/2414-4533.2025.4.15738

Keywords:

colorectal surgery, colorectal anastomosis, anastomotic leak, risk factors, risk stratification, postoperative complications

Abstract

The aim of the work: to identify the main factors affecting the risk of colorectal anastomotic leak following radical one-stage surgical interventions in colorectal surgery.

Materials and Methods. A retrospective study was conducted of surgical treatment outcomes in 44 patients who underwent radical one-stage colonic operations with primary anastomosis. Anterior resection of the rectum was performed in 28 patients (63.5 %), left hemicolectomy in 11 (25 %), and right hemicolectomy in 5 (11.5 %). The classification of risk factors into modifiable and non-modifiable, preoperative, operative, and postoperative categories was used. Statistical analysis included calculation of odds ratios (OR) with 95 % confidence intervals (CI) and relative risk (RR) using SPSS 26.0.

Results. The overall anastomotic leak rate was 13.6 %. The most significant modifiable pre-operative factors were hypoproteinemia (OR=3.74), malnutrition (OR=3.05), and obesity (OR=2.32). Among operative factors, the highest risk was associated with inadequate blood supply to the anastomosis (OR=5.21), poor blood supply to the resection site (OR=4.56), and absence of a diverting stoma (OR=3.52). Among non-modifiable factors, ASA IV (OR=3.68), Charlson Comorbidity Index ≥5 (OR=3.53), tumor location <5 cm from the anal verge (OR=4.16), and emergency surgery (OR=3.75) were prominent. Post-operative massive blood transfusion demonstrated OR=4.18. A risk stratification model was developed: high risk (≥3 factors) – 27.8 %, intermediate risk (1–2 factors) – 8.6 %, low risk (0 factors) – 3.1 %.

Conclusions. Colorectal anastomotic leak is a multifactorial complication. Identification and correction of modifiable risk factors, particularly nutritional status, ensuring adequate vascularization of the anastomosis, and use of a diverting stoma in low resections, allows for individualization of the approach to anastomotic leak prevention and improvement of surgical treatment outcomes.

 

Author Biographies

I. YА. DZIUBANOVSKYІ, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine

DSc (Medicine), Professor, Head of the Department of Surgery, Faculty of Postgraduate Education

V. R. BURATYNSKYI, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine

Рostgraduate Student of the Department of Surgery, Faculty of Postgraduate Education

 

References

Zarnescu EC, Zarnescu NO, Costea R. Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery. Diagnostics. 2021; 11:2382. DOI: 10.3390/ diagnostics11122382.

Kostov GG, Dimov RS, Almeida DD. Risk factors for anastomotic leakage after low anterior resection. Folia Med (Plovdiv). 2020; 62(2):290-4. DOI: 10.3897/folmed.62.e47727.

Jutesten H, Buchwald P, Angenete E, Rutegard M, Lydrup ML. High risk of low anterior resection syndrome in long-term follow-up after anastomotic leakage in anterior resection for rectal cancer. Dis Colon Rectum. 2021; 65(10):1264-73. DOI: 10.1097/dcr.0000000 000002334.

Van Helsdingen CP, Jongen AC, de Jonge WJ, Bouvy ND, Derikx JP. Consensus on the definition of colorectal anastomotic leakage: a modified Delphi study. World J Gastroenterol. 2020; 26(23):3293-03. DOI: 10.3748/wjg.v26.i23.3293.

Yu ZL, Liu XH, Liu HS, et al. Impact of pelvic dimensions on anastomotic leak after anterior resection for patients with rectal cancer. Surg Endosc. 2021; 35(5):2134-43. DOI: 10.1007/ s00464-020-07617-1.

Arron MNN, Greijdanus NG, Broek RPGT, Dekker JWT, van Workum F, van Goor H, Tanis PJ, de Wilt, JH. Trends in risk factors of anastomotic leakage after colorectal cancer surgery (2011–2019): A Dutch population-based study. Color. Dis. 2021 Dec.; 23(12):3251-261. DOI: 10.1111/codi.15911. Epub. 2021 Oct. 7.

Goulart A, Malheiro N, Ríos H, Sousa N, Leao P. Influence of Visceral Fat in the Outcomes of Colorectal Cancer. Dig. Surg. 2018; 36:33-40.

Sparreboom CL, Van Groningen JT, Lingsma HF, Wouters M, Menon AG, Kleinrensink G-J, Jeekel J, Lange JF. Different Risk Factors for Early and Late Colorectal Anastomotic Leakage in a Nationwide Audit. Dis. Colon Rectum. 2018; 61:1258-66.

Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP. Incidence and Risk Factors for Anastomotic Failure in 1594 Patients Treated by Transanal Total Mesorectal Excision. Ann. Surg. 2019; 269:700-11.

Akgun E, Caliskan C, Bozbiyik O, Yoldas T, Sezak M, Ozkok S, Kose T, Karabulut B, Harman M, Ozutemiz O. Randomized clinical trial of short or long interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. BJS. 2018; 105:1417-25.

Rencuzogullari A, Benlice C, Valente M, Abbas MA, Remzi FH, Gorgun E. Predictors of Anastomotic Leak in Elderly Patients After Colectomy: Nomogram-Based Assessment From the American College of Surgeons National Surgical Quality Program Procedure-Targeted Cohort. Dis. Colon Rectum. 2017; 60:527-36.

Zhang W, Lou Z, Liu Q, Meng R, Gong H, Hao L, Liu P, Sun G, Ma J. Multicenter analysis of risk factors for anastomotic leakage after middle and low rectal cancer resection without diverting stoma: A retrospective study of 319 consecutive patients. Int. J. Color. Dis. 2017; 32:1431-37.

Nikolian VC, Kamdar NS, Regenbogen SE, Morris AM, Byrn JC, Suwanabol PA, Campbell DA, Hendren S. Anastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation. Surgery. 2017; 161:1619-27.

Wada T, Kawada K, Hoshino N, Inamoto S, Yoshitomi M, Hida K, Sakai Y. The effects of intraoperative ICG fluorescence angiography in laparoscopic low anterior resection: A propensity score-matched study. Int. J. Clin. Oncol. 2019; 24:394-402.

Watanabe J, Ishibe A, Suwa Y, Suwa, H, Ota M, Kunisaki C, Endo I. Indocyanine green fluorescence imaging to reduce the risk of anastomotic leakage in laparoscopic low anterior resection for rectal cancer: A propensity score-matched cohort study. Surg. Endosc. 2019; 34:202-08.

Ohya H, Watanabe J, Suwa H, Suwa Y, Ishibe A, Masui H, Nagahori K, Kunisaki C, Endo I. Incidence and risk factors for fluorescence abnormalities on near-infrared imaging using indocyanine green in stapled functional end-to-end anastomosis in laparoscopic colectomy. Int. J. Color. Dis. 2020; 35:2011-18.

Nikolian VC, Kamdar NS, Regenbogen SE, Morris AM, Byrn JC, Suwanabol PA, Campbell DA, Hendren S. Anastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation. Surgery. 2017; 161:1619-27.

Nikolian VC, Kamdar NS, Regenbogen SE, Morris AM, Byrn JC, Suwanabol PA, Campbell DA, Hendren S. Anastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation. Surgery. 2017; 161:1619-27.

Hayden DM, Pinzon MCM, Francescatti AB, Saclarides TJ. Patient factors may predict anastomotic complications after rectal cancer surgery. Ann. Med. Surg. 2015; 4:11-16.

Marinello F, Baguena G, Lucas E, Frasson M, Hervas D, Flor-Lorente B, Esclapez P, Espí A, García-Granero E. Anastomotic leakage after colon cancer resection: Does the individual surgeon matter? Color. Dis. 2016; 18:562-69.

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Published

2025-12-30

How to Cite

DZIUBANOVSKYІ I. Y., & BURATYNSKYI, V. R. (2025). RISK FACTORS FOR ANASTOMOTIC LEAKAGE FOLLOWING RADICAL ONE-STAGE SURGICAL INTERVENTIONS IN COLORECTAL SURGERY. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (4), 18–24. https://doi.org/10.11603/2414-4533.2025.4.15738

Issue

No. 4 (2025)

Section

ORIGINAL INVESTIGATIONS

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Copyright (c) 2025 І. Я. ДЗЮБАНОВСЬКИЙ, В. Р. БУРАТИНСЬКИЙ

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