Clin Colon Rectal Surg
DOI: 10.1055/s-0045-1807727
Review Article

Anastomotic Leak Following Colorectal Surgery

Olivia Ziegler
1   Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
,
Audrey S. Kulaylat
2   Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
› Author Affiliations

Abstract

Anastomotic leak (AL) following colorectal surgery is a devastating complication. It is associated with high mortality rates, increased length of stay, and—in the setting of cancer—higher disease recurrence and worse overall survival. Further, it is associated with significantly increased costs, both for the acute hospital setting and the higher-intensity postdischarge care requirements these patients often experience. Identification of factors that prognosticate AL is important, as it may enable earlier detection and even patient optimization prior to surgery.



Publication History

Article published online:
29 April 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Kang CY, Halabi WJ, Chaudhry OO. et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg 2013; 148 (01) 65-71
  • 2 Zarnescu EC, Zarnescu NO, Costea R. Updates of risk factors for anastomotic leakage after colorectal surgery. Diagnostics (Basel) 2021; 11 (12) 2382
  • 3 Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KGM. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 88: 1157-1168
  • 4 McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg 2015; 102 (05) 462-479
  • 5 Daniel VT, Alavi K, Davids JS. et al. The utility of the delphi method in defining anastomotic leak following colorectal surgery. Am J Surg 2020; 219 (01) 75-79
  • 6 Rahbari NN, Weitz J, Hohenberger W. et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery 2010; 147 (03) 339-351
  • 7 van Helsdingen CPM, Jongen ACHM, de Jonge WJ, Bouvy ND, Derikx JPM. Consensus on the definition of colorectal anastomotic leakage: A modified Delphi study. World J Gastroenterol 2020; 26 (23) 3293-3303
  • 8 Olsen BC, Sakkestad ST, Pfeffer F, Karliczek A. Rate of anastomotic leakage after rectal anastomosis depends on the definition: Pelvic abscesses are significant. Scand J Surg 2019; 108 (03) 241-249
  • 9 Kulu Y, Ulrich A, Bruckner T. et al.; International Study Group of Rectal Cancer. Validation of the International Study Group of Rectal Cancer definition and severity grading of anastomotic leakage. Surgery 2013; 153 (06) 753-761
  • 10 Snijders HS, Wouters MW, van Leersum NJ. et al. Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol 2012; 38 (11) 1013-1019
  • 11 Thornton M, Joshi H, Vimalachandran C. et al. Management and outcome of colorectal anastomotic leaks. Int J Colorectal Dis 2011; 26 (03) 313-320
  • 12 Hammond J, Lim S, Wan Y, Gao X, Patkar A. The burden of gastrointestinal anastomotic leaks: an evaluation of clinical and economic outcomes. J Gastrointest Surg 2014; 18 (06) 1176-1185
  • 13 Al-Mazrou AM, Suradkar K, Mauro CM, Kiran RP. Characterization of readmission by day of rehospitalization after colorectal surgery. Dis Colon Rectum 2017; 60: 202-212 . Lippincott Williams and Wilkins.
  • 14 Midura EF, Hanseman D, Davis BR. et al. Risk factors and consequences of anastomotic leak after colectomy: A national analysis. Dis Colon Rectum 2015; 58: 333-338 . Lippincott Williams and Wilkins.
  • 15 Ashraf SQ, Burns EM, Jani A. et al. The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them?. Colorectal Dis 2013; 15 (04) e190-e198
  • 16 Lin JK, Yueh TC, Chang SC. et al. The influence of fecal diversion and anastomotic leakage on survival after resection of rectal cancer. J Gastrointest Surg 2011; 15 (12) 2251-2261
  • 17 Allaix ME, Rebecchi F, Famiglietti F, Arolfo S, Arezzo A, Morino M. Long-term oncologic outcomes following anastomotic leak after anterior resection for rectal cancer: does the leak severity matter?. Surg Endosc 2020; 34 (09) 4166-4176
  • 18 Wang S, Liu J, Wang S, Zhao H, Ge S, Wang W. Adverse effects of anastomotic leakage on local recurrence and survival after curative anterior resection for rectal cancer: a systematic review and meta-analysis. World J Surg 2017; 41 (01) 277-284
  • 19 Lawler J, Choynowski M, Bailey K, Bucholc M, Johnston A, Sugrue M. Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery. BJS Open 2020; 4 (05) 737-747
  • 20 Pozios I, Kaufmann D, Boubaris K. et al. Impact of myopenia and myosteatosis on postoperative outcome and recurrence in Crohn's disease. Int J Colorectal Dis 2022; 37 (04) 791-804
  • 21 Platell C, Mackay J, Woods R. A multivariate analysis of risk factors associated with recurrence following surgery for Crohn's disease. Colorectal Dis 2001; 3 (02) 100-106
  • 22 Kiely JM, Fazio VW, Remzi FH, Shen B, Kiran RP. Pelvic sepsis after IPAA adversely affects function of the pouch and quality of life. Dis Colon Rectum 2012; 55 (04) 387-392
  • 23 Heuthorst L, Wasmann KATGM, Reijntjes MA, Hompes R, Buskens CJ, Bemelman WA. Ileal pouch-anal anastomosis complications and pouch failure: A systematic review and meta-analysis. Ann Surg Open 2021; 2 (02) e074
  • 24 Jung SH, Yu CS, Choi PW. et al. Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum 2008; 51 (06) 902-908
  • 25 Pedrazzani C, Conti C, Turri G. et al. Impact of age on feasibility and short-term outcomes of ERAS after laparoscopic colorectal resection. World J Gastrointest Surg 2019; 11 (10) 395-406
  • 26 Zaimi I, Sparreboom CL, Lingsma HF. et al.; Dutch ColoRectal Audit Group. The effect of age on anastomotic leakage in colorectal cancer surgery: A population-based study. J Surg Oncol 2018; 118 (01) 113-120
  • 27 Bergman H, Ferrucci L, Guralnik J. et al. Frailty: An emerging research and clinical paradigm-issues and controversies. J Gerontol A Biol Sci Med Sci 2007; 62 (07) 731-737
  • 28 Dressler JA, Shah N, Lueckel SN, Cioffi Jr WG. Predicting anastomotic leak after elective colectomy: utility of a modified frailty index. Dis Colon Rectum 2022; 65 (04) 574-580
  • 29 Tan KY, Kawamura YJ, Tokomitsu A, Tang T. Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized. Am J Surg 2012; 204 (02) 139-143
  • 30 Park JS, Choi GS, Kim SH. et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group. Ann Surg 2013; 257 (04) 665-671
  • 31 Bisgård AS, Noack MW, Klein M, Rosenberg J, Gögenur I. Perioperative statin therapy is not associated with reduced risk of anastomotic leakage after colorectal resection. Dis Colon Rectum 2013; 56 (08) 980-986
  • 32 Trencheva K, Morrissey KP, Wells M. et al. Identifying important predictors for anastomotic leak after colon and rectal resection: prospective study on 616 patients. Ann Surg 2013; 257 (01) 108-113
  • 33 Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 2004; 6 (06) 462-469
  • 34 Krarup PM, Jorgensen LN, Andreasen AH, Harling H. Danish Colorectal Cancer Group. A nationwide study on anastomotic leakage after colonic cancer surgery. Colorectal Dis 2012; 14 (10) e661-e667
  • 35 Law WI, Chu KW, Ho JWC, Chan CW. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 2000; 179 (02) 92-96
  • 36 Arron MNN, Greijdanus NG, Ten Broek RPG. et al. Trends in risk factors of anastomotic leakage after colorectal cancer surgery (2011-2019): A Dutch population-based study. Colorectal Dis 2021; 23 (12) 3251-3261
  • 37 Kvist H, Chowdhury B, Grangård U, Tylén U, Sjöström L. Total and visceral adipose-tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. Am J Clin Nutr 1988; 48 (06) 1351-1361
  • 38 Goulart A, Malheiro N, Rios H, Sousa N, Leão P. Influence of visceral fat in the outcomes of colorectal cancer. Dig Surg 2019; 36 (01) 33-40
  • 39 Ba ZF, Yokoyama Y, Toth B, Rue III LW, Bland KI, Chaudry IH. Gender differences in small intestinal endothelial function: inhibitory role of androgens. Am J Physiol Gastrointest Liver Physiol 2004; 286 (03) G452-G457
  • 40 Benson AB, Venook AP, Al-Hawary MM. et al. Rectal cancer, version 2.2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2022; 20 (10) 1139-1167
  • 41 Martin ST, Heneghan HM, Winter DC. Systematic review of outcomes after intersphincteric resection for low rectal cancer. Br J Surg 2012; 99 (05) 603-612
  • 42 Kim HK, Jessup JM, Beard CJ. et al. Locally advanced rectal carcinoma: pelvic control and morbidity following preoperative radiation therapy, resection, and intraoperative radiation therapy. Int J Radiat Oncol Biol Phys 1997; 38 (04) 777-783
  • 43 Sharma A, Jasrotia S, Kumar A. Effects of chemotherapy on the immune system: Implications for cancer treatment and patient outcomes. Naunyn Schmiedebergs Arch Pharmacol 2024; 397 (05) 2551-2566
  • 44 Qin Q, Ma T, Deng Y. et al. Impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection: post hoc analysis of a randomized controlled trial. Dis Colon Rectum 2016; 59 (10) 934-942
  • 45 Sparreboom CL, van Groningen JT, Lingsma HF. et al.; Dutch ColoRectal Audit group. Different risk factors for early and late colorectal anastomotic leakage in a nationwide audit. Dis Colon Rectum 2018; 61 (11) 1258-1266
  • 46 Pommergaard HC, Gessler B, Burcharth J, Angenete E, Haglind E, Rosenberg J. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis 2014; 16 (09) 662-671
  • 47 Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN. Norwegian Rectal Cancer Group. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 2005; 7 (01) 51-57
  • 48 You YN, Hardiman KM, Bafford A. et al.; On Behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons. The American society of colon and rectal surgeons clinical practice guidelines for the management of rectal cancer. Dis Colon Rectum 2020; 63 (09) 1191-1222
  • 49 Marijnen CAM, Kapiteijn E, van de Velde CJH. et al.; Cooperative Investigators of the Dutch Colorectal Cancer Group. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2002; 20 (03) 817-825
  • 50 Hu MH, Huang RK, Zhao RS, Yang KL, Wang H. Does neoadjuvant therapy increase the incidence of anastomotic leakage after anterior resection for mid and low rectal cancer? A systematic review and meta-analysis. Colorectal Dis 2017; 19 (01) 16-26
  • 51 Ma B, Gao P, Wang H. et al. What has preoperative radio(chemo)therapy brought to localized rectal cancer patients in terms of perioperative and long-term outcomes over the past decades? A systematic review and meta-analysis based on 41,121 patients. Int J Cancer 2017; 141 (05) 1052-1065
  • 52 Nikolian VC, Kamdar NS, Regenbogen SE. et al. Anastomotic leak after colorectal resection: A population-based study of risk factors and hospital variation. Surgery 2017; 161: 1619-1627 . Mosby Inc.
  • 53 Bakker IS, Grossmann I, Henneman D, Havenga K, Wiggers T. Risk factors for anastomotic leakage and leak-related mortality after colonic cancer surgery in a nationwide audit. Br J Surg 2014; 101 (04) 424-432 , discussion 432
  • 54 Sciuto A, Merola G, De Palma GD. et al. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol 2018; 24 (21) 2247-2260
  • 55 Kwak HD, Kim SH, Kang DW, Baek SJ, Kwak JM, Kim J. Risk factors and oncologic outcomes of anastomosis leakage after laparoscopic right colectomy. Surg Laparosc Endosc Percutan Tech 2017; 27 (06) 440-444
  • 56 Forrest CR, Pang CY, Lindsay WK. Dose and time effects of nicotine treatment on the capillary blood flow and viability of random pattern skin flaps in the rat. Br J Plast Surg 1987; 40 (03) 295-299
  • 57 Snajdar RM, Busuttil SJ, Averbook A, Graham DJ. Inhibition of endothelial cell migration by cigarette smoke condensate. J Surg Res 2001; 96 (01) 10-16
  • 58 Sørensen LT, Jørgensen T, Kirkeby LT, Skovdal J, Wille-Jørgensen P. Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 1999; 86: 927-931
  • 59 Baucom RB, Poulose BK, Herline AJ, Muldoon RL, Cone MM, Geiger TM. Smoking as dominant risk factor for anastomotic leak after left colon resection. Am J Surg 2015; 210 (01) 1-5
  • 60 Richards CH, Campbell V, Ho C, Hayes J, Elliott T, Thompson-Fawcett M. Smoking is a major risk factor for anastomotic leak in patients undergoing low anterior resection. Colorectal Dis 2012; 14 (05) 628-633
  • 61 Mäkelä JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 2003; 46 (05) 653-660
  • 62 Tønnesen H, Kehlet H. Preoperative alcoholism and postoperative morbidity. Br J Surg 1999; 86 (07) 869-874
  • 63 Konishi T, Watanabe T, Kishimoto J, Nagawa H. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 2006; 202 (03) 439-444
  • 64 Golub R, Golub RW, Cantu Jr R, Stein HD. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 1997; 184 (04) 364-372
  • 65 Slieker JC, Komen N, Mannaerts GH. et al. Long-term and perioperative corticosteroids in anastomotic leakage: a prospective study of 259 left-sided colorectal anastomoses. Arch Surg 2012; 147 (05) 447-452
  • 66 Eriksen TF, Lassen CB, Gögenur I. Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey. Colorectal Dis 2014; 16 (05) O154-O160
  • 67 Hoek VT, Buettner S, Sparreboom CL. et al.; Dutch ColoRectal Audit group. A preoperative prediction model for anastomotic leakage after rectal cancer resection based on 13.175 patients. Eur J Surg Oncol 2022; 48 (12) 2495-2501
  • 68 Tan WP, Talbott VA, Leong QQ, Isenberg GA, Goldstein SD. American Society of Anesthesiologists class and Charlson's comorbidity index as predictors of postoperative colorectal anastomotic leak: a single-institution experience. J Surg Res 2013; 184 (01) 115-119
  • 69 Frasson M, Flor-Lorente B, Rodríguez JLR. et al.; ANACO Study Group. Risk factors for anastomotic leak after colon resection for cancer: Multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients. Ann Surg 2015; 262 (02) 321-330
  • 70 Yamamoto S, Fujita S, Akasu T, Inada R, Moriya Y. Risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using a stapling technique. Surg Laprosc endosc Percutan Tech 2012; 22: 239-243
  • 71 MD S, Chase S, S BR, Nadarajan AR, Nayak S. Serum pre-albumin, a novel indicator of risk of anastomotic leak in bowel anastomosis. Int Surg J 2018; 5 (05) 1724
  • 72 Telem DA, Chin EH, Nguyen SQ, Divino CM. Risk factors for anastomotic leak following colorectal surgery: a case-control study. Arch Surg 2010; 145 (04) 371-376 , discussion 376
  • 73 Pellino G, Frasson M, García-Granero A. et al.; ANACO Study Group. Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients. Colorectal Dis 2018; 20 (11) 986-995
  • 74 Salinas H, Dursun A, Konstantinidis I. et al. Does preoperative total parenteral nutrition in patients with ulcerative colitis produce better outcomes?. Int J Colorectal Dis 2012; 27 (11) 1479-1483
  • 75 Rollins KE, Javanmard-Emamghissi H, Lobo DN. Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis. World J Gastroenterol 2018; 24 (04) 519-536
  • 76 Dahabreh IJ, Steele DW, Shah N, Trikalinos TA. Oral mechanical bowel preparation for colorectal surgery: systematic review and meta-analysis. Dis Colon Rectum 2015; 58 (07) 698-707
  • 77 Leenen JPL, Hentzen JEKR, Ockhuijsen HDL. Effectiveness of mechanical bowel preparation versus no preparation on anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Updates Surg 2019; 71 (02) 227-236
  • 78 Courtney DE, Kelly ME, Burke JP, Winter DC. Postoperative outcomes following mechanical bowel preparation before proctectomy: a meta-analysis. Colorectal Dis 2015; 17 (10) 862-869
  • 79 Toh JWT, Phan K, Hitos K. et al. Association of mechanical bowel preparation and oral antibiotics before elective colorectal surgery with surgical site infection: a network meta-analysis. JAMA Netw Open 2018; 1 (06) e183226
  • 80 Yue Y, Chen X, Wang H, Cheng M, Zheng B. Mechanical bowel preparation combined with oral antibiotics reduces infectious complications and anastomotic leak in elective colorectal surgery: a pooled-analysis with trial sequential analysis. Int J Colorectal Dis 2023; 38 (01) 5
  • 81 Toh JWT, Phan K, Ctercteko G. et al. The role of mechanical bowel preparation and oral antibiotics for left-sided laparoscopic and open elective restorative colorectal surgery with and without faecal diversion. Int J Colorectal Dis 2018; 33 (12) 1781-1791
  • 82 Klinger AL, Green H, Monlezun DJ. et al. The role of bowel preparation in colorectal surgery: results of the 2012-2015 ACS-NSQIP data. Ann Surg 2019; 269 (04) 671-677
  • 83 2017 European Society of Coloproctology (ESCP) Collaborating Group. Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection: an international, multi-centre, prospective audit. Colorectal Dis 2018; 20 (Suppl. 06) 15-32
  • 84 Russ AJ, Casillas MA. Gut microbiota and colorectal surgery: impact on postoperative complications. Clin Colon Rectal Surg 2016; 29 (03) 253-257
  • 85 Wu L, Holbrook C, Zaborina O. et al. Pseudomonas aeruginosa expresses a lethal virulence determinant, the PA-I lectin/adhesin, in the intestinal tract of a stressed host: the role of epithelia cell contact and molecules of the Quorum Sensing Signaling System. Ann Surg 2003; 238 (05) 754-764
  • 86 Seal JB, Alverdy JC, Zaborina O, An G. Agent-based dynamic knowledge representation of Pseudomonas aeruginosa virulence activation in the stressed gut: Towards characterizing host-pathogen interactions in gut-derived sepsis. Theor Biol Med Model 2011; 8: 33
  • 87 Shogan BD, Belogortseva N, Luong PM. et al. Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak. Sci Transl Med 2015; 7 (286) 286ra68
  • 88 van Praagh JB, de Goffau MC, Bakker IS. et al. Mucus microbiome of anastomotic tissue during surgery has predictive value for colorectal anastomotic leakage. Ann Surg 2019; 269 (05) 911-916
  • 89 Hamabe A, Ito M, Nishigori H, Nishizawa Y, Sasaki T. Preventive effect of diverting stoma on anastomotic leakage after laparoscopic low anterior resection with double stapling technique reconstruction applied based on risk stratification. Asian J Endosc Surg 2018; 11 (03) 220-226
  • 90 Choi DH, Hwang JK, Ko YT. et al. Risk factors for anastomotic leakage after laparoscopic rectal resection. J Korean Soc Coloproctol 2010; 26 (04) 265-273
  • 91 Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N. Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis 2008; 23 (07) 703-707
  • 92 Killingback M, Barron P, Dent O. Elective resection and anastomosis for colorectal cancer: a prospective audit of mortality and morbidity 1976-1998. ANZ J Surg 2002; 72 (10) 689-698
  • 93 Boccola MA, Buettner PG, Rozen WM. et al. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg 2011; 35 (01) 186-195
  • 94 Grandison AS, Yates J, Shields R. Capillary blood flow in the canine colon and other organs at normal and raised portal pressure. Gut 1981; 22 (03) 223-227
  • 95 Chowdary Vadlamudi H, Raju YP, Yasmeen BR, Vulava J. Anatomical, biochemical and physiological considerations of the colon in design and development of novel drug delivery systems. Curr Drug Deliv 2012; 9: 556-565
  • 96 Veyrie N, Ata T, Muscari F. et al.; French Associations for Surgical Research. Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg 2007; 205 (06) 785-793
  • 97 Hayden DM, Mora Pinzon MC, Francescatti AB, Saclarides TJ. Patient factors may predict anastomotic complications after rectal cancer surgery: Anastomotic complications in rectal cancer. Ann Med Surg (Lond) 2014; 4 (01) 11-16
  • 98 Iancu C, Mocan LC, Todea-Iancu D. et al. Host-related predictive factors for anastomotic leakage following large bowel resections for colorectal cancer*. J Gastroinstestin Liver Dis 2008; 17: 299-303
  • 99 Cortina CS, Alex GC, Vercillo KN. et al. Longer operative time and intraoperative blood transfusion are associated with postoperative anastomotic leak after lower gastrointestinal surgery. Am Surg 2019; 85 (02) 136-141
  • 100 Bonnet S, Berger A, Hentati N. et al. High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses. Dis Colon Rectum 2012; 55 (05) 515-521
  • 101 Lange MM, Buunen M, van de Velde CJH, Lange JF. Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review. Dis Colon Rectum 2008; 51 (07) 1139-1145
  • 102 Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis 2009; 24 (05) 569-576
  • 103 Cooperman M, Martin Jr EW, Carey LC. Evaluation of ischemic intestine by Doppler ultrasound. Am J Surg 1980; 139 (01) 73-77
  • 104 Dyess DL, Bruner BW, Donnell CA, Ferrara JJ, Powell RW. Intraoperative evaluation of intestinal ischemia: a comparison of methods. South Med J 1991; 84 (08) 966-969 , 974
  • 105 Jafari MD, Wexner SD, Martz JE. et al. Perfusion assessment in laparoscopic left-sided/anterior resection (PILLAR II): a multi-institutional study. J Am Coll Surg 2015; 220 (01) 82-92.e1
  • 106 Ohya H, Watanabe J, Suwa H. et al. Near-infrared imaging using indocyanine green for laparoscopic lateral pelvic lymph node dissection for clinical stage II/III middle-lower rectal cancer: a propensity score-matched cohort study. Dis Colon Rectum 2022; 65 (07) 885-893
  • 107 Watanabe J, Ishibe A, Suwa Y. et al. 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 2020; 34 (01) 202-208
  • 108 Faber RA, Meijer RPJ, Droogh DHM. et al. Indocyanine green near-infrared fluorescence bowel perfusion assessment to prevent anastomotic leakage in minimally invasive colorectal surgery (AVOID): a multicentre, randomised, controlled, phase 3 trial. Lancet Gastroenterol Hepatol 2024; 9 (10) 924-934
  • 109 Alekseev M, Rybakov E, Shelygin Y, Chernyshov S, Zarodnyuk I. A study investigating the perfusion of colorectal anastomoses using fluorescence angiography: results of the FLAG randomized trial. Colorectal Dis 2020; 22 (09) 1147-1153
  • 110 Watanabe J, Takemasa I, Kotake M. et al.; EssentiAL Trial Group. Blood perfusion assessment by indocyanine green fluorescence imaging for minimally invasive rectal cancer surgery (EssentiAL trial): a randomized clinical trial. Ann Surg 2023; 278 (04) e688-e694
  • 111 Slieker JC, Daams F, Mulder IM, Jeekel J, Lange JF. Systematic review of the technique of colorectal anastomosis. JAMA Surg 2013; 148 (02) 190-201
  • 112 Shikata S, Yamagishi H, Taji Y, Shimada T, Noguchi Y. Single- versus two- layer intestinal anastomosis: a meta-analysis of randomized controlled trials. BMC Surg 2006; 6: 2
  • 113 Choy PYG, Bissett IP, Docherty JG, Parry BR, Merrie A, Fitzgerald A. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev 2011; x (09) CD004320
  • 114 Puleo S, Sofia M, Trovato MA. et al. Ileocolonic anastomosis: preferred techniques in 999 patients. A multicentric study. Surg Today 2013; 43 (10) 1145-1149
  • 115 The 2015 European Society of Coloproctology collaborating group. Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit. Colorectal Dis 2017; 19 (08) e296-e311
  • 116 Balciscueta Z, Uribe N, Caubet L. et al. Impact of the number of stapler firings on anastomotic leakage in laparoscopic rectal surgery: a systematic review and meta-analysis. Tech Coloproctol 2020; 24 (09) 919-925
  • 117 Qu H, Liu Y, Bi DS. Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: a systematic review and meta-analysis. Surg Endosc 2015; 29 (12) 3608-3617
  • 118 Oliveira A, Faria S, Gonçalves N, Martins A, Leão P. Surgical approaches to colonic and rectal anastomosis: systematic review and meta-analysis. Int J Colorectal Dis 2023; 38 (01) 52
  • 119 Vallance A, Wexner S, Berho M. et al. A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery. Colorectal Dis 2017; 19 (01) O1-O12
  • 120 Marinello FG, Baguena G, Lucas E. et al. Anastomotic leakage after colon cancer resection: does the individual surgeon matter?. Colorectal Dis 2016; 18 (06) 562-569
  • 121 García-Granero E, Navarro F, Cerdán Santacruz C. et al. Individual surgeon is an independent risk factor for leak after double-stapled colorectal anastomosis: An institutional analysis of 800 patients. Surgery 2017; 162 (05) 1006-1016
  • 122 Kayano H, Okuda J, Tanaka K, Kondo K, Tanigawa N. Evaluation of the learning curve in laparoscopic low anterior resection for rectal cancer. Surg Endosc 2011; 25 (09) 2972-2979
  • 123 Abraham NS, Young JM, Solomon MJ. Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 2004; 91 (09) 1111-1124
  • 124 Bonjer HJ, Deijen CL, Abis GA. et al.; COLOR II Study Group. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 2015; 372 (14) 1324-1332
  • 125 Fleshman J, Branda M, Sargent DJ. et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 2015; 314 (13) 1346-1355
  • 126 Stevenson ARL, Solomon MJ, Lumley JW. et al.; ALaCaRT Investigators. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 2015; 314 (13) 1356-1363
  • 127 Jeong SY, Park JW, Nam BH. et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 2014; 15 (07) 767-774
  • 128 Mungo B, Papageorge CM, Stem M, Molena D, Lidor AO. The impact of operative approach on postoperative complications following colectomy for colon cancer. World J Surg 2017; 41 (08) 2143-2152
  • 129 van der Pas MHGM, Haglind E, Cuesta MA. et al.; COlorectal cancer Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 2013; 14 (03) 210-218
  • 130 Pinar I, Fransgaard T, Thygesen LC, Gögenur I. Long-term outcomes of robot-assisted surgery in patients with colorectal cancer. Ann Surg Oncol 2018; 25 (13) 3906-3912
  • 131 Kostakis ID, Sran H, Uwechue R. et al. Comparison between robotic and laparoscopic or open anastomoses: a systematic review and meta-analysis. Robot Surg 2019; 6: 27-40
  • 132 Solaini L, Bocchino A, Avanzolini A, Annunziata D, Cavaliere D, Ercolani G. Robotic versus laparoscopic left colectomy: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37 (07) 1497-1507
  • 133 Jayne D, Pigazzi A, Marshall H. et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 2017; 318 (16) 1569-1580
  • 134 Hilsabeck JR. The presacral space as a collector of fluid accumulations following rectal anastomosis: tolerance of rectal anastomosis to closed suction pelvic drainage. Dis Colon Rectum 1982; 25 (07) 680-684
  • 135 Sehapayak S, McNatt M, Carter HG, Bailey W, Baldwin Jr A. Continuous sump-suction drainage of the pelvis after low anterior resection: a reappraisal. Dis Colon Rectum 1973; 16 (06) 485-489
  • 136 Menahem B, Vallois A, Alves A, Lubrano J. Prophylactic pelvic drainage after rectal resection with extraperitoneal anastomosis: is it worthwhile? A meta-analysis of randomized controlled trials. Int J Colorectal Dis 2017; 32 (11) 1531-1538
  • 137 Guerra F, Giuliani G, Coletta D. et al. A meta-analysis of randomized controlled trials on the use of suction drains following rectal surgery. Dig Surg 2018; 35 (06) 482-490
  • 138 Tsujinaka S, Kawamura YJ, Konishi F, Maeda T, Mizokami K. Pelvic drainage for anterior resection revisited: use of drains in anastomotic leaks. ANZ J Surg 2008; 78 (06) 461-465
  • 139 Urbach DR, Kennedy ED, Cohen MM. Colon and rectal anastomoses do not require routine drainage: a systematic review and meta-analysis. Ann Surg 1999; 229 (02) 174-180
  • 140 Denost Q, Rouanet P, Faucheron JL. et al.; French Research Group of Rectal Cancer Surgery (GRECCAR). To drain or not to drain infraperitoneal anastomosis after rectal excision for cancer: the GRECCAR 5 randomized trial. Ann Surg 2017; 265 (03) 474-480
  • 141 Lightner AL, Pemberton JH. The role of temporary fecal diversion. Clin Colon Rectal Surg 2017; 30 (03) 178-183
  • 142 Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 2007; 246 (02) 207-214
  • 143 Wong NY, Eu KW. A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 2005; 48 (11) 2076-2079
  • 144 Hüser N, Michalski CW, Erkan M. et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 2008; 248 (01) 52-60
  • 145 Chude GG, Rayate NV, Patris V. et al. Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology 2008; 55 (86-87): 1562-1567
  • 146 Hrebinko K, Anto VP, Reitz KM. et al. Prophylactic defunctioning stomas improve clinical outcomes of anastomotic leak following rectal cancer resections: An analysis of the US Rectal Cancer Consortium. Int J Colorectal Dis 2024; 39 (01) 39
  • 147 Phan K, Oh L, Ctercteko G. et al. Does a stoma reduce the risk of anastomotic leak and need for re-operation following low anterior resection for rectal cancer: systematic review and meta-analysis of randomized controlled trials. J Gastrointest Oncol 2019; 10 (02) 179-187
  • 148 Olecki EJ, Kronfli AP, Stahl KA, King S, C Razavi N, Koltun WA. Stoma-less IPAA is not associated with increased anastomotic leak rate or long-term pouch failure in patients with ulcerative colitis. Dis Colon Rectum 2022; 65 (11) 1342-1350
  • 149 O'Leary DP, Fide CJ, Foy C, Lucarotti ME. Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg 2001; 88 (09) 1216-1220
  • 150 Tsunoda A, Tsunoda Y, Narita K, Watanabe M, Nakao K, Kusano M. Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum 2008; 51 (02) 218-222
  • 151 Vargiu V, Santullo F, Lodoli C. et al. 1327 Tailoring risk factors for anastomotic leakage: a comprehensive single-center analysis of colorectal anastomosis after standard colorectal surgery and cytoreductive surgery for ovarian and gastrointestinal cancers. Int J Gynecol Cancer 2024; 34 (01) A39-A40
  • 152 Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 2002; 26 (04) 499-502
  • 153 Shimura T, Toiyama Y, Hiro J. et al. Monitoring perioperative serum albumin can identify anastomotic leakage in colorectal cancer patients with curative intent. Asian J Surg 2018; 41 (01) 30-38
  • 154 Wick EC, Grant MC, Wu CL. Postoperative multimodal analgesia pain management with nonopioid analgesics and techniques: a review. JAMA Surg 2017; 152 (07) 691-697
  • 155 Warner TD, Mitchell JA. Cyclooxygenases: new forms, new inhibitors, and lessons from the clinic. FASEB J 2004; 18 (07) 790-804
  • 156 Rushfeldt CF, Sveinbjørnsson B, Søreide K, Vonen B. Risk of anastomotic leakage with use of NSAIDs after gastrointestinal surgery. Int J Colorectal Dis 2011; 26 (12) 1501-1509
  • 157 Rainsford KD. Anti-inflammatory drugs in the 21st century. Subcell Biochem 2007; 42: 3-27
  • 158 Modasi A, Pace D, Godwin M, Smith C, Curtis B. NSAID administration post colorectal surgery increases anastomotic leak rate: systematic review/meta-analysis. Surg Endosc 2019; 33 (03) 879-885
  • 159 Bakker N, Deelder JD, Richir MC. et al. Risk of anastomotic leakage with nonsteroidal anti-inflammatory drugs within an enhanced recovery program. J Gastrointest Surg 2016; 20 (04) 776-782
  • 160 Kastora SL, Osborne LL, Jardine R, Kounidas G, Carter B, Myint PK. Non-steroidal anti-inflammatory agents and anastomotic leak rates across colorectal cancer operations and anastomotic sites: A systematic review and meta-analysis of anastomosis specific leak rate and confounding factors. Eur J Surg Oncol 2021; 47 (11) 2841-2848s
  • 161 Peng F, Liu S, Hu Y, Yu M, Chen J, Liu C. Influence of perioperative nonsteroidal anti-inflammatory drugs on complications after gastrointestinal surgery: A meta-analysis. Acta Anaesthesiol Taiwan 2016; 54 (04) 121-128
  • 162 Kotagal M, Hakkarainen TW, Simianu VV, Beck SJ, Alfonso-Cristancho R, Flum DR. Ketorolac use and postoperative complications in gastrointestinal surgery. Ann Surg 2016; 263 (01) 71-75
  • 163 Bhangu A, Singh P, Fitzgerald JEF, Slesser A, Tekkis P. Postoperative nonsteroidal anti-inflammatory drugs and risk of anastomotic leak: meta-analysis of clinical and experimental studies. World J Surg 2014; 38 (09) 2247-2257
  • 164 Paulasir S, Kaoutzanis C, Welch KB. et al. Nonsteroidal anti-inflammatory drugs: do they increase the risk of anastomotic leaks following colorectal operations?. Dis Colon Rectum 2015; 58 (09) 870-877
  • 165 Rutegård M, Westermark S, Kverneng Hultberg D, Haapamäki M, Matthiessen P, Rutegård J. Non-steroidal anti-inflammatory drug use and risk of anastomotic leakage after anterior resection: a protocol-based study. Dig Surg 2016; 33 (02) 129-135
  • 166 Lin X, Li J, Chen W. et al. Diabetes and risk of anastomotic leakage after gastrointestinal surgery. J Surg Res 2015; 196 (02) 294-301
  • 167 Huisman DE, Reudink M, van Rooijen SJ. et al. LekCheck: A prospective study to identify perioperative modifiable risk factors for anastomotic leakage in colorectal surgery. Ann Surg 2022; 275 (01) e189-e197
  • 168 Gustafsson UO, Scott MJ, Hubner M. et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg 2019; 43 (03) 659-695
  • 169 Reudink M, Huisman DE, van Rooijen SJ. et al.; LekCheck Study Group. Association between intraoperative blood glucose and anastomotic leakage in colorectal surgery. J Gastrointest Surg 2021; 25 (10) 2619-2627
  • 170 Floodeen H, Hallböök O, Rutegård J, Sjödahl R, Matthiessen P. Early and late symptomatic anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities?. Colorectal Dis 2013; 15 (03) 334-340
  • 171 Li YW, Lian P, Huang B. et al. Very early colorectal anastomotic leakage within 5 post-operative days: a more severe subtype needs relaparatomy. Sci Rep 2017; 7 (01) 39936
  • 172 Yang SY, Han YD, Cho MS. et al. Late anastomotic leakage after anal sphincter saving surgery for rectal cancer: is it different from early anastomotic leakage?. Int J Colorectal Dis 2020; 35 (07) 1321-1330
  • 173 Škrabec CG, Carné AV, Pérez MC. et al. Early and late anastomotic leak after colorectal surgery: A systematic review of the literature. Cir Esp (Engl Ed) 2023; 101 (01) 3-11
  • 174 Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it's later than you think. Ann Surg 2007; 245 (02) 254-258
  • 175 Komen N, Dijk JW, Lalmahomed Z. et al. After-hours colorectal surgery: a risk factor for anastomotic leakage. Int J Colorectal Dis 2009; 24 (07) 789-795
  • 176 Peberdy MA, Ornato JP, Larkin GL. et al.; National Registry of Cardiopulmonary Resuscitation Investigators. Survival from in-hospital cardiac arrest during nights and weekends. JAMA 2008; 299 (07) 785-792
  • 177 Smith-Coggins R, Rosekind MR, Hurd S, Buccino KR. Relationship of day versus night sleep to physician performance and mood. Ann Emerg Med 1994; 24 (05) 928-934
  • 178 Mishra A, Catchpole K, Dale T, McCulloch P. The influence of non-technical performance on technical outcome in laparoscopic cholecystectomy. Surg Endosc 2008; 22 (01) 68-73
  • 179 Morks AN, Ploeg RJ, Sijbrand Hofker H, Wiggers T, Havenga K. Late anastomotic leakage in colorectal surgery: a significant problem. Colorectal Dis 2013; 15 (05) e271-e275
  • 180 Sala Hernandez A, Frasson M, García-Granero A. et al.; EDEN Study Group. Diagnostic accuracy of C-reactive protein, procalcitonin and neutrophils for the early detection of anastomotic leakage after colorectal resection: a multicentric, prospective study. Colorectal Dis 2021; 23 (10) 2723-2730