Prognostic risk factors of anastomotic leakage following anterior resection in patients with rectal cancer: when is a protective stoma needed? Literature review of 15 457 patients

Abstract

Identification of the risk factors of symptomatic anastomotic leakage (AL) after anterior resection in patients withrectal cancer. A review was made of the literature from 1 January 2000 to 31 December 2013. Studies were identified by an electronic search of the PubMed database with the keywords “anterior resection, anastomotic leakage, risk factors”. Only English-language studies were included. These focused on laparoscopic resection, quality of life, protective stoma and surgery technique, ‘non rectal’ cancer, oncological outcomes were excluded. Studies based on small numbers of patients (which we define as fewer than 100) were also excluded from the review, which is based on an analysisof data from 26 publications. The literature review identified 53 preoperative and intraoperative factors which could be potentially associated with the risk of AL. Among them, 22 have been identified as an independent risk factors for leaks in at least one publication and 10 risk factors in more than one study. The most important factors relating to anastomotic leakage were: male gender, age ≥ 60 years, tumor located ≤ 10 cm from the anal verge, preoperative radiotherapy, smoking, diabetes, low level of the anastomosis, blood loss, blood transfusion and intraoperative complications. The identification of risk factors of AL alone does not allow to indicate precisely when the construction of a protective stoma is indeed mandatory. Thus, further prospective studies are recommended.