Title : Factors affecting anastomotic leakage in colorectal surgery: A systematic review
Abstract:
Background: Anastomotic leakage (AL) is a severe complication in colorectal cancer surgery, associated with increased morbidity, mortality, and poor oncological outcomes. This systematic review aims to synthesize the current evidence on factors affecting anastomotic leakage.
Methods: This systematic review was conducted and reported in accordance with PRISMA guidelines and was registered on PROSPERO (CRD42025637520). PubMed, Cochrane Library, and Google Scholar were searched for studies evaluating risk factors for AL. A total of 129 studies, comprising approximately 54% retrospective analyses, 23% prospective studies, and 23% systematic reviews/meta-analyses, were included. N
Results: The study represents data from over 390,000 patients. The reported incidence of AL ranged from 0.6% to 38.8%, with a majority of large-scale studies (representing over 75% of the patient data) reporting rates between 5% and 15%. High-impact risk factors were identified across patient, disease and surgical domains. Key patient related factors include Male gender (60-80% of AL cases), advanced age, high ASA score (≥III), poor nutritional status, obesity, and smoking. These are compounded by disease related factors such as Low rectal anastomoses (<7 cm from anal verge), advanced tumor stage, and preoperative bowel obstruction. Emergency surgery, prolonged operative time, significant blood loss, perioperative transfusion, and use of multiple (≥3) stapler firings. Conversely, a major protective intervention was identified: intraoperative perfusion assessment with ICG fluorescence angiography, reducing AL rates by up to 73% in some analyses.
Conclusion: In conclusion, anastomotic leakage is a complex outcome driven by a predictable set of risk factors. The study demonstrates that a combination of non-modifiable patient characteristics, disease-related factors, and modifiable intraoperative events, collectively contribute to the risk. A thorough, multi-faceted risk assessment that incorporates these identified factors is therefore essential for accurate patient stratification in colorectal surgery.
