Research progress of relevant factors and prevention of postoperative anastomotic leakage in colorectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

KANG Zhiyong ,  JIANG Changgao

Department of General Surgery, Affiliated Hospital of Yanbian University, Yanji, Jilin 133000, P. R. China;

Corresponding author：

JIANG Changgao, Email: jch2011@163.com

Keywords：

colorectal cancer; anastomotic leakage; relevant factor; prevent

DOI：

10.7507/1007-9424.202003079

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand the related factors and prevention and treatment of anastomotic leakage after colorectal cancer operation.Method The literatures on the studies of colorectal anastomotic leakage in recent years were reviewed and analyzed.Results The occurrence of postoperative anastomotic leakage of colorectal cancer was usually related to many factors, besides the patients’ nutritional status, body mass index, gender, smoking and drinking history, preoperative radiotherapy and chemotherapy, etc., as well as the distance between the anastomotic stoma and the anal margin and the ligation of the left colonic artery. The monitors of albumin, prealbumin, C-reactive protein, procalcitonin and other indicators might be better for early prediction of anastomotic leakage. The use of oral antibiotics while mechanical bowel preparation, intraoperative ICG fluorescence angiography, single-layer intestinal anastomosis, reducing the number of staplers, preserving the left colon artery, placing drainage tube through anus, and minimally invasive colorectal cancer resection might have some advantages in reducing the incidence of postoperative anastomotic leakage.Conclusions As a surgeon, risk factors associated with anastomotic leakage should be fully understood. It is of great significance to use related markers to identify early anastomotic leakage and timely intervene, and use of more accurate surgical procedures to reduce occurrence of anastomotic leakage.

Citation： KANG Zhiyong, JIANG Changgao. Research progress of relevant factors and prevention of postoperative anastomotic leakage in colorectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(11): 1450-1456. doi: 10.7507/1007-9424.202003079 Copy

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2.	McDermott FD, Heeney A, Kelly ME, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg, 2015, 102(5): 462-479.
3.	Ramphal W, Boeding JRE, Gobardhan PD, et al. Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol, 2018, 27(4): 730-736.
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5.	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(3): 339-351.
6.	Sparreboom CL, van Groningen JT, Lingsma HF, et al. Different risk factors for early and late colorectal anastomotic leakage in a Nationwide Audit. Dis Colon Rectum, 2018, 61(11): 1258-1266.
7.	Goshen-Gottstein E, Shapiro R, Shwartz C, et al. Incidence and risk factors for anastomotic leakage in colorectal surgery: A historical cohort study. Isr Med Assoc J, 2019, 21(11): 732-737.
8.	Kjaer M, Kristjánsdóttir H, Andersen L, et al. The effect of gender on early colonic anastomotic wound healing. Int J Colorectal Dis, 2018, 33(9): 1269-1276.
9.	Üreyen O, İlhan E, Dadalı E, et al. Evaluation of factors associated with anastomotic leakage in colorectal surgery. Turkish J Colorect Dis, 2018, 28(3): 129.
10.	Zaimi I, Sparreboom CL, Lingsma HF, et al. The effect of age on anastomotic leakage in colorectal cancer surgery: a population-based study. J Surg Oncol, 2018, 118(1): 113-120.
11.	Penna M, Hompes R, Arnold S, et al. Incidence and risk factors for anastomotic failure in 1 594 patients treated by transanal total mesorectal excision: results from the International TaTME Registry. Ann Surg, 2019, 269(4): 700-711.
12.	Cheng S, He B, Zeng X. Prediction of anastomotic leakage after anterior rectal resection. Pak J Med Sci, 2019, 35(3): 830-835.
13.	Kim MJ, Shin R, Oh HK, et al. The impact of heavy smoking on anastomotic leakage and stricture after low anterior resection in rectal cancer patients. World J Surg, 2011, 35(12): 2806-2810.
14.	Zheng H, Wu Z, Wu Y, et al. Laparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer. Int J Colorectal Dis, 2019, 34(2): 319-328.
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18.	Hamabe A, Ito M, Nishigori H, et al. 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(3): 220-226.
19.	Choi DH, Hwang JK, Ko YT, et al. Risk factors for anastomotic leakage after laparoscopic rectal resection. J Korean Soc Coloproctol, 2010, 26(4): 265-273.
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25.	Catinean A, Neag MA, Muntean DM, et al. An overview on the interplay between nutraceuticals and gut microbiota. Peer J, 2018, 6(e4465).
26.	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.
27.	薛晓强, 白雪杉, 林国乐, 等. 肠道菌群失调与中低位直肠癌术后吻合口漏相关性研究. 中国实用外科杂志, 2019, 39(7): 698-703.
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29.	Marinello FG, Baguena G, Lucas E, et al. Anastomotic leakage after colon cancer resection: does the individual surgeon matter? Colorectal Dis, 2016, 18(6): 562-569.
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33.	Denen DJ. Predictors of colorectal anastomotic leakage in a 5-year review of cases in a Tertiary Hospital. Gut Liver, 2019, 13(6): 166.
34.	Sameer MD, Chase S, Nadarajan AR, et al. Serum pre-albumin, a novel indicator of risk of anastomotic leak in bowel anastomosis. Int Surg J, 2018, 5(5): 1724-1728.
35.	Smith SR, Pockney P, Holmes R, et al. Biomarkers and anastomotic leakage in colorectal surgery: C-reactive protein trajectory is the gold standard. ANZ J Surg, 2018, 88(5): 440-444.
36.	Warschkow R, Beutner U, Steffen T, et al. Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1 832 patients. Ann Surg, 2012, 256(2): 245-250.
37.	Messias B A, Botelho RV, Saad SS, et al. Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery. Sci Reports, 2020, 3 February.
38.	Kostić Z, Panišić M, Milev B, et al. Diagnostic value of serial measurement of C-reactive protein in serum and matrix metalloproteinase-9 in drainage fluid in the detection of infectious complications and anastomotic leakage in patients with colorectal resection. Vojnosanit Pregl, 2015, 72(10): 889-898.
39.	Su’a B, Tutone S, MacFater W, et al. Diagnostic accuracy of procalcitonin for the early diagnosis of anastomotic leakage after colorectal surgery: a meta-analysis. ANZ J Surg, 2020, 90(5): 675-680.
40.	Anwar P N, Abd El-Rahman MA, Baiomy T, et al. Prediction of early anastomotic leakage following colorectal cancer surgery in Zagazig University Hospitals. Zagazig Uni Med J, 2019, May. doi: 10.21608/zumj.2019.11299.1175.
41.	Chen M, Song X, Chen LZ, et al. Comparing mechanical bowel preparation with both oral and systemic antibiotics versus mechanical bowel preparation and systemic antibiotics alone for the prevention of surgical site infection after elective colorectal surgery: a meta-analysis of randomized controlled clinical trials. Dis Colon Rectum, 2016, 59(1): 70-78.
42.	Koller SE, Bauer KW, Egleston BL, et al. Comparative effectiveness and risks of bowel preparation before elective colorectal surgery. Ann Surg, 2018, 267(4): 734-742.
43.	Ambe PC, Zarras K, Stodolski M, et al. Routine preoperative mechanical bowel preparation with additive oral antibiotics is associated with a reduced risk of anastomotic leakage in patients undergoing elective oncologic resection for colorectal cancer. World J Surg Oncol, 2019, 17(1): 20.
44.	Sun WC, Hsu HH, Liu HC, et al. Can mechanical bowel preparation with oral antibiotics reduce surgical site infection and anastomotic leakage rates following elective colorectal resections? Formos J Surg, 2018, 51: 21-25.
45.	Blanco-Colino R, Espin-Basany E. Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol, 2018, 22(1): 15-23.
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1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. McDermott FD, Heeney A, Kelly ME, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg, 2015, 102(5): 462-479.
3. Ramphal W, Boeding JRE, Gobardhan PD, et al. Oncologic outcome and recurrence rate following anastomotic leakage after curative resection for colorectal cancer. Surg Oncol, 2018, 27(4): 730-736.
4. 杨为锦, 林志雄, 宋俊川, 等. 肠腔内造影 CT 对直肠癌术后吻合口漏的诊断价值. 中国普外基础与临床杂志, 2019, 26(5): 568-572.
5. 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(3): 339-351.
6. Sparreboom CL, van Groningen JT, Lingsma HF, et al. Different risk factors for early and late colorectal anastomotic leakage in a Nationwide Audit. Dis Colon Rectum, 2018, 61(11): 1258-1266.
7. Goshen-Gottstein E, Shapiro R, Shwartz C, et al. Incidence and risk factors for anastomotic leakage in colorectal surgery: A historical cohort study. Isr Med Assoc J, 2019, 21(11): 732-737.
8. Kjaer M, Kristjánsdóttir H, Andersen L, et al. The effect of gender on early colonic anastomotic wound healing. Int J Colorectal Dis, 2018, 33(9): 1269-1276.
9. Üreyen O, İlhan E, Dadalı E, et al. Evaluation of factors associated with anastomotic leakage in colorectal surgery. Turkish J Colorect Dis, 2018, 28(3): 129.
10. Zaimi I, Sparreboom CL, Lingsma HF, et al. The effect of age on anastomotic leakage in colorectal cancer surgery: a population-based study. J Surg Oncol, 2018, 118(1): 113-120.
11. Penna M, Hompes R, Arnold S, et al. Incidence and risk factors for anastomotic failure in 1 594 patients treated by transanal total mesorectal excision: results from the International TaTME Registry. Ann Surg, 2019, 269(4): 700-711.
12. Cheng S, He B, Zeng X. Prediction of anastomotic leakage after anterior rectal resection. Pak J Med Sci, 2019, 35(3): 830-835.
13. Kim MJ, Shin R, Oh HK, et al. The impact of heavy smoking on anastomotic leakage and stricture after low anterior resection in rectal cancer patients. World J Surg, 2011, 35(12): 2806-2810.
14. Zheng H, Wu Z, Wu Y, et al. Laparoscopic surgery may decrease the risk of clinical anastomotic leakage and a nomogram to predict anastomotic leakage after anterior resection for rectal cancer. Int J Colorectal Dis, 2019, 34(2): 319-328.
15. Kim CW, Baek SJ, Hur H, et al. Anastomotic leakage after low anterior resection for rectal cancer is different between minimally invasive surgery and open surgery. Ann Surg, 2016, 263(1): 130-137.
16. Bakker IS, Snijders HS, Grossmann I, et al. High mortality rates after nonelective colon cancer resection: Results of a national audit. Colorectal Dis, 2016, 18(6): 612-621.
17. 陈朝乾, 张宗兵, 左芦根, 等. 405 例直肠癌术后吻合口瘘的影响因素分析. 包头医学院学报, 2018, 34(4): 33-35.
18. Hamabe A, Ito M, Nishigori H, et al. 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(3): 220-226.
19. Choi DH, Hwang JK, Ko YT, et al. Risk factors for anastomotic leakage after laparoscopic rectal resection. J Korean Soc Coloproctol, 2010, 26(4): 265-273.
20. Ri M, Aikou S, Seto Y. Obesity as a surgical risk factor. Ann Gastroenterol Surg, 2017, 2(1): 13-21.
21. Akiyoshi T, Ueno M, Fukunaga Y, et al. Effect of body mass index on short-term outcomes of patients undergoing laparoscopic resection for colorectal cancer: a single institution experience in Japan. Surg Laparosc Endosc Percutan Tech, 2011, 21(6): 409-414.
22. 窦若虚, 汪建平. 直肠癌术前放疗与吻合口漏及低位前切除综合征的关系. 中国医刊, 2019, 54(1): 10-15.
23. Ansari N, Solomon MJ, Fisher RJ, et al. Acute adverse events and postoperative complications in a randomized trial of preoperative short-course radiotherapy versus long-course chemoradiotherapy for T3 adenocarcinoma of the rectum: Trans-Tasman Radiation Oncology Group Trial (TROG 01.04). Ann Surg, 2017, 265(5): 882-888.
24. 刘雨薇, 徐裕杰, 李卡, 等. 肠道微生物对胃肠道吻合口漏影响的研究进展. 中国普外基础与临床杂志, 2020, 27(2): 216-220.
25. Catinean A, Neag MA, Muntean DM, et al. An overview on the interplay between nutraceuticals and gut microbiota. Peer J, 2018, 6(e4465).
26. 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.
27. 薛晓强, 白雪杉, 林国乐, 等. 肠道菌群失调与中低位直肠癌术后吻合口漏相关性研究. 中国实用外科杂志, 2019, 39(7): 698-703.
28. Jina A, Singh UC. Factors influencing intestinal anastomotic leak and their predictive value. Int Surg J, 2019, 6: 4495-501.
29. Marinello FG, Baguena G, Lucas E, et al. Anastomotic leakage after colon cancer resection: does the individual surgeon matter? Colorectal Dis, 2016, 18(6): 562-569.
30. Hiraki M, Tanaka T, Ikeda O, et al. Retrospective risk analysis for anastomotic leakage following laparoscopic rectal cancer surgery in a single institute. J Gastrointest Cancer, 2019 Nov 11. doi: 10.1007/s12029-019-00315-9.
31. Tamini N, Cassini D, Giani A, et al. Computed tomography in suspected anastomotic leakage after colorectal surgery: evaluating mortality rates after false-negative imaging. Eur J Trauma Emerg Surg, 2019 Feb 8. doi: 10.1007/s00068-019-01083-8.
32. Sieda B, Abdelhady W, Baghdadi M. Independent perioperative predictive risk factors for the anastomotic leak after emergency bowel resection anastomosis. Int Surg J, 2019, 6(7): 2258-2266.
33. Denen DJ. Predictors of colorectal anastomotic leakage in a 5-year review of cases in a Tertiary Hospital. Gut Liver, 2019, 13(6): 166.
34. Sameer MD, Chase S, Nadarajan AR, et al. Serum pre-albumin, a novel indicator of risk of anastomotic leak in bowel anastomosis. Int Surg J, 2018, 5(5): 1724-1728.
35. Smith SR, Pockney P, Holmes R, et al. Biomarkers and anastomotic leakage in colorectal surgery: C-reactive protein trajectory is the gold standard. ANZ J Surg, 2018, 88(5): 440-444.
36. Warschkow R, Beutner U, Steffen T, et al. Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1 832 patients. Ann Surg, 2012, 256(2): 245-250.
37. Messias B A, Botelho RV, Saad SS, et al. Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery. Sci Reports, 2020, 3 February.
38. Kostić Z, Panišić M, Milev B, et al. Diagnostic value of serial measurement of C-reactive protein in serum and matrix metalloproteinase-9 in drainage fluid in the detection of infectious complications and anastomotic leakage in patients with colorectal resection. Vojnosanit Pregl, 2015, 72(10): 889-898.
39. Su’a B, Tutone S, MacFater W, et al. Diagnostic accuracy of procalcitonin for the early diagnosis of anastomotic leakage after colorectal surgery: a meta-analysis. ANZ J Surg, 2020, 90(5): 675-680.
40. Anwar P N, Abd El-Rahman MA, Baiomy T, et al. Prediction of early anastomotic leakage following colorectal cancer surgery in Zagazig University Hospitals. Zagazig Uni Med J, 2019, May. doi: 10.21608/zumj.2019.11299.1175.
41. Chen M, Song X, Chen LZ, et al. Comparing mechanical bowel preparation with both oral and systemic antibiotics versus mechanical bowel preparation and systemic antibiotics alone for the prevention of surgical site infection after elective colorectal surgery: a meta-analysis of randomized controlled clinical trials. Dis Colon Rectum, 2016, 59(1): 70-78.
42. Koller SE, Bauer KW, Egleston BL, et al. Comparative effectiveness and risks of bowel preparation before elective colorectal surgery. Ann Surg, 2018, 267(4): 734-742.
43. Ambe PC, Zarras K, Stodolski M, et al. Routine preoperative mechanical bowel preparation with additive oral antibiotics is associated with a reduced risk of anastomotic leakage in patients undergoing elective oncologic resection for colorectal cancer. World J Surg Oncol, 2019, 17(1): 20.
44. Sun WC, Hsu HH, Liu HC, et al. Can mechanical bowel preparation with oral antibiotics reduce surgical site infection and anastomotic leakage rates following elective colorectal resections? Formos J Surg, 2018, 51: 21-25.
45. Blanco-Colino R, Espin-Basany E. Intraoperative use of ICG fluorescence imaging to reduce the risk of anastomotic leakage in colorectal surgery: a systematic review and meta-analysis. Tech Coloproctol, 2018, 22(1): 15-23.
46. Ishii M, Hamabe A, Okita K, et al. Efficacy of indocyanine green fluorescence angiography in preventing anastomotic leakage after laparoscopic colorectal cancer surgery. Int J Colorectal Dis, 2020, 35(2): 269-275.
47. Khan RAA, Hameed F, Ahmed B, et al. Intestinal anastomosis; Comparative evaluation for safety, cost effectiveness, morbidity and complication of single versus double layer. Professional Med J Jun, 2010, 17(2): 232-234.
48. Sajid MS, Siddiqui MR, Baig MK. Single layer versus double layer suture anastomosis of the gastrointestinal tract. Cochrane Database Syst Rev, 2012, 1: CD005477.
49. 何建军, 王新, 王银春, 等. 腹腔镜直肠癌保肛手术术后吻合口漏与钉仓数量关系的研究. 医学研究杂志, 2019, 48(3): 96-99, 114.
50. Sakamoto W, Ohki S, Kikuchi T, et al. Higher modified Glasgow prognostic score and multiple stapler firings for rectal transection are risk factors for anastomotic leakage after low anterior resection in rectal cancer. Fukushima J Med Sci, 2020, 66(1): 10-16.
51. Rutegård M, Hassmén N, Hemmingsson O, et al. Anterior resection for rectal cancer and visceral blood flow: an explorative study. Scand J Surg, 2016, 105(2): 78-83.
52. Guo Y, Wang D, He L, et al. Marginal artery stump pressure in left colic artery-preserving rectal cancer surgery: a clinical trial. ANZ J Surg, 2017, 87(7-8): 576-581.
53. 滕文浩, 魏丞, 刘文居, 等. 保留左结肠动脉对接受新辅助治疗的直肠癌患者术后吻合口漏的影响. 中华胃肠外科杂志, 2019, 22(6): 566-572.
54. Yang XY, Ma PF, Zhang XB, et al. Preservation versus non-preservation of left colic artery in colorectal cancer surgery: an updated systematic review and meta-analysis. Medicine (Baltimore), 2019, 98(5): e13720.
55. 陈纲, 李世拥. 腹腔镜直肠癌根治保留左结肠血管的技巧及意义. 中华普外科手术学杂志(电子版), 2018, 12(1): 9-11.
56. Ito T, Obama K, Sato T, et al. Usefulness of transanal tube placement for prevention of anastomotic leakage following laparoscopic low anterior resection. Asian J Endosc Surg, 2017, 10(1): 17-22.
57. 李晓平, 余绮荷, 李尚仁. 紫杉醇脂质体对比紫杉醇用于三阴乳腺癌新辅助化疗的疗效观察. 锦州医科大学学报, 2018, 39(1): 56-59.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Research progress of relevant factors and prevention of postoperative anastomotic leakage in colorectal cancer

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