Evidence according to Cochrane Systematic Reviews on Alterable Risk Factors for Anastomotic Leakage in Colorectal Surgery
Table 1
Cochrane systematic reviews addressing the incidence of anastomotic leakage in colorectal surgery.
Significant/pre-, post-, postop factor
Year
Putative risk factor
Systematic review
Outcome
Leak = primary outcome?
Included studies
Participants
Anastomotic leakage (treatment group)
Anastomotic leakage (control group)
Odds ratio (CI; value)
Location of anastomosis
Yes
2011
Stapled (treatment) versus handsewn (control) methods for ileocolic anastomoses [5]
Treatment = stapled
Anastomotic leak
Yes
7
1125
2.5% (11/441)
6.1% (42/684)
0.48 (CI 0.24-0.95; 0.03)
Ileocolic
Control = handsewn
Yes
2010
Covering ostomy in anterior resection for rectal carcinoma [115]
Treatment = covering ostomy
Anastomotic leak
Yes
6
648
6.3% (21/332)
19.6% (62/316)
0.28 (CI 0.16-0.47; )
Rectal
Control = no covering ostomy
Yes
2012
Impact of surgeon’s operative volume on outcome after colorectal cancer surgery [33]
Treatment = high volume
Anastomotic leak
No
4
5128
4.3% (112/2576)
6.3% (162/2552)
0.67 (CI 0.49-0.92; 0.012)
Colorectal
Control = low volume
No
2012
Impact of hospital volume on outcome after colorectal cancer surgery [33]
Treatment = high volume
Anastomotic leak
No
8
9530
6.5% (355/5435)
4.3% (176/4095)
1.18 (CI 0.87-1.58; 0.29)
Colorectal
Control = low volume
No
2012
Impact of surgeon’s specialization on outcome after colorectal cancer surgery [33]
Treatment = specialist
Anastomotic leak
No
4
9173
3.5% (195/5631)
3.8% (134/3542)
0.87 (CI 0.49-1.55; 0.64)
Colorectal
Control = no specialist
No
2011
Mechanical bowel preparation for elective colorectal surgery [41]
Treatment = bowel prep
Anastomotic leak
Yes
13
4633
4.4% (101/2275)
4.6% (103/2258)
0.99 (CI 0.74-1.31; 0.05)
Colon and rectum
Control = no bowel prep
No
2011
Mechanical bowel preparation for elective colorectal surgery [41]
Treatment = bowel prep
Anastomotic leak
Yes
5
1210
4.4% (27/601)
3.4% (21/609)
1.32 (CI 0.74-2.36; 0.34)
Colon and rectum
Control = rectal enema
No
2013
Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer [43]
Treatment = chemoradiation
Anastomotic leak
No
4
1151
5.3% (31/588)
4.8% (27/563)
1.1 (CI 0.62-1.84; 0.81)
Rectum
Control = radiation alone
n.a.
2004
Curative surgery for obstruction from primary left colorectal carcinoma: primary or staged resection? [18]
Treatment = primary resection
Anastomotic leak
n.a.
0
0
n.a.
n.a.
n.a.
Left colorectal
Control = staged resection
No
2014
Laparoscopic versus open total mesorectal excision for rectal cancer [77]
Treatment = laparoscopic
Anastomotic leak
No
10
2505
7.7% (108/1410)
6.3% (69/1095)
1.01 (CI 0.73-1.4; 0.94)
Rectum
Control = open
No
2017
Laparoscopic versus open resection for sigmoid diverticulitis [78]
Treatment = laparoscopic
Reoperation for anastomotic leak
No
3
349
3.9% (7/180)
5.3% (9/169)
0.72 (CI 0.29-1.95; 0.55)
Rectosigmoid (diverticulitis)
Control = open
Control = handsewn
No
2017
Laparoscopic versus open resection for sigmoid diverticulitis [78]
Treatment = laparoscopic
Reoperation for anastomotic leak
No
3
349
3.9% (7/180)
5.3% (9/169)
0.72 (CI 0.29-1.95; 0.55)
Rectosigmoid (diverticulitis)
No
2012
Stapled versus handsewn methods for colorectal anastomosis surgery [4]
Treatment = stapled
Anastomotic leak
Yes
9
1233
13% (81/622)
13.4% (82/611)
0.97 (CI 0.7-1.35; 0.84)
Colorectal
n.a.
2008
Omentoplasty for the prevention of anastomotic leakage after colonic or rectal resection [88]
Treatment = omentoplasty
n.a.
n.a.
n.a.
n.a.
n.a.
n.a.
n.a.
n.a.
Control = no omentoplasty
No
2012
Single (treatment) layer versus double (control) layer suture anastomosis of the gastrointestinal tract [82]
Treatment = single layer
Anastomotic leak
Yes
7
842
6.1% (25/408)
8.5% (37/434)
0.76 (CI 0.44-1.32; 0.33)
Whole GI tract
Control = double layer
No
2009
Intraperitoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after nongynaecological abdominal surgery [93]
Treatment = prophylactic agents
Anastomotic leak
No
5
2164
4.0% (43/1066)
2.4% (26/1098)
1.61 (CI 0.69-3.71; 0.27)
Whole GI tract
Control = no prophylactic agents
No
2004
Prophylactic anastomotic drainage for colorectal surgery [101]
Treatment = drainage
Anastomotic leak
Yes
2
809
1.7% (7/403)
1.2% (5/406)
1.42 (CI 0.45-4.4; 0.56)
Colorectal
Control = no drainage
No
2007
Ileostomy or colostomy for temporary decompression of left-sided colorectal anastomosis [102]
Treatment = ileostomy
Anastomotic leak
n.a.
4
250
9% (11/127)
12% (15/123)
0.72 (CI 0.36-1.47; 0.52)
Left-sided colorectal
Control = colostomy
No
2007
Prophylactic nasogastric decompression after abdominal surgery (subanalysis colon surgery) [123]
Treatment = nasogastric decompression
Anastomotic leak
Yes
6
1122
1.7% (10/558)
1.6% (9/564)
1.13 (CI 0.46-2.74; 0.79)
Colon
Control = no decompression
No
2018
Early enteral nutrition within 24 h of lower gastrointestinal surgery versus later commencement of feeding for length of hospital stay and postoperative complications [131]
Treatment = early enteral nutrition
Anastomotic leak
Yes
13
1232
3.3% (20/612)
4.7% (29/620)
0.68 (CI 0.39-1.23; 0.21)
Colorectal
Control = later enteral nutrition
No
2016
Epidural local anesthetics versus opioid-based analgesic regimens for abdominal surgery [140]
