Anastomotic Leakage in Colorectal Cancer Surgery

Anastomotic leakage (AL) represents one of the most severe complications following resection for colorectal cancer. It is characterised by a defect in the integrity of the intestinal wall at the site of surgical reconnection, leading to communication between intra- and extraluminal compartments. AL carries significant morbidity and mortality, prolonging hospital stay, increasing the need for reintervention and stoma formation, and potentially compromising long-term oncological outcomes. The incidence of clinical leakage varies from 3 per cent to 15 per cent, influenced by tumour location, patient comorbidities and surgical technique. Risk factors include inadequate perfusion at the anastomotic site, high ligation of the inferior mesenteric artery, technical errors during stapling or suturing, preoperative radiotherapy and systemic factors such as malnutrition and immunosuppression. Early detection relies on clinical vigilance, biomarkers and imaging modalities, while management spans from conservative treatment with antibiotics and drainage to surgical relaparotomy and construction of a diverting stoma. Recent efforts focus on intraoperative perfusion assessment, enhanced recovery protocols and multidisciplinary pathways to mitigate risk and improve outcomes.

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Anastomotic Leakage in Colorectal Cancer Surgery publication trend

The graph below shows the total number of articles in anastomotic leakage in colorectal cancer surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Anastomotic leakage (AL): A breakdown of the surgical connection between two segments of bowel, resulting in leakage of intestinal contents.

Fluorescence angiography: An imaging technique using a fluorescent dye (e.g. indocyanine green) and specialised cameras to assess blood flow in tissue.

Diverting stoma: A temporary external opening of the intestine to divert faecal flow away from the anastomosis to protect healing.

Disease-free survival: The period after treatment during which the patient shows no signs of cancer recurrence.

References

1. Complications in colorectal surgery: risk factors and preventive strategies. Patient Safety in Surgery (2010).
2. High ligation of the inferior mesenteric artery during sigmoid colon and rectal cancer surgery increases the risk of anastomotic leakage: a meta-analysis. World Journal of Surgical Oncology (2018).
3. Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. International Journal of Colorectal Disease (2017).
4. Indocyanine green-enhanced fluorescence to assess bowel perfusion during laparoscopic colorectal resection. Surgical Endoscopy (2015).
5. Oncological Outcomes After Anastomotic Leakage After Surgery for Colon or Rectal Cancer. Annals of Surgery (2022).
6. IntAct: intra‐operative fluorescence angiography to prevent anastomotic leak in rectal cancer surgery: a randomized controlled trial. Colorectal Disease (2018).
7. The Burden of Gastrointestinal Anastomotic Leaks: an Evaluation of Clinical and Economic Outcomes. Journal of Gastrointestinal Surgery (2014).