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04-01-2025 | Ileostomy | Gastrointestinal Oncology

Risk Factors for Anastomotic Leakage: A Comprehensive Single-Center Analysis of Colorectal Anastomoses for Ovarian and Gastrointestinal Cancers

Authors: Francesco Santullo, MD, Virginia Vargiu, MD, Andrea Rosati, MD, Barbara Costantini, MD, Valerio Gallotta, MD, Claudio Lodoli, MD, Carlo Abatini, MD, Miriam Attalla El Halabieh, MD, Valentina Ghirardi, MD, Federica Ferracci, MD, Lorena Quagliozzi, MD, Angelica Naldini, MD, Fabio Pacelli, MD, Giovanni Scambia, MD, Anna Fagotti, MD

Published in: Annals of Surgical Oncology

Abstract

Background

Anastomotic leakage (AL) is a major complication in colorectal surgery, particularly following rectal cancer surgery, necessitating effective prevention strategies. The increasing frequency of colorectal resections and anastomoses during cytoreductive surgery (CRS) for peritoneal carcinomatosis further complicates this issue owing to the diverse patient populations with varied tumor distributions and surgical complexities. This study aims to assess and compare AL incidence and associated risk factors across conventional colorectal cancer surgery (CRC), gastrointestinal CRS (GI-CRS), and ovarian CRS (OC-CRS), with a secondary focus on evaluating the role of protective ostomies.

Patients and Methods

A retrospective analysis was performed on 1324 patients undergoing CRC, GI-CRS, and OC-CRS between January 2015 and December 2022. Multivariate analysis was utilized to identify preoperative, intraoperative, and postoperative variables as potential AL risk factors.

Results

The overall AL rate was 3.0% (40/1324), with no significant differences among the three groups. Distinct risk factors were identified for each group: CRC (preoperative chemoradiotherapy), GI-CRS (ECOG score ≥ 2, preoperative albumin < 30 mg/dL), and OC-CRS (BMI < 18 kg/m², pelvic lymphadenectomy, preoperative albumin < 30 mg/dL, anastomosis distance < 10 cm, postoperative anemia). Protective ostomies did not reduce AL incidence, and a notable discrepancy exists between AL risk factors and those influencing protective ostomy decisions.

Conclusions

AL, while rare, remains a serious postoperative complication in CRC and CRS. Key risk factors include preoperative nutritional status and surgical details such as blood supply and anastomosis level. Each patient group presents unique risks, which must be carefully weighed when considering protective ileostomy.

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Title: Risk Factors for Anastomotic Leakage: A Comprehensive Single-Center Analysis of Colorectal Anastomoses for Ovarian and Gastrointestinal Cancers
Authors: Francesco Santullo, MD
Virginia Vargiu, MD
Andrea Rosati, MD
Barbara Costantini, MD
Valerio Gallotta, MD
Claudio Lodoli, MD
Carlo Abatini, MD
Miriam Attalla El Halabieh, MD
Valentina Ghirardi, MD
Federica Ferracci, MD
Lorena Quagliozzi, MD
Angelica Naldini, MD
Fabio Pacelli, MD
Giovanni Scambia, MD
Anna Fagotti, MD
Publication date: 04-01-2025
Publisher: Springer International Publishing
Keywords: Ileostomy
Colorectal Cancer
Colorectal Cancer
Ovarian Cancer
Ovarian Cancer
Published in: Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-024-16731-6

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Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

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Risk Factors for Anastomotic Leakage: A Comprehensive Single-Center Analysis of Colorectal Anastomoses for Ovarian and Gastrointestinal Cancers

Abstract

Background

Patients and Methods

Results

Conclusions

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Keynote webinar | Spotlight on adolescent vaping

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Abstract

Background

Patients and Methods

Results

Conclusions

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Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions