Objective: This study aimed to determine the incidence, presentation, pathogens, treatment and outcome of patients with anastomotic leakage (AL) after colorectal cancer surgery.

Materials and Methods: The authors retrospectively reviewed the medical records of patients with clinical AL after colorectal cancer surgery during 2004 to 2015 at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.

Results: AL occurred in 84 of 4,357 patients (1.9%): right hemicolectomy (1.4%), left hemicolectomy (1.1%), sigmoidectomy (2.1%), and other sphincter-saving operations (2.4%). AL was commonly diagnosed on postoperative day 3 to 7 with peak on day 4. Eleven cases (13%) were diagnosed after patients were discharged. The most common manifestations of AL were postoperative ileus (n = 67, 80%), fever (n = 64, 76%), and oliguria (n = 62, 74%). Localized peritonitis or generalized peritonitis presented in 24 cases (29%) and 11 cases (13%), respectively. Eleven cases (13%) had septic shock. Some 67 AL cases (80%) required surgery and majority of patients requiring surgery had stoma formation. Nine patients (11%) died. Sixty-three cases (75%) suffered from other complications after treating AL-mostly wound infection and residual intraabdominal collection. Average total length of hospital stay was 30 days. Regarding bacteriology, Escherichia spp. was the most common pathogens followed by mixed organisms and Enterococcus spp. Extended-spectrum beta-lactamase (ESBL) producing organisms were found in 31%.

Conclusion: This study demonstrated a relative low incidence of AL after colorectal cancer surgery but it was associated with
significant morbidity and mortality. Most cases required surgical treatment and stoma formation. Antimicrobial-resistant bacteria were identified in about one-third of AL cases.

Keywords: Anastomotic leakage, Incidence, Presentation, Management, Colon, Rectum, Surgery, Cancer, Thailand, Extended-spectrum beta-lactamase (ESBL)