Anastomotic Leakage following 4,357 Colorectal Cancer Surgery: Incidence, Presentation, Pathogens, Treatment and Outcome
Lohsiriwat V, MD, PhD1, Assawasirisin C, MD1
Affiliation : 1 Colorectal Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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)
