Complications in colorectal surgery: risk factors and preventive strategies

Kirchhoff, Philipp; Clavien, Pierre‐Alain; Hahnloser, Dieter

doi:10.1186/1754-9493-4-5

Cited by 350 publications

(283 citation statements)

References 118 publications

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“…The various surgical methodologies, procedures performed, and patient samples across the studies is a limitation of this review and leads to a high level of variability across the sample, which likely accounts for the wide range of intra-operative (0.0% -23.3%) and post-operative (0.8% -15.0%) leak rates observed across studies. Further, as noted in other studies, the definition for anastomotic leak and other postoperative complications varies across surgical sites and institutions reducing the level of accuracy in estimating anastomotic leak rates [35,40]. Although 10 articles had a similar definition of anastomotic leak there were six slightly different definitions for anastomotic leak; further three manuscripts did not provide a definition for anastomotic leak.…”

Section: Discussionmentioning

confidence: 91%

“…Although the definitive causes of post-operative anastomotic leak remains unknown, leak development is believed to be related to anastomotic healing, as opposed to intraoperative leaks which are the result of injury, adhesions, and weak or insufficient anastomosis, related to factors of the surgery itself [35]. Therefore, aside from a minority of cases where an undetected or uncorrected intra-operative leak progresses to a clinical post-operative leak, there is no reason to assume there is a direct relationship between the development of intra-operative and post-operative leaks.…”

Section: Discussionmentioning

confidence: 99%

“…These findings indicate that despite correction of the leak at the time of surgery through suturing, re-anastomosis, or diversion a subpopulation of patients remain at an increased risk for anastomotic leak even with the use of anastomotic testing. Although some risk factors for anastomotic leak including male gender, steroid use, obesity, malnutrition, and intraoperative blood loss are known, other yet unidentified risk factors certainly exist [9,35]. It is possible that the subpopulation of patients with an initially positive leak test who develop a post-operative leak includes patients at higher risk for anastomotic leak, potentially due to comorbidity, changes in the composition of the patient's microbiome, decreased gastrointestinal healing, or increased damage to colorectal tissue [36,37].…”

Section: Discussionmentioning

confidence: 99%

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Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Schiff¹,

Brady²,

Ghosh³

et al. 2016

J Surg Surgical Res

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048 AbstractPurpose: Anastomotic leak following colorectal resection surgery is associated with high rates of morbidity, infection, and escalated healthcare expenditures. One method to prevent leaks includes early detection through intra-operative testing. This study employed systematic review of the literature to estimate the rate of intra-operative anastomotic leaks in colorectal resection surgery. Method:The Medline and Embase databases were searched to identify articles published between January 1 st , 2003 and August 8 th , 2015 reporting on intra-operative leaks in colorectal resection. The rate of intra-operative testing, intra-and post-operative anastomotic leaks, and surgical methodology were extracted from the final sample of 13 articles.Results: A total of 167 intra-operative leaks were reported within 2,598 colorectal resection surgeries that used intra-operative testing, yielding an average leak rate of 6.4%. Use of laparoscopic techniques was significantly associated with a reduced rate of intra-operative leak (p<0.001). Eight articles reported on the rate of post-operative anastomotic leak in relation to intraoperative testing. Within this sample of 2,098 cases a non-significant trend towards a lower leak rate in the tested population was identified (4.3% v. 6.8%, p=0.051); cases whose leak test was initially positive exhibited a significantly higher rate of post-operative leaks compared to cases with a negative leak test (p=0.006). Conclusion:Intra-operative anastomotic leak testing allows surgeons to address leaks at the time of surgery, and may help to prevent complications in colorectal resection surgery. This study identified a mean intra-operative leak rate of 6.4% in colorectal resection surgery.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Schiff¹,

Brady²,

Ghosh³

et al. 2016

J Surg Surgical Res

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“…The most frequent postoperative surgical complications after colorectal resections are surgical site infection, anastomotic leakage, intraabdominal abscess, ileus and bleeding (5).…”

Section: Discussion Discussionmentioning

confidence: 99%

Impact of Postoperative Septic Complications on Recurrence of Colorectal Cancer

Levý¹,

Lipská²,

Sojka³

et al. 2017

SGO

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Background: About one third of patients racically resected for colorectal cancer develop during follow-up recurrence. Materials and methods: There were 1951 patients operated for colorectal cancer in Surgical Department, Thomayer Hospital Prague, from 1997 to 2015. Radical R0 operation underwent 68% of these patients. Postoperative complications occurred in 457 (34.6%) patients. Impact of postoperative complications on disease free interval was studied in a prospective study. Results: We identified minor complications in 90 patients (6.8%), moderate complications in 28 patients (2.1%), anastomotic leakage in 67 patients (5%) and severe septic complications in 20 patients (1.5%). Another 255 patients (19.3%) had a different, non-inflammatory complications (pulmonary embolism, bowel obstruction, heart failure, etc.). Significantly worse disease-free interval was found in patients with severe septic complications. Conclusion: In our cohort of R0 operated patients, postoperative complication is the second most important prognostic factor following TNM stage of the colorectal cancer. Severe septic complications has an adverse effect on the further course of the disease in terms of relapse. Other potentially septic complications such as anastomotic leakage have no essential impact on recurrence. Therefore, it is necessary to prevent the development of sepsis.

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“…Kirchhoff et al, 2010 reported damage to the spleen (incidence of 0.006%), or intestinal perforation and ureteric injuries (incidence < 0.01%) [14].…”

Section: Variablesmentioning

confidence: 99%

Outcome of Laparoscopic Resection for Left Sided Colon and Rectal Cancer

Abdelhady¹,

Esmail²,

Hablus³

et al. 2017

JCT

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Background: For many years, traditional surgery for left colon and rectal cancers had developed with variable degrees of morbidity. With the evolution of laparoscopy and by the aid of better visualization and magnification, laparoscopic colorectal surgery had appeared, but technically challenging as it involves almost all advanced laparoscopic techniques, with the benefits of minimal morbidity, less pain, earlier recovery, shorter hospital stay, without compromising oncological results. Aim: The aim of this work was to evaluate laparoscopic resection for left sided colon and rectal cancer as regard feasibility, safety and outcomes. Patients and Methods: This prospective study was conducted on 40 patients having left sided colon and rectal cancer, including 29 patients with rectal cancer and 11 patients with left sided colon cancer within the inclusion criteria are evaluated by clinical examination, radiological and colonoscopic study and biopsy and treated by laparoscopic resection and followed ranged from 6 months to 2 years with mean of 20 months. Results: Twenty seven patients (67.5%) underwent laparoscopic anterior resection, 11 patients (27.5%) underwent laparoscopic left hemicolectomy and only 2 patients (5%) underwent laparoscopic abdominoperineal resection, minimal morbidity, no cancer related mortality and no recurrence during the period of follow up either local or systemic. Conclusion: Laparoscopic resection for left sided colon and rectal cancer is technically feasible, oncologically safe and has more benefits on postoperative recovery.

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Complications in colorectal surgery: risk factors and preventive strategies

Cited by 350 publications

References 118 publications

Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Impact of Postoperative Septic Complications on Recurrence of Colorectal Cancer

Outcome of Laparoscopic Resection for Left Sided Colon and Rectal Cancer

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