A nationwide study on anastomotic leakage after colonic cancer surgery


Peter-Martin Krarup MD, Department of Surgery, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark.
E-mail: krarup75@gmail.com


Aim  Anastomotic leakage (AL) is a major challenge in colorectal cancer surgery due to increased morbidity and mortality. Possible risk factors should be investigated differentially, distinguishing between rectal and colonic surgery in large-scale studies to avoid selection bias and confounding.

Method  The incidence and risk factors associated with AL were analysed in an unselected nationwide prospective cohort of patient subjected to curative colonic cancer surgery with primary anastomosis and entered into The Danish Colorectal Cancer Group database between May 2001 and December 2008.

Results  AL occurred in 593 (6.4%) of 9333 patients. Laparoscopic surgery [odds ratio (OR) 1.34; 95% confidence interval (CI) 1.05–1.70; = 0.03); left hemicolectomy (OR 2.02; 95% CI 1.50–2.72; = 0.01) or sigmoid colectomy (OR 1.69; 95% CI 1.32–2.17; = 0.01); intra-operative blood loss (OR 1.04; 95% CI 1.01–1.07; = 0.03); blood transfusion (OR 10.27; 95% CI 6.82–15.45; < 0.001) and male gender (OR 1.41; 95% CI 1.12–1.75; = 0.02) were associated with AL in the multivariate analysis.

Conclusion  The main finding that a laparoscopic approach was associated with an increased risk of AL should prompt close future monitoring. There was no evidence that centralization of surgery to high-volume hospitals reduced the rate of AL.