Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2018; 24(21): 2247-2260
Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2247
Predictive factors for anastomotic leakage after laparoscopic colorectal surgery
Antonio Sciuto, Giovanni Merola, Giovanni D De Palma, Maurizio Sodo, Felice Pirozzi, Umberto M Bracale, Umberto Bracale
Antonio Sciuto, Felice Pirozzi, Department of Abdominal Surgery, Casa Sollievo della Sofferenza Research Hospital, San Giovanni Rotondo 71013, Italy
Giovanni Merola, Department of General Surgery, Casa di Cura Villa Berica, Vicenza 36100, Italy
Giovanni D De Palma, Umberto Bracale, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University Hospital of Naples Federico II, Naples 80131, Italy
Maurizio Sodo, Umberto M Bracale, Department of Public Health, University of Naples Federico II, Naples 80131, Italy
Author contributions: Sciuto A designed the study, performed data analysis and drafted the article; Merola G designed the study, performed data analysis and drafted the article; De Palma GD contributed in the editing and final approval of the version to be published; Sodo M critically revised the manuscript; Pirozzi F critically revised the manuscript; Bracale UM contributed in the design and editing of the article; Bracale U performed data analysis, coordinated the study and contributed in the final approval of the version to be published.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Umberto Bracale, MD, PhD, Lecturer, Surgeon, Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University Hospital of Naples Federico II, Via Sergio Pansini 5, Naples 80131, Italy.
Telephone: +39-339-5720072 Fax: +39-081-7463700
Received: April 4, 2018
Peer-review started: April 6, 2018
First decision: April 19, 2018
Revised: May 6, 2018
Accepted: May 18, 2018
Article in press: May 18, 2018
Published online: June 7, 2018

Every colorectal surgeon during his or her career is faced with anastomotic leakage (AL); one of the most dreaded complications following any type of gastrointestinal anastomosis due to increased risk of morbidity, mortality, overall impact on functional and oncologic outcome and drainage on hospital resources. In order to understand and give an overview of the AL risk factors in laparoscopic colorectal surgery, we carried out a careful review of the existing literature on this topic and found several different definitions of AL which leads us to believe that the lack of a consensual, standard definition can partly explain the considerable variations in reported rates of AL in clinical studies. Colorectal leak rates have been found to vary depending on the anatomic location of the anastomosis with reported incidence rates ranging from 0 to 20%, while the laparoscopic approach to colorectal resections has not yet been associated with a significant reduction in AL incidence. As well, numerous risk factors, though identified, lack unanimous recognition amongst researchers. For example, the majority of papers describe the risk factors for left-sided anastomosis, the principal risk being male sex and lower anastomosis, while little data exists defining AL risk factors in a right colectomy. Also, gut microbioma is gaining an emerging role as potential risk factor for leakage.

Keywords: Laparoscopic colorectal surgery, Colorectal surgery, Anastomotic leakage, Laparoscopy, Risk factor, Rectal cancer, Diverting stoma

Core tip: In colorectal surgery, knowledge and prevention of possible complications are mandatory. Anastomotic leakage is a major issue in laparoscopic colorectal surgery and furthermore, its etiology is not fully understood. The aim of this review was to evaluate the current literature to identify patient-related and perioperative risk factors for leakage in patients undergoing colorectal resection by laparoscopy. Full awareness of risk factors is essential for identifying high-risk patients and properly select them for diverting stomas in order to mitigate potential severe clinical consequences of anastomotic leakage.