Risk of anastomotic leak by anastomosis type in colon cancer

Grace S Hwang, MD, Zhobin Moghadamyeghaneh, MD, Mark H Hanna, MD, Steven Mills, MD, Alessio Pigazzi, MD, PhD, Michael Stamos, MD, Joseph Carmichael, MD. University of California Irvine, School of Medicine, Orange, California

Background

There is limited data regarding the rate of anastomotic leak by type of anastomosis following colon resection. The objective of this study was to compare anastomotic leak following ileocolonic anastomosis with colo-colonic anastomosis in patients with colon cancer. We also evaluated how management of anastomotic leak differed by type of anastomosis.

Method

The American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) database was used to identify patients undergoing colon resection for the diagnosis of colon cancer in 2012. Multivariate regression analysis was performed to compare different anastomosis types with respect to anastomosis leak.

Results

A total of 3,125 patients underwent colon resections for colon cancer in 2012. The most common anastomosis performed was ileocolonic anastomosis (67.9%). Overall, 3.2% (101) of patients who underwent colon resection were diagnosed with an anastomotic leak. Among patients with anastomotic leak, 57.4% were managed with reoperation, 20.8% with percutaneous or endoscopic intervention, and 21.8% were managed with non-operative, non-interventional means. Patients with an anastomotic leak remained hospitalized for 12 days longer than patients without leak (CI: 10.8-13.5, P<0.01). Although colo-colonic anastomoses had a higher rate of anastomotic leak compared to ileocolonic anastomoses, there was no significant differences in leak rates following multivariate (3.7% vs. 3%, AOR: 1.36, P=0.24). Patients who had a leak following colo-colonic anastomosis had a higher rate of reoperation compared to the ileocolonic anastomosis group (59.5% vs. 56.3%, AOR: 1.92, P=0.04). Patients who underwent open colectomy had higher rates of anastomotic leak compared to laparoscopic resections (AOR: 2.50, P<0.01).

Conclusion

Anastomotic leaks occur in about 3.2% of patients following colon resections for colon cancer. Patients with postoperative anastomotic leak remained hospitalized for approximately 2 weeks longer than patients without a leak. A remarkably large portion of patients with anastomotic leak were managed non-surgically. There were no significant differences in rates of anastomotic leak between colo-colonic and ileocolonic anastomosis. However, more patients with anastomotic leak following colo-colonic anastomosis had a significantly higher rate of reoperation compared to patients with ileocolonic anastomosis.