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World J Gastrointest Surg. May 27, 2023; 15(5): 745-756
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.745
Impact of anastomotic leakage on long-term prognosis after colorectal cancer surgery
Valeria Tonini, Manuel Zanni
Valeria Tonini, Manuel Zanni, Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Bologna, Italy
Author contributions: Tonini V and Zanni M contributed equally to this work, performing the research, analizing the data and writing the manuscript All authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Valeria Tonini, MD, PhD, Full Professor, Surgeon, Surgical Oncologist, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, Bologna 40138, Bologna, Italy. valeria.tonini@unibo.it
Received: January 19, 2023
Peer-review started: January 19, 2023
First decision: March 6, 2023
Revised: March 21, 2023
Accepted: April 12, 2023
Article in press: April 12, 2023
Published online: May 27, 2023
Processing time: 126 Days and 22.4 Hours
Abstract

Colorectal cancer (CRC) is one of the most common malignancies in the world. Despite significant improvements in surgical technique, postoperative complications still occur in a fair percentage of patients undergoing colorectal surgery. The most feared complication is anastomotic leakage. It negatively affects short-term prognosis, with increased post-operative morbidity and mortality, higher hospitalization time and costs. Moreover, it may require further surgery with the creation of a permanent or temporary stoma. While there is no doubt about the negative impact of anastomotic dehiscence on the short-term prognosis of patients operated on for CRC, still under discussion is its impact on the long-term prognosis. Some authors have described an association between leakage and reduced overall survival, disease-free survival, and increased recurrence, while other Authors have found no real impact of dehiscence on long term prognosis. The purpose of this paper is to review all the literature about the impact of anastomotic dehiscence on long-term prognosis after CRC surgery. The main risk factors of leakage and early detection markers are also summarized.

Keywords: Anastomotic leakage; Colorectal surgery; Colon cancer; Rectal cancer; Long term prognosis; Long term survival

Core Tip: Colorectal cancer (CRC) is one of the most common malignancies in the world. Despite significant improvements in surgical technique, postoperative complications still occur in a fair percentage of patients undergoing colorectal surgery. The most feared complication is anastomotic leakage. It negatively affects short-term prognosis, with increased post-operative morbidity and mortality, higher hospitalization time and costs. Moreover, it may require further surgery with the creation of a permanent or temporary stoma. While there is no doubt about the negative impact of anastomotic dehiscence on the short-term prognosis of patients operated on for CRC, still under discussion is its impact on the long-term prognosis. Some authors have described an association between leakage and reduced overall survival, disease-free survival, and increased recurrence, while other authors have found no real impact of dehiscence on long term prognosis. The purpose of this paper is to review all the literature about the impact of anastomotic dehiscence on long-term prognosis after CRC surgery. The main risk factors of leakage and early detection markers are also summarized.