Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks.
Br J Surg
; 102(5): 462-79, 2015 Apr.
Article
en En
| MEDLINE
| ID: mdl-25703524
ABSTRACT
BACKGROUND:
Anastomotic leak (AL) represents a dreaded complication following colorectal surgery, with a prevalence of 1-19 per cent. There remains a lack of consensus regarding factors that may predispose to AL and the relative risks associated with them. The objective was to perform a systematic review of the literature, focusing on the role of preoperative, intraoperative and postoperative factors in the development of colorectal ALs.METHODS:
A systematic review was performed to identify adjustable and non-adjustable preoperative, intraoperative and postoperative factors in the pathogenesis of AL. Additionally, a severity grading system was proposed to guide treatment.RESULTS:
Of 1707 papers screened, 451 fulfilled the criteria for inclusion in the review. Significant preoperative risk factors were male sex, American Society of Anesthesiologists fitness grade above II, renal disease, co-morbidity and history of radiotherapy. Tumour-related factors were distal site, size larger than 3 cm, advanced stage, emergency surgery and metastatic disease. Adjustable risk factors were smoking, obesity, poor nutrition, alcohol excess, immunosuppressants and bevacizumab. Intraoperative risk factors were blood loss/transfusion and duration of surgery more than 4 h. Stomas lessen the consequences but not the prevalence of AL. In the postoperative period, CT is the most commonly used imaging tool, with or without rectal contrast, and a C-reactive protein level exceeding 150 mg/l on day 3-5 is the most sensitive biochemical marker. A five-level classification system for AL severity and appropriate management is presented.CONCLUSION:
Specific risk factors and their potential correction or indications for stoma were identified. An AL severity score is proposed to aid clinical decision-making.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Recto
/
Colon
/
Atención Perioperativa
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Fuga Anastomótica
Tipo de estudio:
Etiology_studies
/
Prognostic_studies
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Risk_factors_studies
/
Systematic_reviews
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Br J Surg
Año:
2015
Tipo del documento:
Article
País de afiliación:
Irlanda