Anastomotic leakage after colorectal cancer surgery 2014-2018 – a retrospective chart review and comparison to the Swedish Colorectal Cancer Registry

Abstract Introduction Anastomotic leakage (AL) is a feared complication after colorectal surgery, resulting in both morbidity and mortality. The aim of this study was to evaluate the incidence of AL by retrospective chart review and compare it to the incidence reported in the Swedish Colorectal Cancer Registry (SCRCR). Method Data were retrospectively collected through manual chart review for patients who underwent colorectal cancer resection with the formation of an anastomosis in seven hospitals in Region Västra Götaland (VGR) 2014-2018. Additionally, demographic data, details of surgery and hospital care were collected. Result In this study 3126 patients received anastomosis in colorectal cancer surgery. Manual chart review showed that 287 patients (9.1%) developed AL, while only 149 (4.9%) of these were registered in SCRCR (p-value < 0.001). Out of 138 missed cases in the registry, 58 were classified as Clavien-Dindo IIIb-V. A significant lower incidence of AL (p-value < 0.001) was found in one hospital (4.6%) compared to the two hospitals with highest incidence (12.4% and 13.1%). The remaining four hospitals had an incidence around 8%. There was no significant difference in leaks between acute (7.1%) and elective (9.7%) patients (p-value 0.140). Discussion Anastomotic leakage was significantly underreported in SCRCR. In 43 cases the anastomotic leakage occurred after post operative day 30 (POD 30) and were therefore naturally missed in the registry. However, even excluding these late leaks, the rate of underreporting was 38.9% (95/244).