Colorectal anastomotic leakage: paradoxes of risk factors in modern surgery

Objective. To evaluate the prevalence of risk factors for colorectal anastomotic leakage and to develop appropriate preventive measure. Material and methods. A systematic review of publications in PubMed, Scopus, eLibrary, and Cochrane Library databases was conducted for the period 2000—2023. Inclusion criteria: randomized controlled trials, meta-analyses, and large cohort studies devoted to risk factors of colorectal anastomotic leakage. Eligibility criteria were developed using the PICOS strategy. Particular attention was paid to studies comparing various anastomotic techniques (manual or mechanical), as well as studies assessing the role of patient-related factors (diabetes mellitus, obesity, hypoalbuminemia, etc.) and surgical risk factors. Conclusion. This review provides a comprehensive analysis of etiopathogenetic aspects of colorectal anastomotic leakage with particular attention to the role of patient-associated risk factors. This report systematizes current data on predictors of complications and highlights key controversial issues and unresolved problems in predicting leaks.