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December 1, 2025Colorectal DiseaseOpen Access

Management of anastomotic leak after elective anterior resection for rectal cancer: A systematic review and pooled analysis

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Authors

RWRuth WalshUniversity College DublinEMEdward S. MurphyUniversity College DublinÉRÉanna J. RyanBeaumont Hospital

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Implication

Systematic review and pooled analysis reveals varied success across leak interventions in rectal cancer patients, indicating drainage achieves high resolution with low stoma rates.

Key Points

  • To evaluate the comparative success, mortality, and clinical outcomes among different management strategies for anastomotic leakage following elective anterior resection for rectal cancer.
  • Conducted a systematic search across EMBASE, PubMed, and SCOPUS following AMSTAR2 guidelines for publications between 2010 and 2024.
  • Identified 16 studies encompassing 7,236 rectal cancer patients, including 850 with diagnosed anastomotic leaks.
  • Pooled primary and secondary outcome measures using the DerSimonian–Laird random-effects method, defining success as resolution of pelvic sepsis or complete leak healing.
  • Treatment success was 44.4% for conservative management, 73.7% for drainage procedures (78.7% passive and 73.5% active), 69.7% for anastomosis-conserving surgery, and 77.0% for surgical takedown.
  • Short-term mortality was lowest with conservative management (0%) and drainage (0.97%), compared to surgical takedown (1.49%) and anastomosis-conserving surgery (2.92%).
  • Drainage procedures achieved the lowest long-term stoma rate (22.5%) and re-intervention rate (29.1%), despite a substantially longer mean length of stay (59.9 days) compared to surgical groups (14.7–19.8 days).

Cite This Study

Walsh et al. (2025) studied this question.

synapsesocial.com/papers/6a0cbc629bd1c994e6addb03https://doi.org/10.1111/codi.70335
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Also Consider

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  1. 1Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer2018 · 158 citations
  2. 2Influence of Neoadjuvant Therapy on Success of Endoscopic Vacuum Therapy in Anastomotic Leakage after Rectal Resection Because of Rectal Cancer2024 · 2 citations
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  4. 4Redo coloanal anastomosis for anastomotic leakage after low anterior resection for rectal cancer: an analysis of 59 cases2017 · 32 citations
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