Factors associated with anastomotic leak after surgery for colon cancer

We appreciate the paper summarizing the impact that anatomical location has on anastomotic leak (AL) rates in patients undergoing colectomies.1 We would like to note that while the location of the resection in fact correlates to the rates of AL, there are many additional perioperative characteristics that can significantly impact the results. The factors included in the paper (for example, age, American Society of Anesthesiologists score, operating urgency, entry methods, anastomotic technique, neoadjuvant therapy, etc.) are clearly useful and correlate strongly with the ACS-NSQIP risk calculator. However, stating the unique impact of specific medical complications such as blood loss, infections, cardiac arrest, etc. that may arise rather than grouping them under “medical complications” could have further clarified the message. For example, an intraoperative bleeding volume of ≥100 mL has been shown to correlate to a higher risk of AL, a factor that could have been significant were it included in this study.2 Other clinical characteristics, such as having diabetes mellitus or lung disease, in addition to the type of anaesthesia given (inhalation), the length of operation, and the history of previous abdominal surgery can also increase AL rates according to other publications, and should be considered by the authors in their future studies.3, 4 Additionally, a retrospective review focusing on combining oral antibiotics with mechanical bowel preparation found that the rates of AL within patients who received both were significantly lower than those who underwent mechanical preparation alone.5 Therefore, we believe including the type of bowel preparation the patients underwent to determine the impact it has on anastomotic leak would broaden the author's findings. In summary, we appreciate the author's efforts in determining the factors that influence the possibility of AL in patients undergoing surgery for colon cancer but recommend incorporating the above commonly seen perioperative factors in their future studies. Joseph S. Flanagan: Conceptualization; writing – original draft. Jana K. Elsawwah: Conceptualization; writing – original draft. Zoltan H. Nemeth: Conceptualization; writing – original draft.