Long-term and Perioperative Corticosteroids in Anastomotic Leakage A Prospective Study of 259 Left-Sided Colorectal Anastomoses

Objective: To determine the risk factors for symptomatic anastomotic leakage (AL) after colorectal resection. Design: Review of records of patients who participated in the Analysis of Predictive Parameters for Evident Anastomotic Leakage study. Setting: Eight health centers. Patients: Two hundred fifty-nine patients who underwent left-sided colorectal anastomoses. Intervention: Corticosteroids taken as long-term medication for underlying disease or perioperatively for the prevention of postoperative pulmonary complications. Main Outcome Measures: Prospective evaluations for risk factors for symptomatic AL. Results: In 23% of patients, a defunctioning stoma was constructed. The incidence of AL was 7.3%. The clinical course of patients with AL showed that in 21% of leaks, the drain indicated leakage; in the remaining patients, computed tomography or laparotomy resulted equally often in the detection of AL. In 50% of patients with AL, a Hartmann operation was needed. The incidence of AL was significantly higher in patients with pulmonary comorbidity (22.6% leakage), patients taking corticosteroids as longterm medication (50% leakage), and patients taking corticosteroids perioperatively (19% leakage). Perioperative corticosteroids were prescribed in 8% of patients for the prevention of postoperative pulmonary complications. Conclusions: We found a significantly increased incidence of AL in patients treated with long-term corticosteroids and perioperative corticosteroids for pulmonary comorbidity. Therefore, we recommend that in this patient category, anastomoses should be protected by a diverting stoma or a Hartmann procedure should be considered to avoid AL.