10 Chapter 1 COLORECTAL CANCER Colorectal cancer (CRC) ranks as the third most prevalent cancer globally, comprising around 10% of all cancer cases. Moreover, it stands as the second primary cause of cancer-related deaths worldwide 1. The primary approach for curative treatment of CRC involves surgical removal of the tumor and adjacent lymph nodes. Choice of the best surgical procedure depends on the tumors’ location and patients’ condition, but often involves the creation of a primary anastomosis. The emphasis on improving patient outcomes in colorectal surgery has emerged as a central focus in medical research and clinical care. It is crucial to implement strategies to prevent associated complications to mitigate the impact of CRC surgery and improve patients’ outcomes. The most feared complication after colorectal surgery is anastomotic leakage (AL). It is known that AL patients have a worse overall survival and poorer oncological outcomes, especially after rectal cancer surgery 2-4. Besides, the most important and ultimately life-threatening feature of CRC is the ability to still metastasize after curative surgery. These so-called metachronous metastases have the poorest outcomes when they spread to the peritoneum, as treatment options are limited 5. Minimizing the risk to prevent both AL and PM after colorectal surgery is essential as their development can lead to cancer progression, decreased quality of life, and poorer prognosis. As prevention is better than cure, taking proactive measures to minimize risks through meticulous surgical techniques, appropriate perioperative care, and early detection strategies can significantly improve patient outcomes and reduce the need for more complex and aggressive treatments later on. ANASTOMOTIC LEAKAGE Background AL represents the most common major complication following colorectal resections. Severity of AL spans from minor defects with no evident extravasation of air or fluid to significant dehiscence, with or without localized abscess, phlegmon, and diffuse purulent and/or fecal peritonitis 6, 7. These leaks can manifest early or late postoperatively, taking the form of fistulae, anastomotic strictures, chronic sinuses, or abscess cavities 7, 8. The clinical impact of AL varies from minimal or no symptoms, particularly in diverted patients, to substantial morbidity and mortality arising from abdominal and/or pelvic sepsis 9. AL also exerts a detrimental influence on oncological outcomes, functional results, and quality of life due to the necessity for reoperation, permanent diversion, or delayed ostomy reversal 9-12. Difficult etiology and heterogeneous presentation of AL is reflected by its wide reported incidence rates, ranging from 2% to 25% 10-12. Reporting of AL Despite the growing number of literature that delves into the occurrence, origins, risk factors, treatment methods, and short/long-term consequences of AL after colorectal
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