Impact of Anastomotic Leakage After Colorectal Cancer Surgery on Quality of Life: A Systematic Review
Anke H. C. Gielen, Danique J. I. Heuvelings, Patricia Sylla, Yu-Ting van Loon, Jarno Melenhorst, Nicole D. Bouvy, Merel Kimman, Stéphanie O. Breukink, On behalf of the CoReAL Collaborative
Abstract
BACKGROUND: Colorectal anastomotic leakage remains one of the most frequent and dreaded postoperative complications after colorectal resection. However, limited research has been conducted on the impact of this complication on the quality of life of patients who have undergone colorectal cancer surgery. OBJECTIVE: The aim of this systematic review was to identify, appraise, and synthesize the available evidence regarding the quality of life in patients with anastomotic leakage after oncological colorectal resections to inform clinical decision-making. DATA SOURCES AND STUDY SELECTION: PubMed, Embase, and the Cochrane Library were searched for studies reporting quality of life using validated questionnaires in patients with anastomotic leakage after oncological colorectal resections. The literature search was performed systematically and according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. OUTCOMES: Outcomes from quality-of-life questionnaires of patients with and without anastomotic leakage were analyzed. RESULTS: Thirteen articles reporting on 4618 individual patients were included, among which 527 patients developed anastomotic leakage. Quality of life was evaluated using 10 distinct questionnaires administered at various postoperative time points, ranging from 1 month to 14 years. Quality-of-life outcomes differed across studies and time points, but overall scores were most negatively affected by anastomotic leakage up to 12 months postoperatively. LIMITATIONS: There was a high heterogeneity between the included studies based on the questionnaires used and the time of assessment. CONCLUSIONS: The published evidence suggests that anastomotic leakage after oncologic colorectal resection is associated with impaired quality of life, especially within the first postoperative year. The impact of anastomotic leakage on quality of life warrants further evaluation and discussion with patients.