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Objective: Anastomotic leaks after colo-rectal surgery are commonly treated with percutaneous drainage by interventional radiology (IR). However, the efficacy of this intervention may be affected by preoperative conditions with different inflammatory milieu, such as neoadjuvant chemoradiation for colo-rectal cancer, inflammatory bowel disease (IBD) or diverticulitis. The aim of this study is to determine whether a patient’s underlying disease process impacts the duration and quantity of percutaneous drainage needed before resolution of anastomotic leak.
Design: Retrospective review of a prospectively maintained, IRB-approved database.
Setting: Tertiary care center.
Patients: Patients who underwent colo-rectal surgery complicated by anastomotic leak drained by interventional radiology 2000-2012 at Massachusetts General Hospital.
Main Outcome Measures: Length of time IR drain needed and number of interventions.
Results: 89 patients were included. The study population was grouped into patients with colo-rectal cancer who did (n=27, 30%) or did not (n=26, 30%) undergo neoadjuvant therapy; patients with IBD (n=17, 19%); and patients with diverticulitis or traumatic injury (n=19, 21%). Average time of indwelling IR drain was longest in patients who underwent neoadjuvant therapy or had IBD (147 and 98 days, respectively) compared with patients who had diverticulitis/traumatic injury or did not undergo neoadjuvant therapy (65 and 40 days, respectively). Patients who underwent neoadjuvant therapy or had IBD also required 33% more IR drain procedures and 50% more CT scans before resolution of anastomotic leak. Ultimately 20-30% of patients in each group required re-operation.
Conclusions: Neoadjuvant chemoradiation for colo-rectal cancer and inflammatory bowel disease prolong time to healing in patients with anastomotic leaks after colo-rectal surgery who are treated with percutaneous drainage.