title: Long-term and perioperative corticosteroids in anastomotic leakage: a prospective study of 259 left-sided colorectal anastomoses.
abstract: OBJECTIVE
  To determine the risk factors for symptomatic anastomotic leakage (AL) after colorectal resection.
  
  
  METHODS
  Review of records of patients who participated in the Analysis of Predictive Parameters for Evident Anastomotic Leakage study.
  
  
  METHODS
  Eight health centers.
  
  
  METHODS
  Two hundred fifty-nine patients who underwent left-sided colorectal anastomoses.
  
  
  METHODS
  Corticosteroids taken as long-term medication for underlying disease or perioperatively for the prevention of postoperative pulmonary complications.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  trialregister.nl Identifier: NTR1258
authors.affiliation: Departments of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands. juliette_slieker@hotmail.com
authors.forename: Juliette C
authors.initials: JC
authors.lastname: Slieker
authors.forename: Niels
authors.initials: N
authors.lastname: Komen
authors.forename: Niels A P
authors.initials: NA
authors.lastname: Komen
authors.forename: Guido H
authors.initials: GH
authors.lastname: Mannaerts
authors.forename: Tom M
authors.initials: TM
authors.lastname: Karsten
authors.forename: Paul
authors.initials: P
authors.lastname: Willemsen
authors.forename: Magdalena
authors.initials: M
authors.lastname: Murawska
authors.forename: Johannes
authors.initials: J
authors.lastname: Jeekel
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000305:Adrenal Cortex Hormones