title: Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality.
abstract: BACKGROUND
  Availability of anastomotic leakage rates and mortality rates following anastomotic leakage is essential when informing patients with rectal cancer preoperatively. We performed a meta-analysis of studies describing anastomotic leakage and the subsequent postoperative mortality in relation to the overall postoperative mortality after low anterior resection for rectal cancer.
  
  
  METHODS
  A systematic search was performed of the published literature. Data on the definition and incidence rate of AL, postoperative mortality caused by AL, and overall postoperative mortality were extracted. Data were pooled and a meta-analysis was performed.
  
  
  RESULTS
  Twenty-two studies with 10,343 patients in total were analyzed. Meta-analysis of the data showed an average AL rate of 9%, postoperative mortality caused by leakage of 0.7% and overall postoperative mortality of 2%. The studies showed variation in incidence, definition and measurement of all outcomes.
  
  
  CONCLUSIONS
  We found a considerable overall AL rate and a large contribution of AL to the overall postoperative mortality. The variability of definitions and measurement of AL, postoperative mortality caused by leakage and overall postoperative mortality may hinder providing reliable risk information. Large-scale audit programs may provide accurate and valid risk information which can be used for preoperative decision making.
authors.affiliation: Leiden University Medical Centre, Department of Surgery, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands. h.s.snijders@lumc.nl
authors.forename: H S
authors.initials: HS
authors.lastname: Snijders
authors.forename: M W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: N J
authors.initials: NJ
authors.lastname: van Leersum
authors.forename: N E
authors.initials: NE
authors.lastname: Kolfschoten
authors.forename: D
authors.initials: D
authors.lastname: Henneman
authors.forename: A C
authors.initials: AC
authors.lastname: de Vries
authors.forename: R A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: B A
authors.initials: BA
authors.lastname: Bonsing
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology* / Q000401:mortality; D013505:Digestive System Surgical Procedures / Q000401:mortality; D006801:Humans; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012307:Risk Factors