Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey.
OBJECTIVE
Background Anastomotic leakage is a serious complication in colorectal surgery. Treatment with corticosteroids is known to impair wound healing but their effect on the healing of a colorectal anastomosis remains unclear, and studies have reported conflicting results. Objective The aim of this study was to evaluate the current evidence regarding the effect of corticosteroids on the risk of anastomotic leakage following colorectal surgery.


METHODS
Search strategy A systematic review was conducted following a search of PubMed and Embase. Selection criteria Inclusion criteria were studies published in English and involving humans. A minimum cohort of 50 patients was required and anastomoses involving the ileum, colon and rectum were included. Studies that investigated corticosteroids as a risk factor for anastomotic leakage were included regardless of the duration and the dose of corticosteroids. Data Collection and analysis A comparison was conducted between anastomotic leakage in noncorticosteroid- and corticosteroid-treated patients. The main outcome measure was the risk of anastomotic leakage.


RESULTS
Twelve studies with a total of 9564 patients were included in the review. In total, 1034 patients received corticosteroids in the preoperative period, and 344 patients were diagnosed with anastomotic leakage, 70 of whom had received corticosteroids. Six of the 12 studies showed an increased risk for anastomotic leakage in the corticosteroid group. Overall, the anastomotic leakage rate was 6.77% (95% CI: 5.48-9.06) in the corticosteroid group and 3.26% (95% CI: 2.94-3.58) in the noncorticosteroid group.


CONCLUSIONS
Caution should be shown in patients scheduled for lower gastrointestinal surgery with anastomosis.
Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
T F
TF
Eriksen
C B
CB
Lassen
I
I
Gögenur
D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000139:chemically induced / Q000453:epidemiology*; D003106:Colon / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D014945:Wound Healing / Q000187:drug effects
D000305:Adrenal Cortex Hormones
anastomotic leakage; corticosteroids; gastrointestinal surgery colorectal anastomoses