Presentation (CTI)

OBJECTIVES: Anastomotic leaks (AL) represent a severe complication in colorectal surgery, affecting 3-15% of patients and carrying significant morbidity, mortality, and healthcare costs. Despite extensive research identifying various risk factors, clinical decision-making remains variable due to the lack of standardized protocols. This review highlights patient-modifiable preoperative risk factors for AL in order to guide patient-centered surgical optimization strategies.
METHODS: A comprehensive scoping review of PubMed and Cochrane Library was conducted, restricted to studies published between 2015 and 2025 to capture recent evidence. Eligible articles explicitly reported anastomotic leak risk factors or predictive scores. Case reports, animal studies, and studies without specific risk factor analysis were excluded.
RESULTS: Thirty-eight studies were included. Consistently reported patient-modifiable risk factors for AL included smoking, alcohol consumption, nutritional status (scores), diabetes control, obesity, and other patient comorbidities. No single factor emerged as dominant. Predictive models were developed in 14 studies, with discriminatory performance ranging from modest (AUC 0.60-0.70) to fair (AUC up to 0.80). However, calibration was often suboptimal, and external validation was rare.
CONCLUSIONS: Several patient-related variables can be targeted through preoperative interventions to decrease AL incidence. Interventions such as nutritional support, smoking cessation, and optimized diabetes control demonstrate promise in reducing leak rates in high-risk patients. Patients with multiple risk factors may require enhanced monitoring protocols and protective surgical strategies, including temporary diversion. These findings provide a framework to eventually implement patient-centered surgical optimization strategies and highlight the importance of engaging patients in their preoperative care to reduce AL incidence.