Mesenteric Artery Stenosis is a Risk Factor for Anastomotic Leakage in Colorectal Surgery

Objective: Anastomotic leakage (AL) after colorectal surgery leads to substantial morbidity and mortality. Theoretically, compromised blood flow caused by mesenteric artery (MA) stenosis may create suboptimal healing conditions at the anastomotic site, increasing susceptibility to AL. The association between MA stenosis on pre-operative computed tomography (CT) scans and AL in patients undergoing colorectal surgery was investigated.

Methods: A multicentre, retrospective, frequency matched, nested 1:5 case control study was conducted in the Netherlands. For each patient with AL, five controls without AL were recruited from the same database matched for age and body mass index. Pre-operative CT scans were blindly assessed to identify MA stenosis ≥ 50% as the primary outcome and atherosclerotic burden and vascular pathology as secondary outcomes.

Results: A total of 130 patients with AL and 627 matched controls without AL were included. The prevalence of stenosis ≥ 50% in the superior mesenteric artery (SMA) was higher in patients with AL compared with controls (13.8% vs. 2.2%; p < .001). Stenosis ≥ 50% in the inferior mesenteric artery (IMA) also showed a higher prevalence in patients with AL (24.6% vs. 12.1%; p < .001). Multivariate regression analysis showed a 5.9 times higher risk (95% confidence interval [CI] 2.78 - 12.60,; p < .001) of AL in patients with SMA stenosis and 2.1 times higher risk for patients with IMA stenosis (95% CI 1.11 - 3.63; p = .007). Stenosis ≥ 50% of the coeliac artery showed no association with the occurrence of AL.

Conclusion: The presence of SMA or IMA stenosis ≥ 50% on pre-operative CT scans is associated with a six and two times higher odds for AL, respectively, when corrected for known risk factors for AL. Whether preventive stent placement reduces the risk of AL still needs to be investigated.