• Juliette C Slieker, Niels Komen, Niels A P Komen, Guido H Mannaerts, Tom M Karsten, Paul Willemsen, Magdalena Murawska, Johannes Jeekel, and Johan F Lange.
• Departments of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands. juliette_slieker@hotmail.com
• Arch Surg. 2012 May 1;147(5):447-52.

ObjectiveTo determine the risk factors for symptomatic anastomotic leakage (AL) after colorectal resection.DesignReview of records of patients who participated in the Analysis of Predictive Parameters for Evident Anastomotic Leakage study.SettingEight health centers.PatientsTwo hundred fifty-nine patients who underwent left-sided colorectal anastomoses.InterventionCorticosteroids taken as long-term medication for underlying disease or perioperatively for the prevention of postoperative pulmonary complications.Main Outcome MeasuresProspective evaluations for risk factors for symptomatic AL.ResultsIn 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.ConclusionsWe 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.Trial Registrationtrialregister.nl Identifier: NTR1258

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