Colorectal anastomotic leakage Unraveling a multifaceted complication

Colorectal anastomotic leakage (CAL) is a serious and potentially life-threatening complication following colorectal surgery. This thesis addresses the challenges in defining, predicting, diagnosing, and understanding the pathophysiology of CAL.
In Part 1, the definition of CAL is refined using a modified Delphi analysis. Part 2 focuses on improving preoperative prediction of CAL by investigating various factors, including preoperative fecal microbiome profiles, plasma biomarkers, and body composition metrics. Part 3 describes the IMARI study, a protocol aimed at enhancing CAL prevention, early diagnosis, and treatment through multi-step interventions such as mechanical bowel preparation, splenic flexure mobilization, and routine CRP measurements. Finally, Part 4 explores the physiological processes of normal and disturbed anastomotic healing in a rat model. Furthermore, we investigate the effect of butyrate on intestinal anastomotic healing in animal models.
This research advances CAL management by refining its definition, assessing predictive factors, testing new diagnostic approaches, and elucidating the underlying processes of intestinal healing and leakage, providing a comprehensive framework for improved colorectal cancer surgical care.