Radiotherapy as a potential risk factor for delayed anastomotic leakage after rectal surgery: a meta-analysis.

BACKGROUND

Radiotherapy is a well-recognized risk factor of acute leakage after colorectal surgery. However, its relationship with delayed leakage remains unclear. The aim of this systemic review and meta-analysis was to determine its association with delayed anastomotic leakage (DAL) after rectal surgery.

METHODS

A comprehensive literature search was conducted across seven international databases (PubMed, Embase, Cochrane CENTRAL, ClinicalKeys, EBSCOhost-CINAHL, Web of Science, and Google Scholar), five Chinese/Taiwanese databases, the ProQuest Dissertations, and three Grey literature databases. All studies that reported DAL where radiotherapy and nonradiotherapy study groups were included. The random-effect model was used to combine data. Data were presented as odds-ratios (ORs) with 95% confidence intervals (CI). The main outcome measured was DAL.

RESULTS

Six comparative series involving a total of 4991 patients were analyzed. DAL was identified in 323 cases, occurring between 22 and 2059 days post-operation. The results revealed a statistically significant increase in the risk of DAL following radiotherapy (OR = 5.208; 95% CI = 3.241-8.371; p < 0.001). Heterogeneity was observed across the included studies (Cochran Q = 12.769 (p=0.026), I2=60.844%, Tau2 = 0.188, predictive interval (PI) = 5.208, 95% PI = 1.313-20.665).

CONCLUSIONS

Radiotherapy is a potential risk factor for DAL after anterior resection and low anterior resection.