Colorectal surgery for the oncological disease is now performed with improved safety, however, anastomotic leakage remains the most feared and devastating complication from both a surgical and oncological aspect. It not only affects the outcome of the surgery, but also increases the times and costs of hospitalization, and worsens the prognosis in terms of short- and long-term outcomes. Its clinical features range from radiological only finding to peritonitis and sepsis with multi-organ failure. C-reactive protein and procalcitonin remain early predictors of anastomotic leakage beginning from postoperative days 2–3, but an abdominal-pelvic computed tomography scan is yet the gold standard for the diagnosis. 

Several treatments can be embraced for anastomotic leakage. Yet, a universally accepted flowchart for the management is still lacking, which should be customized according to the patients general condition, anastomotic defect size and location, indication for primary resection and presence of the proximal stoma. Patients who underwent proximal fecal diversion at the initial operation are usually managed non‐operatively. 

Laparoscopy can be employed after minimally invasive surgery which tends to reduce surgical stress in patients allowing a definitive treatment. Reoperation for sepsis control is rarely required in patients who already have a diverting stoma at the time of the leak, particularly in extraperitoneal anastomoses. In patients without a stoma who do not require abdominal reoperation for a contained pelvic leak, several treatment options can be employed like laparoscopic diverting ileostomy combined with trans-anal anastomotic tube drainage, percutaneous drainage or recently developed endoscopic procedures, such as a stent or clip placement or endoluminal vacuum‐assisted therapy. 

Source: Surg Oncol. 2022 Mar;40:101708. doi: 10.1016/j.suronc.2022.101708. Epub 2022 Jan 24.