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Anastomotic leak patient stratification

Anastomotic leakage is the most severe complication after colorectal surgery. Numerous risk factors for postoperative dehiscence have been proposed, although there is no clear consensus.

Recovery after surgery for patients with colorectal disease has improved with the advent of minimal access surgery and standardized recovery protocols. Despite these advances, anastomotic leakage remains one of the most dreaded complications following colorectal surgery, with rates of 3-27% depending on specific risk factors. Although a set of risk factors have been reported, anastomotic leakage  remains difficult to predict and diagnose early after surgery. In many patients, its course is insidious, with ileus, vague abdominal symptoms and failure to progress, and a mean time to clinical diagnosis of 6–12 days after surgery. In the early postoperative period, intra-abdominal sepsis can be difficult to distinguish from the physiological systemic inflammatory response to surgery. Patients may be discharged within a few days of surgery and run the risk of readmission with anastomotic leakage or severe sepsis. If diagnosed late, it can progress to overwhelming sepsis, multiple organ dysfunction and death. Long-term consequences of significant anastomotic leakage may include increased risk of colorectal cancer recurrence, reduced quality of life and decreased long-term survival. A timely diagnosis of leakage before clinical symptoms become apparent is very important.

In this lecture, George Gkoutos explains the possibility of generating phenotypic profiles for each colorectal surgery patients and employs a variety of artificial intelligence approach to assess our ability to predict anastomotic leakage.