Correlation between Albumin, Colon Leakage Score (CLS), and Anastomotic Leakage after Colorectal Cancer Resection

Reno Rudiman, Putie Hapsari, Novi Christina Indrajaya


Anastomotic leakage is still the most undesirable complication of colorectal surgery. The reported incidence of anastomotic leakage after colorectal surgery varies from 1.8% to 15.9%. The impact of anastomotic leakage is increased morbidity, mortality (12–30%), length of stay, and cost of hospitalization; hence, this complication should be prevented as much as possible.Several studies have shown a correlation between low albumin levels and increased anastomotic leakage.The Colon Leakage Score (CLS) is a standard score for predicting anastomotic leakage, but this score does not include the albumin level as a parameter of anastomotic leakage despite the importance of the albumin level’s contribution on the anastomotic leakage. Therefore, this study sought to analyze the correlation between the albumin level, CLS, and the incidence of anastomotic leakage after anastomotic resection surgery in colorectal cancer (CRC) patients at Dr. Hasan Sadikin General Hospital Bandung, Indonesia. This study was a cross-sectional retrospective analytical study on medical records of CRC patients over the age of 18 who underwent intestinal anastomotic resection surgery between 2016–2020. There were thirty-two patients with colorectal cancer underwent anastomotic resection during the study period, with two patients experienced anastomotic leakage. Correlation analysis showed that the correlation coefficient for the albumin level and anastomotic leakage was 0.209, while the correlation coefficient between CLS and anastomotic leakage was 0.110. There is no correlation between albumin level, CLS, and the incidence of anastomotic leakage after anastomotic resection surgery in CRC patients treated at Dr. Hasan Sadikin General Hospital Bandung, Indonesia


anastomotic leakage, anastomotic resection, albumin, colorectal cancer, colon leakage score

Full Text:



  1. National Cancer Combating Commission. National guidelines for colorectal cancer management medical services. colorectal cancer management guidelines. Jakarta: Ministerial Decree of Health of the Republic of Indonesia; 2018.
  2. WHO. Global Cancer Observatory. Indonesia GLOBOCAN 2020. 360-indonesia-fact-sheets. International Agency for Research on Cancer World Health Organization March 2021. Available from:
  3. Dr. Hasan Sadikin General Hospital. Inpatient data from January 2016–December 2020. Digestive Surgery. Bandung. 2021.
  4. Frasson M, Flor-Lorente B, Rodríguez JL, Granero-Castro P, Hervás D, Alvarez Rico MA, et al. Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 Patients. Ann Surg. 2015;262(2):321–30.
  5. An V, Chandra R, Lawrence M. Anastomotic failure in colorectal surgery: where are we at?. Indian J Surg. 2018;80(2):163–70.
  6. Zarnescu EC, Zarnescu NO, Costea R. Updates of risk factors for anastomotic leakage after colorectal surgery. Diagnostics (Basel). 2021;11(12):2382.
  7. Calin MD, Bălălău C, Popa F, Voiculescu S, Scăunașu RV. Colic anastomotic leakage risk factors. J Med Life. 2013;6(4):420–3.
  8. Galata C, Busse L, Birgin E, Weiß C, Hardt J, Reißfelder C, et al. Role of albumin as a nutritional and prognostic marker in elective intestinal surgery. Can J Gastroenterol Hepatol. 2020;2020:7028216.
  9. Yu XQ, Zhao B, Zhou WP, Han LZ, Cai GH, Fang ZW, et al. Utility of colon leakage score in left-sided colorectal surgery. J Surg Res. 2016;202(2):398–402.
  10. den Dulk M, Witvliet MJ, Kortram K, Neijenhuis PA, de Hingh IH, Engel AF, et al. The DULK (Dutch leakage) and modified DULK score compared: actively seek the leak. Colorectal Dis. 2013;15(9):e528–33.
  11. Dekker JW, Liefers GJ, de Mol van Otterloo JC, Putter H, Tollenaar RA. Predicting the risk of anastomotic leakage in left-sided colorectal surgery using a colon leakage score. J Surg Res. 2011;166(1):e27–34.
  12. Pierpont YN, Dinh TP, Salas RE, Johnson EL, Wright TG, Robson MC, et al. Obesity and surgical wound healing: a current review. ISRN Obes. 2014;2014:638936.
  13. Mohamed AA, Atrayee B, Sehwan J, Seong HY, Jun WY, Frank JG, et al. CYP2E1 potentiates binge alcohol-induced gut leakiness, steatohepatitis and apoptosis. Free Radic Biol Med. 2013;65:1238–45.
  14. Gould LJ, Fulton AT. Wound healing in older adults. R I Med J (2013). 2016;99(2):34–6.
  15. Tomasz S, Monika R, Anna D, Ewa N, Tomasz A, Katarzyna, et al. A Review of colorectal cancer in terms of epidemiology, risk factors, development, symptoms and diagnosis. Cancers (Basel). 2021;13(9):2025.
  16. Jeannete M, Jennifer H. Anastomotic technique-how to optimize success and minimize leak rates. Clin Colon Rectal Surg. 2021;34:371–8.
  17. Ahmed AYA. Effects of blood transfusion in outcome of elective bowel anastomosis. Global J Med Res. 2012;12(8):34–8.
  18. Cortina CS, Alex GC, Vercillo KN, Fleetwood VA, Smolevitz JB, Poirier J, Longer operative time and intraoperative blood transfusion are associated with postoperative anastomotic leak after lower gastrointestinal surgery. Am Surg. 2019;85(2):136–41.
  19. Erin EH, Michelle S, Sandhya RV, Charles FZ, Sarah MS, Abu M, Adding Examples to the asa-physical status classification improves correct assignment to patients. Anesthesiology. 2017;126(4):614–22.


Article Metrics

Abstract view : 333 times
PDF - 272 times

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


Creative Commons License
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License


View My Stats