Outcomes of laparoscopic reoperation for anastomotic leak-associated peritonitis following colorectal cancer surgery: a comparative study.

BACKGROUND: Anastomotic leakage after colorectal cancer surgery can lead to severe peritonitis requiring urgent surgical reintervention. Although laparotomy has traditionally been the standard approach in this setting, the role of laparoscopy for reoperation remains uncertain. This study aimed to evaluate the feasibility and safety of a laparoscopic-first strategy for reoperation in patients with anastomotic leak-associated peritonitis. METHODS: This retrospective study included patients who underwent reoperation for anastomotic leakage after colorectal cancer surgery between 2006 and 2025. Patients were analyzed according to the initially intended surgical approach (laparoscopic vs open). Baseline characteristics were compared using standardized mean differences. The primary outcome was severe postoperative complications (Clavien-Dindo grade ≥ III). RESULTS: Forty-two patients were included, with 21 assigned to each group. Conversion to laparotomy occurred in five patients (24%) in the laparoscopic group. The incidence of severe complications was significantly lower in the laparoscopic group (14% vs 57%), corresponding to a risk difference of - 42.9% (95% CI, - 68.8 to - 16.9). Organ/space surgical site infection was also less frequent in the laparoscopic group (10% vs 48%). Operative time and blood loss during reoperation were comparable between groups, while postoperative hospital stay was shorter in the laparoscopic group. No in-hospital deaths occurred. Kaplan-Meier analysis showed no significant differences in overall or cancer-specific survival between the groups. CONCLUSIONS: Laparoscopic reoperation for anastomotic leak-associated peritonitis after colorectal cancer surgery was associated with reduced severe postoperative complications without compromising survival. A laparoscopic-first strategy may be feasible in selected patients.