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Anastomotic leak and cancer-specific outcomes after curative rectal cancer surgery: a systematic review and meta-analysis

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Abstract

Background

The aim of the present study was to perform a systematic review and meta-analysis of cancer-specific outcomes after curative rectal cancer surgery comparing anastomotic leak (AL) with no leak.

Methods

PubMed, Medline and Embase databases were searched to identify studies comparing cancer-specific outcomes after rectal cancer surgery in patients with AL and without. A meta-analysis with a random-effects model was used to calculate pooled odds ratios (OR) and confidence intervals (CI) for each outcome measure.

Results

A total of 18 studies were included for meta-analysis, comprising a total of 18,039 patients after curative rectal resection (1764 AL, 16,275 without AL). The overall rate of AL was 9.8%. After AL and excluding 30-day mortality there was an increased risk of local recurrence (OR 1.50; CI 1.23, 1.82), worse overall survival (OR 0.69; CI 0.60–0.81), decreased disease free survival (OR 0.51; CI 0.36–0.73) and cancer specific survival (OR 0.71; CI 0.54–0.94). Distant recurrence (OR 1.10; CI 0.89–1.37) and overall recurrence (OR 1.33; CI 0.64–2.76) were not significantly different between the two groups.

Conclusions

AL may negatively impact cancer-specific outcomes after curative rectal cancer surgery and could be considered an independent negative prognostic factor.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, UK

    A. Karim, V. Cubas & H. Patel

  2. Department of Colorectal Surgery, Russels Hall Hospital, Dudley, UK

    S. Zaman, S. Khan & P. Waterland

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  1. A. Karim
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  2. V. Cubas
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  3. S. Zaman
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  4. S. Khan
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  5. H. Patel
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  6. P. Waterland
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Contributions

AK and PWW conception and design of study, acquisition of data, analysis and interpretation of data, drafting article, final approval. VC, SZ and SK drafting article, final approval. HPP acquisition of data, analysis and interpretation of data, drafting article, final approval.

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Correspondence to A. Karim.

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Karim, A., Cubas, V., Zaman, S. et al. Anastomotic leak and cancer-specific outcomes after curative rectal cancer surgery: a systematic review and meta-analysis. Tech Coloproctol 24, 513–525 (2020). https://doi.org/10.1007/s10151-020-02153-5

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  • DOI: https://doi.org/10.1007/s10151-020-02153-5

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