Anastomotic leakage after curative rectal cancer resection has no impact on long-term survival: a propensity score analysis
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Anastomotic leakage (AL) is a severe and frequent complication of rectal cancer resection, with an incidence rate of approximately 9 %. Although the impact of AL on morbidity and short-term mortality has been established, the literature is contradictory regarding its influence on long-term, cancer-specific survival. The present investigation assessed the long-term survival of 584 patients with stage I–III rectal cancer.
The 10-year overall survival and cancer-specific survival were analyzed in 584 patients from a single tertiary center. All patients had undergone curative rectal cancer resection between 1991 and 2010. Patients with and without AL were compared using both a multivariate Cox hazards model and propensity score analysis.
A total of 64 patients developed AL (11.0 %, 95 % confidence interval (CI) = 8.7 to 13.8 %). The median follow-up was 5.2 years for all patients; and 7.4 years for patients still alive at the end of the investigated period. AL did persistently not impair cancer-specific survival based on unadjusted Cox regression (hazard ratio of death (HR) = 1.27, 95 % CI = 0.65 to 2.48, P = 0.489); risk-adjusted Cox regression (HR = 1.10, 95 % CI = 0.54 to 2.20, P = 0.799); and propensity score matching (HR = 1.18, 95 % CI = 0.57 to 2.43, P = 0.660).
Based on the present propensity score analysis, the oncologic outcomes in patients undergoing curative rectal cancer resections were not impaired by the development of anastomotic leakage.
KeywordsRectal cancer resection Anastomotic leackage Overall survival Cancer-specific survival Propensity score matching
Conflict of interest
The authors declare that they have no competing interests.
Compliance with ethical standards
For this type of study formal consent is not required. However all patients agreed that their data may be used for scientific analyses on a general consenting form, when they entered the hospital. These proceedings were generally approved by the local ethic board.
- 1.Kim SH, Bae KB, Kim JM, Shin JH, An MS, Ha TG, Ryu SM, Kim KH, Kim TH, Choi CS, Shin JY, Oh M, Baek SH, Hong KH (2012) Oncologic outcomes and risk factors for recurrence after tumor-specific mesorectal excision of rectal cancer: 782 cases. J Korean Soc Coloproctol 28(2):100–107. doi: 10.3393/jksc.2012.28.2.100 PubMedCentralCrossRefPubMedGoogle Scholar
- 3.Reshef A, Lavery I, Kiran RP (2012) Factors associated with oncologic outcomes after abdominoperineal resection compared with restorative resection for low rectal cancer: patient- and tumor-related or technical factors only? Dis Colon Rectum 55(1):51–58. doi: 10.1097/DCR.0b013e3182351c1f CrossRefPubMedGoogle Scholar
- 5.Snijders HS, Wouters MW, van Leersum NJ, Kolfschoten NE, Henneman D, de Vries AC, Tollenaar RA, Bonsing BA (2012) Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol 38(11):1013–1019. doi: 10.1016/j.ejso.2012.07.111 CrossRefPubMedGoogle Scholar
- 6.den Dulk M, Marijnen CA, Collette L, Putter H, Pahlman L, Folkesson J, Bosset JF, Rodel C, Bujko K, van de Velde CJ (2009) Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg 96(9):1066–1075. doi: 10.1002/bjs.6694 CrossRefGoogle Scholar
- 7.Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253(5):890–899. doi: 10.1097/SLA.0b013e3182128929 CrossRefPubMedGoogle Scholar
- 8.Warschkow R, Steffen T, Thierbach J, Bruckner T, Lange J, Tarantino I (2011) Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy. A retrospective study with bootstrap analysis. Ann Surg Oncol 18(10):2772–2782. doi: 10.1245/s10434-011-1696-1 CrossRefPubMedGoogle Scholar
- 9.Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740. doi: 10.1056/NEJMoa040694 CrossRefPubMedGoogle Scholar
- 11.Ishwaran H, Kogalur UB, Blackstone EH, Lauer MS (2008) Random survival forests. Ann Appl Stat 841–860. doi: 10.1214/08-AOAS169
- 17.Warschkow R, Guller U, Koberle D, Muller SA, Steffen T, Thurnheer M, Schmied BM, Tarantino I (2014) Perioperative blood transfusions do not impact overall and disease-free survival after curative rectal cancer resection: a propensity score analysis. Ann Surg 259(1):131–138. doi: 10.1097/SLA.0b013e318287ab4d CrossRefPubMedGoogle Scholar
- 18.Smith JD, Butte JM, Weiser MR, D’Angelica MI, Paty PB, Temple LK, Guillem JG, Jarnagin WR, Nash GM (2013) Anastomotic leak following low anterior resection in stage IV rectal cancer is associated with poor survival. Ann Surg Oncol 20(8):2641–2646. doi: 10.1245/s10434-012-2854-9 CrossRefPubMedGoogle Scholar
- 23.Kulu Y, Tarantio I, Warschkow R, Kny S, Schneider M, Schmied BM, Buchler MW, Ulrich A (2015) Anastomotic leakage is associated with impaired overall and disease-free survival after curative rectal cancer resection: a propensity score analysis. Ann Surg Oncol 22(6):2059–2067. doi: 10.1245/s10434-014-4187-3 CrossRefPubMedGoogle Scholar
- 24.Quirke P, Steele R, Monson J, Grieve R, Khanna S, Couture J, O’Callaghan C, Myint AS, Bessell E, Thompson LC, Parmar M, Stephens RJ, Sebag-Montefiore D (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–828. doi: 10.1016/s0140-6736(09)60485-2 PubMedCentralCrossRefPubMedGoogle Scholar
- 27.Sturmer T, Joshi M, Glynn RJ, Avorn J, Rothman KJ, Schneeweiss S (2006) A review of the application of propensity score methods yielded increasing use, advantages in specific settings, but not substantially different estimates compared with conventional multivariable methods. J Clin Epidemiol 59(5):437–447. doi: 10.1016/j.jclinepi.2005.07.004 PubMedCentralCrossRefPubMedGoogle Scholar