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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.

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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.

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Correspondence to Lukas Marti.

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Ebinger, S.M., Warschkow, R., Tarantino, I. et al. Anastomotic leakage after curative rectal cancer resection has no impact on long-term survival: a propensity score analysis. Int J Colorectal Dis 30, 1667–1675 (2015).

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