Skip to main content

Advertisement

Log in

Prognosis After Anastomotic Leakage in Colorectal Surgery

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

INTRODUCTION

Anastomotic leakage is a major complication of colorectal surgery causing a significant increase in 30-day mortality. The long-term prognosis of anastomotic leakage is poorly documented. This study was designed to assess whether anastomotic leakage affects five-year survival and local recurrence.

METHODS

A total of 5,173 patients were recruited to the Wessex Colorectal Cancer Audit during the period September 1991 to August 1995 (prospective data, 5-year follow-up). The effect of anastomotic leakage on five-year survival and local recurrence was analyzed using Kaplan-Meier curves and the log-rank test.

RESULTS

A total of 1,834 patients underwent a curative resection with an anastomosis (anastomotic leak = 71; 3.9 percent): 30-day mortality: 18.3 percent in the leak group, and 3.5 percent in the nonleak group (P < 0.001); local recurrence: 19 percent in the leak group, and 9.8 percent in the nonleak group (P = 0.018). A total of 1,201 patients underwent colonic anastomosis (anastomotic leak = 31; 2.6 percent). There was no significant difference in local recurrence or five-year survival between the leak and nonleak groups. A total of 633 patients underwent rectal anastomosis (anastomotic leakage = 40; 6.3 percent): 30-day mortality: 10 percent in the leak group, and 2 percent in the nonleak group (P = 0.014); cumulative five-year estimate of local recurrence: 25.1 (95 percent confidence interval, 9.6–40.5) percent in the leak group, and 10.4 (95 percent confidence interval, 7.7–13) percent in the nonleak group (P = 0.007). Cumulative five-year estimate of overall survival: 52.8 (95 percent confidence interval, 36.1–69.4) percent in the leak group, and 63.9 (95 percent confidence interval, 59.9–67.9) percent in the nonleak group (P = 0.19).

CONCLUSIONS

After rectal anastomosis, an anastomotic leak is associated with a significant increase in local recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1.
Fig. 2.

Similar content being viewed by others

REFERENCES

  1. E Rullier C Laurent JL Garrelon P Michel J Saric M Parneix (1998) ArticleTitleRisk factors for anastomotic leakage after resection of rectal cancer Br J Surg 85 355–8 Occurrence Handle1:STN:280:DyaK1c7ptVaruw%3D%3D Occurrence Handle9529492

    CAS  PubMed  Google Scholar 

  2. A Vignali VW Fazio IC Lavery et al. (1997) ArticleTitleFactors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients J Am Coll Surg 185 105–13 Occurrence Handle10.1016/S1072-7515(97)00018-5 Occurrence Handle1:STN:280:ByiA1M%2FhtlM%3D Occurrence Handle9249076

    Article  CAS  PubMed  Google Scholar 

  3. TE Pakkastie PE Luukkonen HJ Jarvinen (1994) ArticleTitleAnastomotic leakage after anterior resection of the rectum Eur J Surg 160 293–7 Occurrence Handle1:STN:280:ByuA2Mrktlc%3D Occurrence Handle8075199

    CAS  PubMed  Google Scholar 

  4. ND Karanjia AP Corder P Bearn RJ Heald (1994) ArticleTitleLeakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum Br J Surg 81 1224–6 Occurrence Handle1:STN:280:ByqD2c7hs1A%3D Occurrence Handle7953369

    CAS  PubMed  Google Scholar 

  5. M Killingback P Barron O Dent (2002) ArticleTitleElective resection and anastomosis for colorectal cancer: a prospective audit of mortality and morbidity 1976–1998 ANZ J Surg 72 689–98 Occurrence Handle12534376

    PubMed  Google Scholar 

  6. RJ Detry A Kartheuser L Delriviere J Saba PJ Kestens (1995) ArticleTitleUse of the circular stapler in 1000 consecutive colorectal anastomoses: experience of one surgical team Surgery 117 140–5 Occurrence Handle1:STN:280:ByqC2cbit1Q%3D Occurrence Handle7846617

    CAS  PubMed  Google Scholar 

  7. R Golub RW Golub R Cantu SuffixJr HD Stein (1997) ArticleTitleA multivariate analysis of factors contributing to leakage of intestinal anastomoses J Am Coll Surg 184 364–72 Occurrence Handle1:STN:280:ByiB2MrjtlA%3D Occurrence Handle9100681

    CAS  PubMed  Google Scholar 

  8. A Alves Y Panis D Trancart JM Regimbeau M Pocard P Valleur (2002) ArticleTitleFactors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients World J Surg 26 499–502 Occurrence Handle11910487

    PubMed  Google Scholar 

  9. RK Phillips R Hittinger L Blesovsky JS Fry LP Fielding (1984) ArticleTitleLocal recurrence following ‘curative’ surgery for large bowel cancer: 1. The overall picture. Br J Surg 71 12–6 Occurrence Handle1:STN:280:BiuD1c7jtVU%3D Occurrence Handle6689962

    CAS  PubMed  Google Scholar 

  10. P Sauven MJ Playforth M Evans AV Pollock (1989) ArticleTitleEarly infective complications and late recurrent cancer in stapled colonic anastomoses Dis Colon Rectum 32 33–5 Occurrence Handle1:STN:280:BiaD1M%2FnsFc%3D Occurrence Handle2642789

    CAS  PubMed  Google Scholar 

  11. S Petersen M Freitag G Hellmich K Ludwig (1998) ArticleTitleAnastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer Int J Colorectal Dis 13 160–3 Occurrence Handle1:STN:280:DyaK1M%2FivVaitg%3D%3D Occurrence Handle9810519

    CAS  PubMed  Google Scholar 

  12. AM Akyol JR McGregor DJ Galloway GD Murray WD George (1991) ArticleTitleAnastomotic leaks in colorectal cancer surgery: a risk factor for recurrence? Int J Colorectal Dis 6 179–83 Occurrence Handle1:STN:280:By2C387nt1I%3D Occurrence Handle1770281

    CAS  PubMed  Google Scholar 

  13. S Merkel WY Wang O Schmidt et al. (2001) ArticleTitleLocoregional recurrence in patients with anastomotic leakage after anterior resection for rectal carcinoma Colorectal Dis 3 154–60 Occurrence Handle1:STN:280:DC%2BD3s3msFSitQ%3D%3D Occurrence Handle12790981

    CAS  PubMed  Google Scholar 

  14. S Fujita T Teramoto M Watanabe S Kodaira M Kitajima (1993) ArticleTitleAnastomotic leakage after colorectal cancer surgery: a risk factor for recurrence and poor prognosis Jpn J Clin Oncol 23 299–302 Occurrence Handle1:STN:280:ByuD2cjmvFA%3D Occurrence Handle8230754

    CAS  PubMed  Google Scholar 

  15. SW Bell KG Walker MJ Rickard et al. (2003) ArticleTitleAnastomotic leak after curative anterior resection results in a higher prevalence of local recurrence Br J Surg 90 1261–6 Occurrence Handle10.1002/bjs.4219 Occurrence Handle1:STN:280:DC%2BD3svltl2htQ%3D%3D Occurrence Handle14515297

    Article  CAS  PubMed  Google Scholar 

  16. ND Karanjia AP Corder PJ Holdsworth RJ Heald (1991) ArticleTitleRisk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis Br J Surg 78 196–8 Occurrence Handle1:STN:280:By6C1MfntFU%3D Occurrence Handle2015471

    CAS  PubMed  Google Scholar 

  17. H Kessler P Hermanek SuffixJr H Wiebelt (1993) ArticleTitleOperative mortality in carcinoma of the rectum. Results of the German multicentre study Int J Colorectal Dis 8 158–66 Occurrence Handle1:STN:280:ByuD28rksVA%3D Occurrence Handle8245673

    CAS  PubMed  Google Scholar 

  18. HC Umpleby B Fermor MO Symes RC Williamson (1984) ArticleTitleViability of exfoliated colorectal carcinoma cells Br J Surg 71 659–63 Occurrence Handle1:STN:280:BiqD3c7gvVU%3D Occurrence Handle6478151

    CAS  PubMed  Google Scholar 

  19. D Skipper AJ Cooper JE Marston I Taylor (1987) ArticleTitleExfoliated cells and in vitro growth in colorectal cancer Br J Surg 74 1049–52 Occurrence Handle1:STN:280:BieD2sfovFY%3D Occurrence Handle3690235

    CAS  PubMed  Google Scholar 

  20. CA Slanetz SuffixJr (1984) ArticleTitleThe effect of inadvertent intra-operative perforation on survival and recurrence in colorectal cancer Dis Colon Rectum 27 792–7 Occurrence Handle6389051

    PubMed  Google Scholar 

Download references

ACKNOWLEDGMENTS

This work is attributable to the South West Cancer Intelligence Service on behalf of the Wessex Colorectal Cancer Audit Working Group, which includes Dr. J. Smith (Chairman), Director of South West Cancer Intelligence Service; Dr. C. Baughan, Consultant Oncologist, Southampton; Mr. D. Britton, Consultant Surgeon, Bath; Dr. C. Du Boulay, Consultant Pathologist, Southampton; Mr. B. Fozard, Consultant Surgeon, Bournemouth; Mr. P. Burgess, Consultant Surgeon, Swindon; Mr. R. Heald, Consultant Surgeon, Basingstoke; Mr. P. Jeffrey, Consultant Surgeon, Dorchester; Mr. R. Lane, Consultant Surgeon, Winchester, Professor J. Primrose, Consultant Surgeon, Southampton; Mr. R. Talbot, Consultant Surgeon, Poole; Mr. M. Thompson, Consultant Surgeon, Portsmouth; and Mr. T. Walsh, Consultant Surgeon, Isle of Wight. The authors thank Mrs. D. Bailey, South West Cancer Intelligence Service, for data coordination and the following past members of the working group: Dr. H. Sanderson, Professor I. Taylor, Surgeon Commander R. Leicester, Dr. D. Nicholas, Dr. R. Ryall, Dr. E. Husband, Mr. R. Glass, and Mr. F. McGinn. The authors also thank Professor Peter Thomas, Research and De-velopment Support Unit, Poole General Hospital for his help with statistical analysis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Graham Branagan M.S., F.R.C.S..

Additional information

Reprints are not available.

Supported by Ethicon Endo-Surgery, which enabled this data to be presented to the European Association of Coloproctology, Sitges, Barcelona, Spain, September 18 to 20, 2003.

About this article

Cite this article

Branagan, G., Finnis, D. Prognosis After Anastomotic Leakage in Colorectal Surgery. Dis Colon Rectum 48, 1021–1026 (2005). https://doi.org/10.1007/s10350-004-0869-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-0869-4

Key words

Navigation