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Anastomotic Leakage Contributes to the Risk for Systemic Recurrence in Stage II Colorectal Cancer

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

In stage II colorectal cancer (CRC), high-risk patient selection is required, but no candidate markers have been elucidated. Our concern was whether anastomotic leakage (Lk) is a potential available clinicopathological factor for selecting high-risk stage II.

Methods

Two hundred seven patients with stage II CRC who underwent curative resection were analyzed. Clinical variables were tested for their relationship to survival.

Results

The 5-year disease-free survival rate (DFS) was 87.0%. The univariable prognostic analyses indicated that Lk (P = 0.003) was the only significant factor. The multivariable prognostic analysis revealed that Lk remained to be potently independent [hazard ratio (HR), 4.21, P = 0.021), and the DFS was 58.3% in cases with Lk, while 88.7% in the counterpart. The multivariable logistic regression analysis revealed perioperative blood transfusion (P = 0.001) was independently associated with Lk. Intriguingly, Lk was closely associated with hematogenic recurrence (P = 0.003) rather than peritoneal or local recurrence. Although sustained increase of the serum C-reactive protein at 2 weeks after operation predicted poor prognosis, the mutitivariable analysis including the C-reactive protein level revealed that Lk still indicated the prognostic potential (HR, 3.70, P = 0.075).

Conclusions

The findings concluded that Lk may be a high risk for systemic recurrence in stage II CRC.

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Correspondence to Masahiko Watanabe.

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Supplemental Fig. 1

Kaplan–Meier analysis of 5-year DFS according to (A) lymphatic involvement (ly), (B) vascular involvement (v), and (C) both ly and v involvement (VI) (GIF 22 kb)

High-resolution image (PDF 200 kb)

Supplemental Fig. 2

Kaplan–Meier analysis of 5-year DFS according to CRP at 2 week after operation [post-CRP (2w)] (n = 175) (GIF 18 kb)

High-resolution image (PDF 200 kb)

Supplemental Table 1

Diagnostic details of the patients with anastomotic leakage (XLS 14.5 kb)

Supplemental Table 2

Correlation between CRP and clinicopathological factors in stage II patients (XLS 46.0 kb)

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Katoh, H., Yamashita, K., Wang, G. et al. Anastomotic Leakage Contributes to the Risk for Systemic Recurrence in Stage II Colorectal Cancer. J Gastrointest Surg 15, 120–129 (2011). https://doi.org/10.1007/s11605-010-1379-4

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  • DOI: https://doi.org/10.1007/s11605-010-1379-4

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