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Anastomotic Leakage Is Associated with Impaired Overall and Disease-Free Survival after Curative Rectal Cancer Resection: A Propensity Score Analysis

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Whether anastomotic leakage (AL) has a negative impact on survival remains a matter of debate. This study aimed to assess the impact of AL on the overall and disease-free survival of patients undergoing curative resection of stages 1–3 rectal cancer using propensity-scoring methods.

Methods

In a single-center study, 570 patients undergoing curative resection of stages 1–3 rectal cancer between January 2002 and December 2011 were assessed. The mean follow-up period was 4.7 ± 2.9 years. Patients who did and did not experience AL were compared using Cox regression and propensity score analyses.

Results

Overall, 51 patients (8.9 %) experienced an AL. The characteristics of the patients were highly biased concerning AL (propensity score, 0.16 ± 0.12 vs. 0.09 ± 0.07; P < 0.001). Anastomotic leakage was uniformly associated with a significantly increased risk of mortality in unadjusted analysis [hazard ratio (HR) 2.30; 95 % confidence interval (CI) 1.40–3.76; P = 0.003], multivariable Cox regression (HR 2.27; 95 % CI 1.33–3.88; P = 0.005), and propensity score-adjusted Cox regression (HR 2.07; 95 % CI 1.21–3.55; P = 0.014). Similarly, disease-free survival was significantly impaired in patients who experienced AL according to unadjusted analysis (HR 1.88; 95 % CI 1.19–2.95; P = 0.011), multivariable Cox regression (HR 1.90; 95 % CI 1.17–3.09; P = 0.014), and propensity score-adjusted Cox regression (HR 2.31; 95 % CI 1.40–3.80; P = 0.002).

Conclusions

This is the first propensity score-based analysis providing evidence that oncologic outcome may be impaired after curative rectal cancer resection in patients with AL.

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References

  1. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890–9.

    Article  PubMed  Google Scholar 

  2. Smith JD, Paty PB, Guillem JG, Temple LK, Weiser MR, Nash GM. Anastomotic leak is not associated with oncologic outcome in patients undergoing low anterior resection for rectal cancer. Ann Surg. 2012;256:1034–8.

    Article  PubMed  Google Scholar 

  3. Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147:339–51.

    Article  PubMed  Google Scholar 

  4. Ishwaran H, Kogalur UB, Blackstone EH, Lauer MS. Random survival forests. Ann Appl Stat. 2008;2:841–60.

    Article  Google Scholar 

  5. Joffe MM, Rosenbaum PR. Invited commentary: propensity scores. Am J Epidemiol. 1999;150:327–33.

    Article  CAS  PubMed  Google Scholar 

  6. Rosenbaum PR. Model-based direct adjustment. J Am Stat Assoc. 1987;82:387–94.

    Article  Google Scholar 

  7. Rosenbaum PR. Optimal matching for observational studies. J Am Stat Assoc. 1989;84:1024–32.

    Article  Google Scholar 

  8. Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997;127(8 Pt 2):757–63.

    Article  CAS  PubMed  Google Scholar 

  9. Hansen BB, Klopfer SO. Optimal full matching and related designs via network flows. J Comput Graph Stat. 2006;15:609–27.

    Article  Google Scholar 

  10. Sekhon JS. Multivariate and propensity score matching software with automated balance optimization: The Matching Package for R. J Stat Software. 2011;42:1–52.

    Google Scholar 

  11. den Dulk M, Marijnen CA, Collette L, et al. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg. 2009;96:1066–75.

    Article  Google Scholar 

  12. Aggarwal BB, Vijayalekshmi RV, Sung B. Targeting inflammatory pathways for prevention and therapy of cancer: short-term friend, long-term foe. Clin Cancer Res. 2009;15:425–30.

    Article  CAS  PubMed  Google Scholar 

  13. Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454:436–44.

    Article  CAS  PubMed  Google Scholar 

  14. Biagi JJ, Raphael MJ, Mackillop WJ, Kong W, King WD, Booth CM. Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA. 2011;305:2335–42.

    Article  CAS  PubMed  Google Scholar 

  15. Des Guetz G, Nicolas P, Perret GY, Morere JF, Uzzan B. Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis. Eur J Cancer. 2010;46:1049–55.

  16. Ulrich AB, Seiler C, Rahbari N, Weitz J, Buchler MW. Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum. 2009;52:412–8.

    Article  PubMed  Google Scholar 

  17. Chen J, Wang DR, Yu HF, Zhao ZK, Wang LH, Li YK. Defunctioning stoma in low anterior resection for rectal cancer: a meta-analysis of five recent studies. Hepatogastroenterology. 2012;59:1828–31.

    Article  PubMed  Google Scholar 

  18. Huser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, Friess H. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg. 2008;248:52–60.

    Article  PubMed  Google Scholar 

  19. Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg. 2009;96:462–72.

    Article  CAS  PubMed  Google Scholar 

  20. Dickman PW, Adami HO. Interpreting trends in cancer patient survival. J Intern Med. 2006;260:103–17.

    Article  CAS  PubMed  Google Scholar 

  21. Sarfati D, Blakely T, Pearce N. Measuring cancer survival in populations: relative survival vs cancer-specific survival. Int J Epidemiol. 2010;39:598–610.

    Article  PubMed  Google Scholar 

  22. Tarantino I, Achermann P, Guller U, et al. Relative survival is an adequate estimate of cancer-specific survival: baseline mortality-adjusted 10-year survival of 771 rectal cancer patients. Ann Surg Oncol. 2013;20:3877–84.

    Article  PubMed  Google Scholar 

  23. Chua YJ, Sargent D, Cunningham D. Definition of disease-free survival: this is my truth—show me yours. Ann Oncol. 2005;16:1719–21.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Alexis Ulrich MD.

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Kulu, Y., Tarantio, I., Warschkow, R. et al. Anastomotic Leakage Is Associated with Impaired Overall and Disease-Free Survival after Curative Rectal Cancer Resection: A Propensity Score Analysis. Ann Surg Oncol 22, 2059–2067 (2015). https://doi.org/10.1245/s10434-014-4187-3

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  • DOI: https://doi.org/10.1245/s10434-014-4187-3

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