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Prognosis After Anastomotic Leakage in Colorectal Surgery

  • Original Contribution
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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.

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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.

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Authors and Affiliations

  1. Department of Surgery, Salisbury District Hospital, Salisbury, Wilts, United Kingdom

    Graham Branagan M.S., F.R.C.S. & Derek Finnis F.R.C.S.(Engl.), FRCSC

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  1. Graham Branagan M.S., F.R.C.S.
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  2. Derek Finnis F.R.C.S.(Engl.), FRCSC
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Correspondence to Graham Branagan M.S., F.R.C.S..

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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.

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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

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

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