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Anastomotic leakage after surgery for rectal cancer: a risk factor of local recurrence, distant metastasis and reduced cancer-specific survival?

Jörgren, Fredrik LU ; Johansson, R; Damber, L and Lindmark, Gudrun LU (2011) In Colorectal Disease 13(3). p.272-283
Abstract
ABSTRACT Background We explored the impact of anastomotic leakage (AL) on the oncological outcome after anterior resection (AR) for rectal cancer which is still controversial.. Local recurrence (LR) and overall recurrenc(OAR) and cancer-specific survival were analysed. Method Patients undergoing AR for rectal cancer with a registered AL between 1995 and 1997 and a control group were identified in the Swedish Rectal Cancer Registry. The medical records were retrieved for additional data and validation. Differences in the oncological outcome at 5 year follow-up were analysed with multivariate methods. Results After validation, 114 patients with AL and 136 controls with locally radical surgery for tumours of TNM stages I-III were analysed.... (More)
ABSTRACT Background We explored the impact of anastomotic leakage (AL) on the oncological outcome after anterior resection (AR) for rectal cancer which is still controversial.. Local recurrence (LR) and overall recurrenc(OAR) and cancer-specific survival were analysed. Method Patients undergoing AR for rectal cancer with a registered AL between 1995 and 1997 and a control group were identified in the Swedish Rectal Cancer Registry. The medical records were retrieved for additional data and validation. Differences in the oncological outcome at 5 year follow-up were analysed with multivariate methods. Results After validation, 114 patients with AL and 136 controls with locally radical surgery for tumours of TNM stages I-III were analysed. There was no difference detected between patients with AL and controls regarding rates of LR [8% (9/114) vs 9% (12/136); P=0.97], distant metastasis [18% (20/114) vs 23% (31/136); P=0.37] and OAR [19% (22/114) vs 28% (38/136); P=0.15]. The 5 year cancer specific survival was almost 80% in both groups. In multivariate analysis, AL was not a risk factor for LR, distant metastasis or OAR and had no impact on 5 year overall or 5 year cancer specific survival. Irrespective of the occurrence of AL, preoperative radiotherapy (P=0.055) and rectal washout (P=0.046) reduced the LR rate, but did not influence survival. Conclusion AL was not proven to be a risk factor for worse oncological outcome. Hence additional adjuvant treatment or extended follow-up on the basis of the occurrence of AL after AR might not be justified. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
survival rate, neoplasm metastasis, neoplasm recurrence, anastomosis, Rectal neoplasm, anterior resection
in
Colorectal Disease
volume
13
issue
3
pages
272 - 283
publisher
Wiley-Blackwell
external identifiers
  • wos:000287317000010
  • pmid:19912285
  • scopus:79951533186
ISSN
1462-8910
DOI
10.1111/j.1463-1318.2009.02136.x
language
English
LU publication?
yes
id
5e33c92b-656a-4eb9-b620-45198ff815d6 (old id 1511949)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19912285?dopt=Abstract
date added to LUP
2009-12-01 15:25:36
date last changed
2017-10-08 03:16:17
@article{5e33c92b-656a-4eb9-b620-45198ff815d6,
  abstract     = {ABSTRACT Background We explored the impact of anastomotic leakage (AL) on the oncological outcome after anterior resection (AR) for rectal cancer which is still controversial.. Local recurrence (LR) and overall recurrenc(OAR) and cancer-specific survival were analysed. Method Patients undergoing AR for rectal cancer with a registered AL between 1995 and 1997 and a control group were identified in the Swedish Rectal Cancer Registry. The medical records were retrieved for additional data and validation. Differences in the oncological outcome at 5 year follow-up were analysed with multivariate methods. Results After validation, 114 patients with AL and 136 controls with locally radical surgery for tumours of TNM stages I-III were analysed. There was no difference detected between patients with AL and controls regarding rates of LR [8% (9/114) vs 9% (12/136); P=0.97], distant metastasis [18% (20/114) vs 23% (31/136); P=0.37] and OAR [19% (22/114) vs 28% (38/136); P=0.15]. The 5 year cancer specific survival was almost 80% in both groups. In multivariate analysis, AL was not a risk factor for LR, distant metastasis or OAR and had no impact on 5 year overall or 5 year cancer specific survival. Irrespective of the occurrence of AL, preoperative radiotherapy (P=0.055) and rectal washout (P=0.046) reduced the LR rate, but did not influence survival. Conclusion AL was not proven to be a risk factor for worse oncological outcome. Hence additional adjuvant treatment or extended follow-up on the basis of the occurrence of AL after AR might not be justified.},
  author       = {Jörgren, Fredrik and Johansson, R and Damber, L and Lindmark, Gudrun},
  issn         = {1462-8910},
  keyword      = {survival rate,neoplasm metastasis,neoplasm recurrence,anastomosis,Rectal neoplasm,anterior resection},
  language     = {eng},
  number       = {3},
  pages        = {272--283},
  publisher    = {Wiley-Blackwell},
  series       = {Colorectal Disease},
  title        = {Anastomotic leakage after surgery for rectal cancer: a risk factor of local recurrence, distant metastasis and reduced cancer-specific survival?},
  url          = {http://dx.doi.org/10.1111/j.1463-1318.2009.02136.x},
  volume       = {13},
  year         = {2011},
}