Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence?

This study examines anastomotic leaks as a potential influence on the long term outcome of patients with colorectal cancer. 167 patients were studied who had clinical and radiological assessment of anastomotic integrity in the post-operative period, following potentially curative resections for left-sided colonic or rectal cancer. There was no evidence of a leak in 135 of these patients, while the remaining 32 developed a clinical and/or a radiological leak. At the end of a mean follow-up of 25 months, 15 patients with leaks (46.9%) developed tumour recurrence, compared with 25 of those without any leak (18.5%; p less than 0.001). Cancer specific mortality at 24 months was also significantly higher for patients with leaks (36.9% +/- 9.7% versus 12.6% +/- 3.3%; p less than 0.001). The influence of anastomotic leaks on the outcome was independent of tumour stage. These results suggest that in patients undergoing surgery for colorectal cancer development of an anastomotic leak is significantly associated with a poorer long-term outcome.