Tarik Sammour1, Ian P Hayes2,3, Ian T Jones2,3, Malcolm C Steel4, Ian Faragher5, Peter Gibbs6. 1. Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA. 2. Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia. 3. Colorectal Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia. 4. Colorectal Unit, Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia. 5. Colorectal Unit, Department of Surgery, Western Hospital, Melbourne, Victoria, Australia. 6. Department of Medical Oncology, Walter + Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: There is conflicting evidence regarding the oncological impact of anastomotic leak following colorectal cancer surgery. This study aims to test the hypothesis that anastomotic leak is independently associated with local recurrence and overall and cancer-specific survival. METHODS: Analysis of prospectively collected data from multiple centres in Victoria between 1988 and 2015 including all patients who underwent colon or rectal resection for cancer with anastomosis was presented. Overall and cancer-specific survival rates and rates of local recurrence were compared using Cox regression analysis. RESULTS: A total of 4892 patients were included, of which 2856 had completed 5-year follow-up. The overall anastomotic leak rate was 4.0%. Cox regression analysis accounting for differences in age, sex, body mass index, American Society of Anesthesiologists score and tumour stage demonstrated that anastomotic leak was associated with significantly worse 5-year overall survival (χ 2 = 6.459, P = 0.011) for colon cancer, but only if early deaths were included. There was no difference in 5-year colon cancer-specific survival (χ 2 = 0.582, P = 0.446) or local recurrence (χ 2 = 0.735, P = 0.391). For rectal cancer, there was no difference in 5-year overall survival (χ 2 = 0.266, P = 0.606), cancer-specific survival (χ 2 = 0.008, P = 0.928) or local recurrence (χ 2 = 2.192, P = 0.139). CONCLUSION: Anastomotic leak may reduce 5-year overall survival in colon cancer patients but does not appear to influence the 5-year overall survival in rectal cancer patients. There was no effect on local recurrence or cancer-specific survival.
BACKGROUND: There is conflicting evidence regarding the oncological impact of anastomotic leak following colorectal cancer surgery. This study aims to test the hypothesis that anastomotic leak is independently associated with local recurrence and overall and cancer-specific survival. METHODS: Analysis of prospectively collected data from multiple centres in Victoria between 1988 and 2015 including all patients who underwent colon or rectal resection for cancer with anastomosis was presented. Overall and cancer-specific survival rates and rates of local recurrence were compared using Cox regression analysis. RESULTS: A total of 4892 patients were included, of which 2856 had completed 5-year follow-up. The overall anastomotic leak rate was 4.0%. Cox regression analysis accounting for differences in age, sex, body mass index, American Society of Anesthesiologists score and tumour stage demonstrated that anastomotic leak was associated with significantly worse 5-year overall survival (χ 2 = 6.459, P = 0.011) for colon cancer, but only if early deaths were included. There was no difference in 5-year colon cancer-specific survival (χ 2 = 0.582, P = 0.446) or local recurrence (χ 2 = 0.735, P = 0.391). For rectal cancer, there was no difference in 5-year overall survival (χ 2 = 0.266, P = 0.606), cancer-specific survival (χ 2 = 0.008, P = 0.928) or local recurrence (χ 2 = 2.192, P = 0.139). CONCLUSION:Anastomotic leak may reduce 5-year overall survival in colon cancerpatients but does not appear to influence the 5-year overall survival in rectal cancerpatients. There was no effect on local recurrence or cancer-specific survival.
Authors: T Sammour; L Cohen; A I Karunatillake; M Lewis; M J Lawrence; A Hunter; J W Moore; M L Thomas Journal: Tech Coloproctol Date: 2017-10-28 Impact factor: 3.781
Authors: Kay T Choy; Tze Wei Wilson Yang; Alexander Heriot; Satish K Warrier; Joseph C Kong Journal: Int J Colorectal Dis Date: 2021-01-30 Impact factor: 2.571
Authors: F Ris; E Liot; N C Buchs; R Kraus; G Ismael; V Belfontali; J Douissard; C Cunningham; I Lindsey; R Guy; O Jones; B George; P Morel; N J Mortensen; R Hompes; R A Cahill Journal: Br J Surg Date: 2018-04-16 Impact factor: 6.939