Hiroshi Hasegawa1, Takeru Matsuda2, Akira Arimoto2, Kimihiro Yamashita2, Masayasu Nishi3, Nobuhisa Takase2,4, Masayoshi Hosono5, Tetsu Nakamura2, Satoshi Suzuki2, Yoshihiro Kakeji2. 1. Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Chuoku, Kobe, Japan. hasega@med.kobe-u.ac.jp. 2. Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Chuoku, Kobe, Japan. 3. Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Japan. 4. Department of Surgery, Kakogawa Central City Hospital, Kakogawa, Japan. 5. Department of Surgery, Takatsuki Hospital, Takatsuki, Japan.
Abstract
PURPOSE: The influence of anastomotic leakage on long-term survival in patients with rectal cancer is debatable. The aim of this study was to evaluate relationships between anastomotic leakage and long-term survival. METHODS: In this multicenter retrospective cohort study, 395 consecutive stage I to III rectal cancer patients underwent anterior resection between 2007 and 2012. Five-year overall survival, 5-year disease-free survival, and 5-year local recurrence-free survival were compared between patients with leakage (Leakage (+)) and patients without leakage (Leakage (-)). RESULTS: Of 395 patients, 50 (12.7%) had anastomotic leakage. Of these 50, 34 (68.0%) required urgent surgery and 16 (32.0%) could be managed by watchful waiting or with percutaneous drainage. The median follow-up period was 62.6 months. Five-year overall survival did not differ between the two groups (Leakage (+) 93.8% vs. Leakage (-) 89.0%, P = 0.121). Five-year disease-free survival also did not differ between the two groups (81.6% vs. 80.3%, P = 0.731), and neither did 5-year local recurrence-free survival (91.9% vs. 86.1%, P = 0.206). In a multivariable Cox regression model, BMI > 25, preoperative CA19-9 > 37, pathological T stage, pathological N stage, and circumferential resection margin (CRM) positive were independent predictors of disease-free survival. Moreover, pathological T stage, pathological N stage, and CRM positive were the only independent predictors of overall survival and local recurrence-free survival. Anastomotic leakage was not a risk factor for overall survival, disease-free survival, or local recurrence-free survival. CONCLUSION: Anastomotic leakage is not associated with a significant decrease in long-term survival in rectal cancer patients.
PURPOSE: The influence of anastomotic leakage on long-term survival in patients with rectal cancer is debatable. The aim of this study was to evaluate relationships between anastomotic leakage and long-term survival. METHODS: In this multicenter retrospective cohort study, 395 consecutive stage I to III rectal cancerpatients underwent anterior resection between 2007 and 2012. Five-year overall survival, 5-year disease-free survival, and 5-year local recurrence-free survival were compared between patients with leakage (Leakage (+)) and patients without leakage (Leakage (-)). RESULTS: Of 395 patients, 50 (12.7%) had anastomotic leakage. Of these 50, 34 (68.0%) required urgent surgery and 16 (32.0%) could be managed by watchful waiting or with percutaneous drainage. The median follow-up period was 62.6 months. Five-year overall survival did not differ between the two groups (Leakage (+) 93.8% vs. Leakage (-) 89.0%, P = 0.121). Five-year disease-free survival also did not differ between the two groups (81.6% vs. 80.3%, P = 0.731), and neither did 5-year local recurrence-free survival (91.9% vs. 86.1%, P = 0.206). In a multivariable Cox regression model, BMI > 25, preoperative CA19-9 > 37, pathological T stage, pathological N stage, and circumferential resection margin (CRM) positive were independent predictors of disease-free survival. Moreover, pathological T stage, pathological N stage, and CRM positive were the only independent predictors of overall survival and local recurrence-free survival. Anastomotic leakage was not a risk factor for overall survival, disease-free survival, or local recurrence-free survival. CONCLUSION:Anastomotic leakage is not associated with a significant decrease in long-term survival in rectal cancerpatients.
Authors: T Sprenger; T Beißbarth; R Sauer; J Tschmelitsch; R Fietkau; T Liersch; W Hohenberger; L Staib; J Gaedcke; H-R Raab; C Rödel; M Ghadimi Journal: Br J Surg Date: 2018-05-30 Impact factor: 6.939
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