Impact of anastomotic leakage on outcomes in patients with rectal cancer

Abstract

Background. The effect of anastomotic leakage (AL) on oncological outcomes after total mesorectumectomy is controversial.Objective: to investigate the influence of AL and other factors on oncological outcome.Materials and methods. Data of 67 patients underwent total mesorectumectomy with normal healing were compared with those for 16 patients who experienced AL. Long-term oncological outcomes were analysed.Results. Median follow-up was 43 months. AL rate was 19.4 % (16 cases out of 83). Following factors had negative influence on lower 4-year disease-free survival rate and reached statistical significance in univariant analysis: tumor invasion (hazard ratio (HR) 8.8; 95 % сonfidence interval (CI) 1.4–13.7; р = 0.01), metastases in regional lymph nodes (HR 3.5; 95 % CI 1.2–12.3; р = 0.03), tumor stage (р = 0.048), level of tumor differentiation (HR 0.1; 95 % CI 0–0.6; р <0.0001), tumor stenosis (HR 8.8; 95 % CI 1.4–13.7; р = 0.002), AL (HR 3.9; 95 % CI 1.6–37.1; р = 0.01). In the logistic regression analysis independent risk factors for the development of recurrence were not revealed.Conclusion. AL was not proved to be a risk factor of worse oncological outcome. Hence, additional adjuvant treatment or extended follow-up on the basis of the occurrence of AL after low anterior resection of rectal cancer might not be justified.

Keywords

• rectal cancer
• total mesorectumectomy
• anastomotic leakage