Does anastomotic leakage after rectal cancer resection worsen long-term oncologic outcome?
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ORIGINAL ARTICLE
Does anastomotic leakage after rectal cancer resection worsen long-term oncologic outcome? Hiroshi Hasegawa 1 & Takeru Matsuda 1 & Akira Arimoto 1 & Kimihiro Yamashita 1 & Masayasu Nishi 2 & Nobuhisa Takase 1,3 & Masayoshi Hosono 4 & Tetsu Nakamura 1 & Satoshi Suzuki 1 & Yoshihiro Kakeji 1 Accepted: 4 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 diseasefree 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. Keywords Rectal cancer . Anastomotic leakage . Oncologic outcome . Risk factors
Introduction Reducing anastomotic leakage and its potentially negative influence is very important for rectal cancer treatment. After anterior resection for rectal cancer, anastomotic leakage occurs in about 10% of patients, according to recent national
* Hiroshi Hasegawa [email protected] 1
Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Chuoku, Kobe, Japan
2
Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Japan
3
Department of Surgery, Kakogawa Central City Hospital, Kakogawa, Japan
4
Department of Surgery, Takatsuki Hospital, Takatsuki, Japan
database studies, which suggest that it leads to a significant increase in short-term mortality [1–3]. While the negative impact on short-term outcomes is clear, the influenc
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