Risk Factors and Oncologic Impact of Anastomotic Leakage after Rectal Cancer Surgery.
- Author:
Sang Hun JUNG
1
;
Chang Sik YU
;
Pyong Wha CHOI
;
Dae Dong KIM
;
Dong Hyun HONG
;
Hee Cheol KIM
;
Jin Cheon KIM
Author Information
1. Colorectal Clinic, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. csyu@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Anastomotic leakage;
Rectal cancer surgery;
Risk factor;
Survival rate
- MeSH:
Anastomotic Leak*;
Autonomic Pathways;
Follow-Up Studies;
Humans;
Multivariate Analysis;
Prognosis;
Rectal Neoplasms*;
Recurrence;
Retrospective Studies;
Risk Factors*;
Survival Rate
- From:Journal of the Korean Society of Coloproctology
2006;22(6):371-379
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Anastomotic leakage (AL) is a serious and life-threatening complication following rectal cancer surgery. The impact on long-term oncologic outcome in patients with AL is not clear. The aim of this retrospective study was to evaluate the risk factors of AL and its impact on long-term prognosis after rectal cancer surgery. METHODS: We investigated 1,391 patients who underwent primary resection and anastomosis for rectal cancer between January 1997 and August 2003. Operations were performed as follows: AR (n=164), LAR (n=898), uLAR (n=329). Standard procedures in our clinic were mesorectal excision according to tumor location and autonomic nerve preservation. Median follow-up period was 40.1 months (2~96 months). RESULTS: AL rate was 2.5% (n=35). Gender (male), age (>60 years) and uLAR were independent risk factors in multivariate analysis (HR: 3.03, 95% CI: 1.18~7.22; HR: 2.42, 95% CI: 1.12~7.83; HR: 2.68, 95% CI: 1.08~7.09, respectively). Local recurrence in the AL group was significantly higher than that in the non-AL group (P<0.05), but there was no significant difference in multivariate analysis (P=0.14). Systemic recurrence between both groups was not statistically different. The 5-year overall survival rate was significantly lower in the AL group than in the non-AL group (55.1% vs 74.1%, P<0.05) and the cancer- specific survival rate was lower in the AL group than in the non-AL group (63.0% vs 78.3%, P=0.05). CONCLUSIONS: Age, gender, and anastomotic level were risk factors for AL after rectal cancer surgery and anastomotic leakage was associated with a poor survival.
