Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer |
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Authors: | S Petersen M Freitag G Hellmich K Ludwig |
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Institution: | Klinik für Allgemein- und Abdominalchirurgie, St?dtisches Klinikum Dresden-Friedrichstadt, Friedrichstrasse 41, D-01067 Dresden, Germany, DE
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Abstract: | Anastomotic leakage is a serious complication in colorectal surgery, especially in the treatment of adenocarcinoma located
in the left-sided colon and rectum. It is controversial whether anastomotic leakage is a prognostic factor for local recurrence
and/or survival in this disease. To evaluate the impact of anastomotic dehiscence on the outcome of surgery we reviewed data
on 467 consecutive patients with adenocarcinoma of the left colon and rectum treated between 1985 and 1995 in our Department.
Of these, 41 (8.8%) developed anastomotic leakage. The overall-survival differed nonsignificantly (P=0.57) between leakage and nonleakage groups. Of 331 patients with curative resection 29 showed an anastomotic leakage. There
were 46 R0-resected patients who died under disease-related conditions: 7 patients in the leakage group (24.1%) and 39 in
the nonleakage group (12.9%; P=0.045). In the curatively resected group 5 of 29 patients developed local recurrence in the leakage group (17.2%) but only
26 of 302 patients in the nonleakage group (8.6%; P = 0.0357). Multivariate analysis showed only the factors of age, stage of resection, staging of lymph nodes, and tumor staging
as independent prognostic factors for overall survival. For local recurrence the multivariate analysis revealed tumor staging
and anastomotic leakage as independently significant. Anastomotic leakage thus appears to be a prognostic factor for local
tumor recurrence of colorectal cancer. In addition, disease-related survival is considerably decreased under leakage conditions.
Anastomotic leakage was not shown in this study to be an independent prognostic factor for overall survival due to the lack
of statistical significance.
Accepted: 20 July 1998 |
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