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Impact of anastomotic leak on recurrence and survival after colorectal cancer surgery: a BioGrid Australia analysis
Author(s) -
Sammour Tarik,
Hayes Ian P.,
Jones Ian T.,
Steel Malcolm C.,
Faragher Ian,
Gibbs Peter
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13648
Subject(s) - medicine , colorectal cancer , anastomosis , leak , proportional hazards model , surgery , cancer , survival rate , survival analysis , stage (stratigraphy) , paleontology , environmental engineering , engineering , biology
Background There is conflicting evidence regarding the oncological impact of anastomotic leak following colorectal cancer surgery. This study aims to test the hypothesis that anastomotic leak is independently associated with local recurrence and overall and cancer‐specific survival. Methods Analysis of prospectively collected data from multiple centres in Victoria between 1988 and 2015 including all patients who underwent colon or rectal resection for cancer with anastomosis was presented. Overall and cancer‐specific survival rates and rates of local recurrence were compared using Cox regression analysis. Results A total of 4892 patients were included, of which 2856 had completed 5‐year follow‐up. The overall anastomotic leak rate was 4.0%. Cox regression analysis accounting for differences in age, sex, body mass index, American Society of Anesthesiologists score and tumour stage demonstrated that anastomotic leak was associated with significantly worse 5‐year overall survival ( χ 2 = 6.459, P = 0.011) for colon cancer, but only if early deaths were included. There was no difference in 5‐year colon cancer‐specific survival ( χ 2 = 0.582, P = 0.446) or local recurrence ( χ 2 = 0.735, P = 0.391). For rectal cancer, there was no difference in 5‐year overall survival ( χ 2 = 0.266, P = 0.606), cancer‐specific survival ( χ 2 = 0.008, P = 0.928) or local recurrence ( χ 2 = 2.192, P = 0.139). Conclusion Anastomotic leak may reduce 5‐year overall survival in colon cancer patients but does not appear to influence the 5‐year overall survival in rectal cancer patients. There was no effect on local recurrence or cancer‐specific survival.