Anastomotic leakage after rectal anastomosis was associated with a significant increase in the cumulative five-year estimate of local recurrence compared to no leakage (25.1% vs 10.4%; P=0.007).
Cohort (n=5,173)
Does anastomotic leakage affect five-year survival and local recurrence in patients undergoing colorectal surgery?
Anastomotic leakage after rectal anastomosis is associated with a significant increase in local recurrence and 30-day mortality.
Absolute Event Rate: 25.1% vs 10.4%
p-value: p=0.007
INTRODUCTION: Anastomotic leakage is a major complication of colorectal surgery causing a significant increase in 30-day mortality. The long-term prognosis of anastomotic leakage is poorly documented. This study was designed to assess whether anastomotic leakage affects five-year survival and local recurrence. METHODS: A total of 5,173 patients were recruited to the Wessex Colorectal Cancer Audit during the period September 1991 to August 1995 (prospective data, 5-year follow-up). The effect of anastomotic leakage on five-year survival and local recurrence was analyzed using Kaplan-Meier curves and the log-rank test. RESULTS: A total of 1,834 patients underwent a curative resection with an anastomosis (anastomotic leak = 71; 3.9 percent): 30-day mortality: 18.3 percent in the leak group, and 3.5 percent in the nonleak group (P < 0.001); local recurrence: 19 percent in the leak group, and 9.8 percent in the nonleak group (P = 0.018). A total of 1,201 patients underwent colonic anastomosis (anastomotic leak = 31; 2.6 percent). There was no significant difference in local recurrence or five-year survival between the leak and nonleak groups. A total of 633 patients underwent rectal anastomosis (anastomotic leakage = 40; 6.3 percent): 30-day mortality: 10 percent in the leak group, and 2 percent in the nonleak group (P = 0.014); cumulative five-year estimate of local recurrence: 25.1 (95 percent confidence interval, 9.6-40.5) percent in the leak group, and 10.4 (95 percent confidence interval, 7.7-13) percent in the nonleak group (P = 0.007). Cumulative five-year estimate of overall survival: 52.8 (95 percent confidence interval, 36.1-69.4) percent in the leak group, and 63.9 (95 percent confidence interval, 59.9-67.9) percent in the nonleak group (P = 0.19). CONCLUSIONS: After rectal anastomosis, an anastomotic leak is associated with a significant increase in local recurrence.
Branagan et al. (2005) conducted a cohort in Colorectal Cancer (n=5,173). Anastomotic leakage vs. No anastomotic leakage was evaluated on Cumulative five-year estimate of local recurrence after rectal anastomosis (p=0.007). Anastomotic leakage after rectal anastomosis was associated with a significant increase in the cumulative five-year estimate of local recurrence compared to no leakage (25.1% vs 10.4%; P=0.007).