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Annals of Surgery:
doi: 10.1097/SLA.0b013e3182128929
Meta Analyses

Increased Local Recurrence and Reduced Survival From Colorectal Cancer Following Anastomotic Leak: Systematic Review and Meta-Analysis

Mirnezami, Alexander PhD, FRCS*; Mirnezami, Reza MRCS; Chandrakumaran, Kandiah PhD, FRCS; Sasapu, Kishore FRCS§; Sagar, Peter MD, FRCS§; Finan, Paul MD, FRCS§

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Abstract

Objective: To examine the long-term oncological impact of anastomotic leakage (AL) after restorative surgery for colorectal cancer using meta-analytical methods. Outcomes evaluated were local recurrence, distant recurrence, and survival.

Background: Recurrence after potentially curative surgery for colorectal cancer remains a significant clinical problem and has a poor prognosis. AL may be a risk factor for disease recurrence, however available studies have been conflicting. A meta-analysis was conducted to investigate the impact of AL on disease recurrence and long-term survival.

Methods: Studies published between 1965 and 2009 evaluating the long-term oncological impact of AL were identified by an electronic literature search. Outcomes evaluated included local recurrence, distant recurrence, and cancer specific survival. Meta-analysis was performed using the DerSimonian-Laird random-effects model to compute odds ratio and 95% confidence intervals. Study heterogeneity was evaluated using Q statistics and I2 and publication bias assessed with funnel plots and Egger's test.

Results: Twenty-one studies comprising 13 prospective nonrandomized studies, 1 prospective randomized, and 7 retrospective studies met the inclusion criteria, yielding a total of 21,902 patients. For rectal anastomoses, the odd ratios (OR) of developing a local recurrence when there was AL was 2.05 (95% CI = 1.51–2.8; P = 0.0001). For studies describing both colon and rectal anastomoses, the OR of local recurrence when there was an AL was 2.9 (95% CI = 1.78–4.71; P < 0.001). The OR of developing a distant recurrence after AL was 1.38 (95% CI = 0.96–1.99; P = 0.083). Long term cancer specific mortality was significantly higher after AL with an OR of 1.75 (95% CI = 1.47–2.1; P = 0.0001).

Conclusions: AL has a negative prognostic impact on local recurrence after restorative resection of rectal cancer. A significant association between colorectal AL and reduced long-term cancer specific survival was also noted. No association between AL and distant recurrence was found.

© 2011 Lippincott Williams & Wilkins, Inc.

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