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Anastomotic Leaks After Restorative Resections for Rectal Cancer Compromise Cancer Outcomes and Survival

Lu, Zheqin R. M.B.B.S., B.Med.Sci; Rajendran, Nirooshun B.Sc., M.B.B.S., F.R.C.S.; Lynch, A. Craig M.B.Ch.B., M.Med.Sci., F.R.A.C.S., F.C.S.S.A.N.Z., F.A.S.C.R.S. (Int.); Heriot, Alexander G. M.A., M.B.B.Chir., M.D., F.R.C.S. (Gen.), F.R.C.S.Edinb., F.R.A.C.S.; Warrier, Satish K. M.B.B.S., M.S., F.R.A.C.S.

Diseases of the Colon & Rectum: March 2016 - Volume 59 - Issue 3 - p 236–244
doi: 10.1097/DCR.0000000000000554
Current Status

BACKGROUND: Anastomotic leaks after restorative resections for rectal cancer may lead to worse long-term outcomes.

OBJECTIVE: The purpose of this study was to evaluate the best current evidence assessing anastomotic leaks in rectal cancer resections with curative intent and their impact on survival and cancer recurrence.

DATA SOURCES: A meta-analysis was performed using MEDLINE, EMBASE, and Cochrane search engines for relevant studies published between January 1982 and January 2015.

STUDY SELECTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was used to screen and select relevant studies for the review using key words “colorectal surgery; colorectal neoplasm; rectal neoplasm” and “anastomotic leak.”

INTERVENTION: Anastomotic leak groups were compared with nonanastomotic leak groups.

MAIN OUTCOME MEASURES: ORs were calculated from binary data for local recurrence, distant recurrence, and cancer-specific mortality. A random-effects model was then used to calculate pooled ORs with 95% CIs.

RESULTS: Eleven studies with 13,655 patients met the inclusion criteria. This included 5 prospective cohort and 6 retrospective cohort studies. Median follow-up was 60 months. Higher cancer-specific mortality was noted in the leak group with an OR of 1.30 (95% CI, 1.04–1.62; p < 0.05). Local recurrences were more likely in rectal cancer resections complicated by anastomotic leaks (OR = 1.61 (95% CI, 1.25–2.09); p < 0.001). Distant recurrence was not more likely in the anastomotic leak group (OR = 1.07 (95% CI, 0.87–1.33); p = 0.52).

LIMITATIONS: All 11 studies are level 3 evidence cohort studies. Additional sensitivity analyses were performed to minimize cross-study heterogeneity.

CONCLUSIONS: Anastomotic leaks after restorative resections for rectal cancer adversely impact cancer-specific mortality and local recurrence.

1 Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia

2 Department of Colorectal Surgery, Alfred Health, Prahran, Victoria, Australia

Financial Disclosure: None reported.

Poster presentation at the Royal Australasian College of Surgeons Annual Scientific Congress, Perth, Western Australia, Australia, May 4 to 8, 2015.

Correspondence: Satish K. Warrier, M.B.B.S., M.S., F.R.A.C.S., Department of Colorectal Surgery, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, Victoria, Australia 3002. E-mail:

© 2016 The American Society of Colon and Rectal Surgeons