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Anastomotic leakage is associated with poor long term outcome in patients following curative colorectal resection for malignancy
Wai Lun Law, Hok Kwok Choi, Yee Man Lee, Judy W. Ho, Chi Leung Seto; Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Centre, Hong Kong, Hong Kong

Background: The impact of anastomotic leakage on long term survival and cancer recurrence in following curative surgery for colorectal cancer has not been well documented. This study aimed to investigate impact of anastomotic leakage on the long term survival and recurrence of patients who underwent curative resection for colorectal cancer. Methods: Prospectively collected data of the 1580 patients (904 men) with the median age of 70 years (range: 24-94) who underwent curative resection for colorectal cancer between 1996 and 2004 were included. Patients without an anastmosis were excluded. In the analysis of long term outcome, patients died postoperatively (30 days)were excluded. Survival and recurrence were analyzed using Kaplan Meier method and variables were compared with log rank test. Cox regression model was used in multivariate analysis. Patients with Results: The cancer was situated in the colon and the rectum in 933 and 647 patients, respectively. Anastomotic leakage occurred in 60 patients (clinical leakage: n=48; radiological leak: n=12). The leakage rate was significantly higher in patients with surgery for rectal cancer (6.3% vs. 2.0%, p<0.001). The 5-year cancer specific survivals were 56.9% in those with leakage and 75.9% in those without complications (p=0.012). The 5-year systemic recurrence rates were 48.4% and 22.6% in patients with and without anastomotic leak, respectively (p=0.001) while the 5 year local recurrence rates were 10.5% and 5.7%, respectively (p=0.009). The presence of postoperative leak remained an independent factor associated with a worse cancer specific survival (p=0.043, hazard ratio: 1.62, 95% CI: 1.02-2.61) and a higher systemic recurrence rate (hazard ratio: 2.00, 95% CI: 1.26-3.17) when the gender, urgency of the operation, the site and stage of the tumor were adjusted in multivariate analysis. Conclusion: The presence of anastomotic leakage is associated with a worse cancer specific survival and a higher systemic recurrence rate in patients following curative colorectal resection.


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