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Einfluss der Anastomoseninsuffizienz auf das Langzeitüberleben beim tiefen Rektumkarzinom

Impact of anastomotic leakage on long-term survival in mid-to-low rectal cancer

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Zusammenfassung

Hintergrund

Das Auftreten einer Anastomoseninsuffizienz (AI) nach einer sphinktererhaltenden tiefen vorderen Rektumresektion bei Patienten mit einem Rektumkarzinom des mittleren und unteren Drittels ist mit einer erhöhten postoperativen Morbiditäts- und Mortalitätsrate vergesellschaftet. Der Einfluss auf das Langzeitüberleben hingegen ist nach wie vor nicht ausreichend untersucht und Gegenstand einer aktuell kontrovers geführten Diskussion.

Ziel der Arbeit

Das Ziel der vorliegenden Arbeit war es, den Einfluss der AI auf das Langzeitüberleben bei Patienten mit einem Rektumkarzinom des mittleren und unteren Drittels nach einer sphinktererhaltenden Rektumresektion zu analysieren.

Material und Methoden

Aus einer prospektiv angelegten auditfähigen Datenbank „Kolorektales Karzinom“ der Universitätsklinik für Chirurgie Salzburg wurden im Zeitraum von Januar 2003 bis Oktober 2010 alle kurativ sphinktererhaltend operierten Patienten im UICC-Stadium (y)0–III mit einem histologisch gesicherten primären Adenokarzinom des mittleren und unteren Rektumdrittels (n = 108) in die Analyse eingeschlossen und der Einfluss der AI auf das 5-Jahres-Gesamtüberleben [OS] sowie das tumorspezifische [CSS] und rezidivfreie [RFS] Überleben untersucht.

Ergebnisse

Die Gesamt-AI-Rate betrug 17,6 % (Grad A: 4,6 %, Grad B: 4,6 % und Grad C: 8,3 %). Bei einer medianen Nachuntersuchungszeit von 70 Monaten (24–123) hatten Patienten mit einer AI jeweils eine signifikant ungünstigere 5-Jahres-OS- (63,6 vs. 87,8 %; p = 0,02), CSS- (72,2 vs. 93,5 %; p = 0,02) und RFS-Rate (61,1 vs. 84,2 %; p = 0,01). Die AI wurde in der univariaten Cox-Regressionsanalyse als unabhängiger Risikofaktor für das OS (Hazard Ratio [HR] 3,05, 95 %-Konfidenzintervall [KI]: 1,11–8,39; p = 0,03), CSS (HR 4,21, 95 %-KI: 1,13–15,70; p = 0,03) und RFS (HR 3,02, 95 %-KI: 1,20–7,58; p = 0,02) identifiziert.

Diskussion

Die AI war in unserer Kohorte mit einem signifikant ungünstigen Einfluss auf das 5-Jahres-Gesamt- und onkologische Überleben assoziiert.

Abstract

Background

The occurrence of anastomotic leakage (AL) after sphincter preserving anterior rectal resection in patients with rectal cancer is associated with increased morbidity and mortality. The impact of AL on long-term survival has, however, still not been sufficiently investigated and is currently the subject of controversial discussion.

Objectives

The aim of this study was to investigate the impact of AL on long-term survival in patients with Union of International Cancer Control (UICC) (y)0–III stage mid-to-low rectal cancer who underwent sphincter preserving rectal resection.

Material and methods

A total of 108 patients with a mid-to-low rectal cancer (UICC stage (y)0–III) who underwent sphincter preserving surgery between January 2003 and October 2010 were identified within the institutional prospective colorectal cancer database. The impact of AL on 5-year overall (OS), cancer specific (CSS) and relapse-free survival (RFS) was investigated.

Results

The overall leakage rate was 17.6 % (grade A 4.6 %, grade B 4.6 % and grade C 8.3 %). After a median follow-up of 70 months (range 24–123 months), patients with an anastomotic leakage had a significantly decreased 5-year OS (63.6 % versus 87.8 %, p = 0.02), CSS (72.2 % versus 93.5 %, p = 0.02) and RFS rate (61.1 % versus 84.2 %, p = 0.01). In univariable Cox regression analysis AL was associated with an unfavorable OS (hazard ratio HR 3.05, 95 % CI: 1.11–8.39, p = 0.03), CSS (HR 4.21, 95 % CI: 1.13–15.70, p = 0.03) and RFS (HR 3.02, 95 % CI: 1.20–7.58, p = 0.02).

Conclusion

In the study cohort anastomotic leakage after sphincter preserving anterior resection in patients with mid-to-low rectal cancer was associated with a significantly unfavorable impact on overall and oncological survival.

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Authors and Affiliations

  1. Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich

    T. Jäger, C. Nawara, J. Holzinger, D. Öfner-Velano & A. Dinnewitzer

  2. Institut für Pathologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich

    D. Neureiter

  3. Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Department Operative Medizin, Medizinische Universität, Innsbruck, Österreich

    D. Öfner-Velano

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  1. T. Jäger
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  2. C. Nawara
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Correspondence to T. Jäger.

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Jäger, T., Nawara, C., Neureiter, D. et al. Einfluss der Anastomoseninsuffizienz auf das Langzeitüberleben beim tiefen Rektumkarzinom. Chirurg 86, 1072–1082 (2015). https://doi.org/10.1007/s00104-015-0090-0

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