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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 5/2005

01-05-2005 | Original Contribution

Prognosis After Anastomotic Leakage in Colorectal Surgery

Authors: Graham Branagan, M.S., F.R.C.S., Derek Finnis, F.R.C.S.(Engl.), FRCSC

Published in: Diseases of the Colon & Rectum | Issue 5/2005

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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.
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Metadata
Title
Prognosis After Anastomotic Leakage in Colorectal Surgery
Authors
Graham Branagan, M.S., F.R.C.S.
Derek Finnis, F.R.C.S.(Engl.), FRCSC
Publication date
01-05-2005
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 5/2005
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-004-0869-4

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