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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2017

01-10-2017 | Colorectal Cancer

Oncologic Impact of Anastomotic Leakage Following Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

Authors: Gi Won Ha, MD, PhD, Jong Hun Kim, MD, PhD, Min Ro Lee, MD, PhD

Published in: Annals of Surgical Oncology | Issue 11/2017

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Abstract

Background

Anastomotic leakage (AL) is a major complication of surgery for colorectal cancer (CRC), and is associated with increased morbidity and mortality; However, there are conflicting results on the impact of AL on long-term oncologic outcomes.

Objective

The aim of this meta-analysis was to assess the oncologic outcomes of AL following restorative surgery for CRC.

Methods

Multiple comprehensive databases, including PubMed, EMBASE, and The Cochrane Library, were searched for studies that assessed the oncologic effects of AL following surgery for CRC. The included studies evaluated local and distant recurrence, overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Outcome data were pooled, and overall effect size was calculated using random effects models.

Results

Thirty-four nonrandomized studies including 78,434 patients met the inclusion criteria. The results show that AL was associated with increased local recurrence (relative risk [RR] 1.90, 95% confidence interval [CI] 1.48–2.44, I 2 = 78%) and reduced OS (RR 1.36, 95% CI 1.24–1.50, I 2 = 74%), CSS (RR 1.41, 95% CI 1.19–1.68, I 2 = 56%), and DFS (RR 1.40, 95% CI 1.20–1.63, I 2 = 86%). AL had no significant effect on distant recurrence (RR 1.20, 95% CI 0.94–1.53, I 2 = 61%).

Conclusions

AL after restorative surgery for CRC is associated with increased local recurrence and reduced long-term survival, including OS, CSS, and DFS.
Literature
1.
Koperna T. Cost-effectiveness of defunctioning stomas in low anterior resections for rectal cancer: a call for benchmarking. Arch Surg. 2003;138:1334–9.CrossRefPubMed
2.
Boccola MA, Lin J, Rozen WM, Ho YH. Reducing anastomotic leakage in oncologic colorectal surgery: an evidence-based review. Anticancer Res. 2010;30:601–7.PubMed
3.
Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88:1157–68.CrossRefPubMed
4.
Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890–9.CrossRefPubMed
5.
Law WL, Choi HK, Lee YM, Ho JW, Seto CL. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg. 2007;11:8–15.CrossRefPubMed
6.
Sauven P, Playforth MJ, Evans M, Pollock AV. Early infective complications and late recurrent cancer in stapled colonic anastomoses. Dis Colon Rectum. 1989;32:33–5.CrossRefPubMed
7.
Akyol AM, McGregor JR, Galloway DJ, Murray GD, George WD. Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence? Int J Colorectal Dis. 1991;6:179–83.CrossRefPubMed
8.
Fujita S, Teramoto T, Watanabe M, Kodaira S, Kitajima M. Anastomotic leakage after colorectal cancer surgery: a risk factor for recurrence and poor prognosis. Jpn J Clin Oncol. 1993;23:299–302.PubMed
9.
Petersen S, Freitag M, Hellmich G, Ludwig K. Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis. 1998;13:160–3.CrossRefPubMed
10.
Merkel S, Wang WY, Schmidt O, Dworak O, Wittekind C, Hohenberger W, et al. Locoregional recurrence in patients with anastomotic leakage after anterior resection for rectal carcinoma. Colorectal Dis. 2001;3:154–60.CrossRefPubMed
11.
Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, et al. Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg. 2003;90:1261–6.CrossRefPubMed
12.
Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg. 2004;240:255–9.CrossRefPubMedPubMedCentral
13.
Branagan G, Finnis D. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum. 2005;48:1021–6.CrossRefPubMed
14.
McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg. 2005;92:1150–4.CrossRefPubMed
15.
Ptok H, Marusch F, Meyer F, Schubert D, Gastinger I, Lippert H, Study Group Colon/Rectum Carcinoma (Primary Tumour). Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg. 2007;94:1548–54.CrossRefPubMed
16.
Jung SH, Yu CS, Choi PW, Kim DD, Park IJ, Kim HC, et al. Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum. 2008;51:902–8.CrossRefPubMed
17.
Marra F, Steffen T, Kalak N, Warschkow R, Tarantino I, Lange J, et al. Anastomotic leakage as a risk factor for the long-term outcome after curative resection of colon cancer. Eur J Surg Oncol. 2009;35:1060–4.CrossRefPubMed
18.
Kube R, Mroczkowski P, Granowski D, Benedix F, Sahm M, Schmidt U, et al. Anastomotic leakage after colon cancer surgery: a predictor of significant morbidity and hospital mortality, and diminished tumour-free survival. Eur J Surg Oncol. 2010;36:120–4.CrossRefPubMed
19.
Boccola MA, Buettner PG, Rozen WM, Siu SK, Stevenson AR, Stitz R, et al. Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg. 2011;35:186–95.CrossRefPubMed
20.
Katoh H, Yamashita K, Wang G, Sato T, Nakamura T, Watanabe M. Anastomotic leakage contributes to the risk for systemic recurrence in stage II colorectal cancer. J Gastrointest Surg. 2011;15:120–9.CrossRefPubMed
21.
Lin JK, Yueh TC, Chang SC, Lin CC, Lan LT, Wang HS, et al. The influence of fecal diversion and anastomotic leakage on survival after resection of rectal cancer. J Gastrointest Surg. 2011;15:2251–61.CrossRefPubMed
22.
Kang J, Choi GS, Oh JH, Kim NK., Park JS, Kim MJ, et al. Multicenter analysis of long-term oncologic impact of anastomotic leakage after laparoscopic total mesorectal excision. Medicine. 2015;94:e1202.CrossRefPubMedPubMedCentral
23.
Kim IY, Kim BR, Kim YW. The impact of anastomotic leakage on oncologic outcomes and the receipt and timing of adjuvant chemotherapy after colorectal cancer surgery. Int J Surg. 2015;22:3–9.CrossRefPubMed
24.
Kulu Y, Tarantio I, Warschkow R, Kny S, Schneider M, Schmied BM, et al. Anastomotic leakage is associated with impaired overall and disease-free survival after curative rectal cancer resection: a propensity score analysis. Ann Surg Oncol. 2015;22:2059–67.CrossRefPubMed
25.
26.
Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN, Norwegian Rectal Cancer Group. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis. 2005;7:51–7.CrossRefPubMed
27.
Lee WS, Yun SH, Roh YN, Yun HR, Lee WY, Cho YB, et al. Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg. 2008;32:1124–9.CrossRefPubMed
28.
den Dulk M, Marijnen CA, Collette L, Putter H, Påhlman L, Folkesson J, et al. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg. 2009;96:1066–75.CrossRef
29.
Eberhardt JM, Kiran RP, Lavery IC. The impact of anastomotic leak and intra-abdominal abscess on cancer-related outcomes after resection for colorectal cancer: a case control study. Dis Colon Rectum. 2009;52:380–6.CrossRefPubMed
30.
Bertelsen CA, Andreasen AH, Jørgensen T, Harling H, Danish Colorectal Cancer Group. Anastomotic leakage after curative anterior resection for rectal cancer: short and long-term outcome. Colorectal Dis. 2010;12:e76–81.CrossRefPubMed
31.
Jörgren F, Johansson R, Damber L, Lindmark G. Anastomotic leakage after surgery for rectal cancer: a risk factor for local recurrence, distant metastasis and reduced cancer-specific survival? Colorectal Dis. 2011;13:272–83.CrossRefPubMed
32.
Ebinger SM, Warschkow R, Tarantino I, Schmied BM, Marti L. Anastomotic leakage after curative rectal cancer resection has no impact on long-term survival: a propensity score analysis. Int J Colorectal Dis. 2015;30:1667–75.CrossRefPubMed
33.
Jannasch O, Klinge T, Otto R, Chiapponi C, Udelnow A, Lippert H, et al. Risk factors, short and long term outcome of anastomotic leaks in rectal cancer. Oncotarget. 2015;6:36884–93.PubMedPubMedCentral
34.
Lim SB, Yu CS, Kim CW, Yoon YS, Park IJ, Kim JC. The types of anastomotic leakage that develop following anterior resection for rectal cancer demonstrate distinct characteristics and oncologic outcomes. Int J Colorectal Dis. 2015;30:1533–40.CrossRefPubMed
35.
Nachiappan S, Askari A, Malietzis G, Giacometti M, White I, Jenkins JT, et al. The impact of anastomotic leak and its treatment on cancer recurrence and survival following elective colorectal cancer resection. World J Surg. 2015;39:1052–8.CrossRefPubMed
36.
Lu ZR, Rajendran N, Lynch AC, Heriot AG, Warrier SK. Anastomotic leaks after restorative resections for rectal cancer compromise cancer outcomes and survival. Dis Colon Rectum. 2016;59:236–44.CrossRefPubMed
37.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9.CrossRefPubMed
38.
Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions, version 5.1.0. Vol. 5. The Cochrane Collaboration; 2011.
39.
Kulu Y, Ulrich A, Bruckner T, Contin P, Welsch T, Rahbari NN, et al. Validation of the International Study Group of Rectal Cancer definition and severity grading of anastomotic leakage. Surgery. 2013;153:753–61.CrossRefPubMed
40.
Hayden JA, van der Windt DA, Cartwright JL, Cote P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med. 2013;158:280–6.CrossRefPubMed
41.
42.
43.
Thabane L, Akhtar-Danesh N. Guidelines for reporting descriptive statistics in health research. Nurse Res. 2008;15:72–81.CrossRefPubMed
44.
Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol. 2008;37:1148–57.CrossRefPubMed
45.
46.
47.
Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Local recurrence following ‘curative’ surgery for large bowel cancer: I-the overall picture. Br J Surg. 1984;71:12–6.CrossRefPubMed
48.
Pakkastie TE, Luukkonen PE, Järvinen HJ. Anterior resection controls cancer of the rectum as well as abdominoperineal excision. Eur J Surg. 1995;161:833–9.PubMed
49.
Amato A, Pescatori M, Butti A. Local recurrence following abdominoperineal excision and anterior resection for rectal carcinoma. Dis Colon Rectum. 1991;34:317–22.CrossRefPubMed
50.
Cong ZJ, Hu LH, Bian ZQ, Ye GY, Yu MH, Gao YH, et al. Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One. 2013;8:e75519.CrossRefPubMedPubMedCentral
51.
Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010;147:339–51.CrossRefPubMed
52.
Umpleby HC, Fermor B, Symes MO, Williamson RC. Viablilty of exfoliated colorectal carcinoma cells. Br J Surg. 1984;71:659–63.CrossRefPubMed
53.
Salvans S, Mayol X, Alonso S, Messeguer R, Pascual M, Mojal S, et al. Postoperative peritoneal infection enhances migration and invasion capacities of tumor cells in vitro: an insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer. Ann Surg. 2014;260:939–44.CrossRefPubMed
54.
Alonso S, Pascual M, Salvans S, Mayol X, Mojal S, Gil MJ, et al. Postoperative peritoneal infection increases colorectal cancer recurrence: a prospective matched cohort study of inflammatory and angiogenic responses as mechanisms responsible for this association. Eur J Surg Oncol. 2015;41:208–14.CrossRefPubMed
55.
Bohle B, Pera M, Pascual M, Alonso S, Mayol X, Salvado M, et al. Postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after surgical excision of colon cancer in mice. Surgery. 2010;147:120–6.CrossRefPubMed
56.
McMillan DC, Wotherspoon HA, Fearon KC, Sturgeon C, Cooke TG, McArdle CS. A prospective study of tumor recurrence and acute-phase response after apparently curative colorectal cancer surgery. Am J Surg. 1995;170:319–22.CrossRefPubMed
57.
McMillan DC, Canna K, McArdle CS. Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg. 2003;90:215–9.CrossRefPubMed
58.
Skipper D, Cooper AJ, Marston JE, Taylor I. Exfoliated cells and in vitro growth in colorectal cancer. Br J Surg. 1987;74:1049–52.CrossRefPubMed
Metadata
Title
Oncologic Impact of Anastomotic Leakage Following Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis
Authors
Gi Won Ha, MD, PhD
Jong Hun Kim, MD, PhD
Min Ro Lee, MD, PhD
Publication date
01-10-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 11/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5881-8

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