Impact of anastomotic leakage on long-term oncologic outcome and its related factors in rectal cancer

Noh, Gyoung Tae; Ann, Yeo Shen; Cheong, Chinock; Han, Jeong Hee; Cho, Min Soo; Hur, Hyuk; Min, Byung Soh; Lee, Kang Young; Kim, Nam Kyu

doi:10.1097/md.0000000000004367

Cited by 32 publications

(30 citation statements)

References 35 publications

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“…Several reports on CRC emphasize that a cut‐off value of PNI of 44.5 or more is associated to less frequent postoperative complications and a longer OS; a PNI above 36 in patients who underwent elective low anterior resection with colorectal anastomosis, is associated with a longer disease‐free survival . Several cutoff points for the PNI are reported, usually range from 35 to 50 …”

Section: Discussionmentioning

confidence: 99%

“…Several reports on CRC emphasize that a cut-off value of PNI of 44.5 or more is associated to less frequent postoperative complications and a longer OS 15,34-37 ; a PNI above 36 in patients who underwent elective low anterior resection with colorectal anastomosis, is associated with a longer diseasefree survival. 38 Several cutoff points for the PNI are reported, usually range from 35 to 50. 32 In our study, a cut-off value for PNI is intentionally not defined, because the association of PNI and OS yielded a clear biological gradient by bivariate analysis (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

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Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study

et al. 2019

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Background The TNM classification does not completely reflect the prognosis of patients with colorectal cancer (CRC). Several clinical factors have been used to increase its prognostic value, but factors pertaining to the patient's immunonutritional status have not usually been addressed. The aim of this study is to evaluate the role of Prognostic nutritional index (PNI) and other well‐known prognostic factors by multivariate analysis in a cohort of patients with CRC. Methods This is a retrospective cohort study of consecutive patients with CRC managed in a cancer center between January 1992 and December 2016. Cox's model was used to define the association of the PNI and other factors with Overall survival (OS). Results A total of 3301 patients were included: 47.7% were female and 52.3% were male, with a mean age of 58.7 years. By bivariate analysis, PNI was strongly associated with OS (Risk ratio [RR] 0.968, 95% Confidence interval [CI] 0.962‐0.974; P < 0.001). On multivariate analysis, PNI was an independent explanatory variable (as continuous variable and as categorized variable; RR 0.732, 95% CI 0.611‐0.878; RR 0.656, 95% CI 0.529‐0.813 and RR 0.646, 95% CI 0.521‐0.802, for quintiles 2, 3, and 4‐5, respectively); a biological gradient effect was demonstrated. The final prognostic model included PNI, location of the neoplasia in the colorectum, basal hemoglobin, lymphocyte count, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, TNM stage, differentiation degree, R classification, and postoperative complications. Conclusions PNI is a significant and independent prognostic factor in patients with CRC. Its prognostic value adds precision to the TNM staging system including specific subgroups of patients with CRC; it should be evaluated in prospective clinical studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study

et al. 2019

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“…However, Anastomotic leakage after rectal cancer is still controversial for the long‐term oncological outcome. Some research show that it is no significant correlation between anastomotic leakage and long‐term oncological outcome 13‐62 …”

Section: Introductionmentioning

confidence: 99%

The influence of anastomotic leakage for rectal cancer oncologic outcome: A systematic review and meta‐analysis

Yang

Chen

et al. 2020

Journal of Surgical Oncology

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Background and Objective: Anastomotic leakage is a serious complication after arterial resection of rectal cancer. It has been found that anastomotic leakage is related to the oncological outcome. The purpose of the study is to evaluate the long-term outcome of the rectal tumor after anastomotic leakage. Methods:The effect of anastomotic leakage on the oncological outcome of rectal cancer was studied by electronic literature retrieval. Using the DerSimonian Laird random effect model to calculate the odds ratio and 95% confidence interval.Research heterogeneity was evaluated by Q statistics and I 2 , and bias was evaluated by funnel plot and Begg's test.Results: A total of 35 studies and 44 698 patients were included in the study.The studies have shown that anastomotic leakage is associated with local recurrence (OR = 1.93; 95% CI, 1.57-2.38; P < .0001), overall survival (OR = 1.64; 95% CI, 1.37-1.95; P < .00001), disease-free survival (OR = 2.07; 95% CI, 1.50-2.87; P < .00001) and cancer-specific survival (OR = 1.32; 95% CI, 1.02-1.70; P = .012), while it was not related to distant recurrence (OR = 1.25; 95% CI, 0.95-1.65; P = .12). Conclusions:The results showed that anastomotic leakage after anterior resection increased the risk of local recurrence, decreased the overall survival, cancer-specific survival and disease-free survival. K E Y W O R D S anastomotic leakage, oncologic outcome, rectal cancer 1 | INTRODUCTION Colorectal cancer has become the second reason of cancer-relative death, and the morbidity of colorectal cancer is increasing every year. 1 Anastomotic leakage (AL) is one of the serious surgical complication after anterior resection. 2,3There is been reported that the incidence of anastomotic leakage after colorectal surgery is 3% to 21%. 4-11 It led a series complications and mortality, increased cost and time inpatient, even need to operate to the stoma. 12 In addition, it has been reported that anastomotic leakage is relative to poor oncologic outcomes such as local recurrence, decreased overall survival (OS), cancer-specific survival, and disease-free survival. However, Anastomotic leakage after rectal cancer is still controversial for the long-term oncological outcome. Some research show that it is no significant correlation between anastomotic leakage and long-term oncological outcome. Four previous meta-analyses reported the oncological outcome of anastomotic leakage after colorectal cancer surgery. [63][64][65][66] Two of these studies did not separate data from colorectal cancer completely. The other two studies analyzed patients who received rectal anterior resection alone. However, one meta-analysis of rectal anterior resection failed to analyze the influence of anastomotic leakage on the OS and disease-free survival (DFS). Another meta-analysis did not analyze the effect of anastomotic leakage on distant metastasis and DFS. Therefore, we conducted a current meta-analysis to provide a comprehensive and up to date long-term outcome analysis of anastomotic leakage after rectal surgery. 1...

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“…Moreover, patients who developed AL can have poor long-term anorectal function resulting from pelvic fibrosis, which includes decreased maximum tolerated volume, increased fecal frequency, urgency, and incontinence [4]. More seriously, AL can also promote pelvic recurrence and decrease the overall survival, as it contributes to the spread of intraluminal residual tumor cells and local inflammatory related immunosuppression and delays postoperative adjuvant therapy [5,6].…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

Wang

Liu

2020

Gastroenterology Research and Practice

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Background. Anastomotic leakage (AL) is a common and devastating postoperative issue for patients who have undergone anterior resection of rectal carcinoma and can lead to increased short-term morbidity and mortality. Moreover, it might be associated with a worse oncological prognosis of tumors. This study is aimed at exploring the risk factors for symptomatic AL after laparoscopic anterior resection (LAR) for rectal tumors without a preventive diverting stoma. Materials and Methods. This case control study retrospectively reviewed the data of 496 consecutive patients who underwent LAR of the rectum without a preventive diverting stoma at the Cancer Hospital, Chinese Academy of Medical Sciences between September 2016 and September 2017. All patients were divided into an AL group and a control group based on the occurrence of postoperative symptomatic AL. Factors regarding patient-related variables, operation-related variables, and tumor-related variables were collected and assessed between the two groups through univariate and multivariate logistic regression analyses to identify independent risk factors for AL. Results. In total, 18 (3.6%) patients developed postoperative symptomatic AL. Univariate analysis showed that a synchronous primary malignancy of the left hemicolon (P=0.047), intraoperative chemotherapy (P=0.003), and level of anastomosis (P=0.033) were significantly related with AL. Multivariate analysis was subsequently performed to adjust for confounding biases and confirmed that a synchronous primary malignancy of the left hemicolon (odds ratio (OR), 12.225; 95% confidence interval (CI), 1.764-84.702; P=0.011), intraoperative chemotherapy (OR, 3.931; 95% CI, 1.334-11.583; P=0.013), and level of anastomosis (OR, 3.224; 95% CI, 1.124-9.249; P=0.030) were independent risk factors for symptomatic AL for patients who received LAR for rectal neoplasms without a preventive diverting stoma. Conclusions. Synchronous primary malignancy of the left hemicolon, intraoperative chemotherapy, and a low anastomotic level can increase the risks of postoperative symptomatic AL after LAR of the rectum without a protective diverting stoma.

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Impact of anastomotic leakage on long-term oncologic outcome and its related factors in rectal cancer

Cited by 32 publications

References 35 publications

Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study

Association of the prognostic nutritional index and overall survival in patients with colorectal cancer: A STROBE compliant retrospective cohort study

The influence of anastomotic leakage for rectal cancer oncologic outcome: A systematic review and meta‐analysis

A Retrospective Study of Risk Factors for Symptomatic Anastomotic Leakage after Laparoscopic Anterior Resection of the Rectal Cancer without a Diverting Stoma

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