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

Abstract

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...

Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

“…In contrast, the previous meta-analysis by Bashir et al concluded that patients with AL have a lower 5-year OS of 58% compared with 73% in nonleaking patients [24]. Moreover, the negative impact of AL on OS was indicated by Yang et al and a large Scandinavian cohort study by Stormark et al [25,26]. Our study confirmed the impaired OS and DFS in patients suffering from AL, and there is a rationale for such findings.…”

Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

“…and a large Scandinavian cohort study by Stormark et al 25,26 Our study con rmed the impaired OS and DFS in patients suffering from AL and there is a rationale for such ndings. First, AL may lead to an increased rate of local recurrence because of cancer cell implantation and progression at the in amed leaking anastomotic site.…”

Risk Factors of Symptomatic Anastomotic Leakage and its Impacts on Long Term&nbsp;Survival after Laparoscopic Low Anterior Resection for Rectal Cancer:&nbsp;A Retrospective Single Center Study

“…Therefore, the risk factors of AL after laparoscopic LAR may differ from those after laparotomy. Furthermore, by reviewing articles published in the past 5 years, we found out that no agreement has been achieved on whether AL has an impact on oncological outcomes or not [10,12,13]. Therefore, the present study has two clinical objectives: (1) to identify the risk factors of symptomatic AL after laparoscopic LAR based on patient, surgery, and tumor-related variables and (2) to investigate the impact of symptomatic AL on 3and 5-year overall survival rates.…”