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      Adverse Effects of Anastomotic Leakage on Local Recurrence and Survival After Curative Anterior Resection for Rectal Cancer: A Systematic Review and Meta-analysis

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          Abstract

          Background

          Anastomotic leakage is a serious complication associated with anterior resection for rectal cancer, the long-term effects of which are unclear. Therefore, a systematic review and meta-analysis were conducted to evaluate the impact of anastomotic leakage on disease recurrence and survival.

          Methods

          We searched PubMed, Embase, and the Cochrane Library databases from their inception to January 2016. Studies evaluating the oncologic impact of anastomotic leakage were included in the meta-analysis. Outcome measures were local recurrence, overall survival, cancer-specific survival, and distant recurrence. Pooled hazard ratio (HR) with 95 % confidence interval (CI) was calculated using random effects models.

          Results

          Fourteen studies containing 11,353 patients met inclusion criteria. Anastomotic leakage was associated with a greater local recurrence (HR 1.71; 95 % CI 1.22–2.38) and decreased in both overall survival (HR 1.67; 95 % CI 1.19–2.35) and cancer-specific survival (HR 1.30; 95 % CI 1.08–1.56); anastomotic leakage did not increase distant recurrence (HR 1.03; 95 % CI 0.76–1.40).

          Conclusions

          Anastomotic leakage was associated with high local recurrence and poor survival (both overall and cancer-specific), but not with distant recurrence.

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          Most cited references37

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          Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer.

          Nuh N. Rahbari, Jürgen Weitz, Werner Hohenberger … (2010)
          Anastomotic leakage represents a major complication after anterior resection of the rectum. The incidence of anastomotic leakage varies considerably among clinical studies in part owing to the lack of a standardized definition of this complication. The aim of the present article was to propose a definition and severity grading of anastomotic leakage after anterior rectal resection. After a literature review a consensus definition and severity grading of anastomotic leakage was developed within the International Study Group of Rectal Cancer. Anastomotic leakage should be defined as a defect of the intestinal wall at the anastomotic site (including suture and staple lines of neorectal reservoirs) leading to a communication between the intra- and extraluminal compartments. Severity of anastomotic leakage should be graded according to the impact on clinical management. Grade A anastomotic leakage results in no change in patients' management, whereas grade B leakage requires active therapeutic intervention but is manageable without re-laparotomy. Grade C anastomotic leakage requires re-laparotomy. The proposed definition and clinical grading is applicable easily in the setting of clinical studies. It should be applied in future reports to facilitate valid comparison of the results of different studies. Copyright 2010 Mosby, Inc. All rights reserved.
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            Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis.

            Alexander Mirnezami, Reza Mirnezami, Kandiah Chandrakumaran … (2011)
            To examine the long-term oncological impact of anastomotic leakage (AL) after restorative surgery for colorectal cancer using meta-analytical methods. Outcomes evaluated were local recurrence, distant recurrence, and survival. Recurrence after potentially curative surgery for colorectal cancer remains a significant clinical problem and has a poor prognosis. AL may be a risk factor for disease recurrence, however available studies have been conflicting. A meta-analysis was conducted to investigate the impact of AL on disease recurrence and long-term survival. Studies published between 1965 and 2009 evaluating the long-term oncological impact of AL were identified by an electronic literature search. Outcomes evaluated included local recurrence, distant recurrence, and cancer specific survival. Meta-analysis was performed using the DerSimonian-Laird random-effects model to compute odds ratio and 95% confidence intervals. Study heterogeneity was evaluated using Q statistics and I and publication bias assessed with funnel plots and Egger's test. Twenty-one studies comprising 13 prospective nonrandomized studies, 1 prospective randomized, and 7 retrospective studies met the inclusion criteria, yielding a total of 21,902 patients. For rectal anastomoses, the odd ratios (OR) of developing a local recurrence when there was AL was 2.05 (95% CI = 1.51-2.8; P = 0.0001). For studies describing both colon and rectal anastomoses, the OR of local recurrence when there was an AL was 2.9 (95% CI = 1.78-4.71; P < 0.001). The OR of developing a distant recurrence after AL was 1.38 (95% CI = 0.96-1.99; P = 0.083). Long term cancer specific mortality was significantly higher after AL with an OR of 1.75 (95% CI = 1.47-2.1; P = 0.0001). AL has a negative prognostic impact on local recurrence after restorative resection of rectal cancer. A significant association between colorectal AL and reduced long-term cancer specific survival was also noted. No association between AL and distant recurrence was found. @ 2011 Lippincott Williams & Wilkins, Inc.
            Article 0 comments Cited 268 times – based on 0 reviews     Review now
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              Systemic inflammatory response predicts survival following curative resection of colorectal cancer.

              D McMillan, K Canna, C S McArdle (2003)
              Some studies have shown that the presence of a systemic inflammatory response, as evidenced by raised circulating concentrations of C-reactive protein (CRP), predicted recurrence and overall survival in patients with colorectal cancer. The aim of this study was to examine the relationship between the inflammatory response and overall and cancer-specific survival in patients undergoing potentially curative resection for colorectal cancer. A total of 174 patients considered to have undergone curative resection were studied. Circulating CRP concentrations were measured before and/or after operation. The majority of patients were aged 65 years or more, had colonic tumours and Dukes' stage B lesions. During follow-up, 47 patients (27 per cent) developed recurrence and 59 (34 per cent) died. On univariate analysis, age (P < 0.01), Dukes' stage (P < 0.001), and CRP levels before (P < 0.01) and after (P < 0.01) operation were significantly associated with overall and cancer-specific survival. On multivariate analysis of patients in whom preoperative CRP concentration was measured, age (P < 0.01), Dukes' stage (P < 0.05) and CRP concentration (P < 0.01) were independently associated with both overall and cancer-specific survival. In patients who have undergone potentially curative resection for colorectal cancer, the presence of a systemic inflammatory response predicts a poor outcome.
              Article 0 comments Cited 138 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Shuanhu Wang: +86-552-3086151 , knight01030103@126.com
                Wenbin Wang: wbwangay@163.com
                Journal
                Journal ID (nlm-ta): World J Surg
                Journal ID (iso-abbrev): World J Surg
                Title: World Journal of Surgery
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 0364-2313
                ISSN (Electronic): 1432-2323
                Publication date (Electronic): 14 October 2016
                Publication date PMC-release: 14 October 2016
                Publication date (Print): 2017
                Volume: 41
                Issue: 1
                Pages: 277-284
                Affiliations
                [1 ]Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui China
                [2 ]Department of General Surgery, The Forth Affiliated Hospital of Anhui Medical University, Hefei, Anhui China
                Article
                Publisher ID: 3761
                DOI: 10.1007/s00268-016-3761-1
                PMC ID: 5209428
                PubMed ID: 27743072
                SO-VID: 17fa622e-0e42-4de6-b66f-6ff190fcd7c1
                Copyright © © The Author(s) 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                Subject: Scientific Review
                Custom metadata
                issue-copyright-statement © Société Internationale de Chirurgie 2017

                ScienceOpen disciplines: Surgery
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                ScienceOpen disciplines: Surgery

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