For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
5
views
45
references
 Top references
cited by
9
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      369
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      The impact of anastomotic leakage on oncology after curative anterior resection for rectal cancer : A systematic review and meta-analysis

      review-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background:

          Anastomotic leakage (AL) is a serious clinical complication after anterior resection for rectal cancer and will lead to an increase in postoperative mortality. However, the effect on long-term oncology outcomes remains controversial.

          Methods:

          We searched the PubMed, Embase, and Cochrane library databases for related articles. The included studies assessed local recurrence, distant recurrence, overall survival, cancer-specific survival and disease-free survival. The systematic reviews and meta-analyses was conducted in accordance with the PRISMA guidelines. The combined RRs with 95% CI were then calculated using a fixed effects model or a randomized effect model.

          Results:

          A total of 18 cohort studies included 34,487 patients who met the inclusion criteria. The meta-analysis demonstrated that AL was associated with increased local recurrence (RR 1.47, 95% CI 1.14–1.90, I 2 = 57.8%). Anastomotic leakage decreased overall survival (RR 0.92, 95% CI 0.88–0.96, I 2 = 58.1%), cancer-specific survival (RR 0.96, 95% CI 0.92–1.00, I 2 = 30.4%), and disease-free survival (RR 0.85, 95% CI 0.77–0.94, I 2 = 80.4%). Distant recurrence may had no significant effects of AL (RR 1.16, 95% CI 0.91–1.46, I 2 = 58.4%).

          Conclusion:

          AL has a negative effect on local recurrence and long-term survival (including overall survival, cancer-specific survival, and disease-free survival) after anterior resection for rectal cancer, but not related to distant recurrence.

          Related collections

          Most cited references45

          • Record: found
          • Abstract: found
          • Article: not found

          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.
          Article 0 comments Cited 429 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03.

            Mark S. Roh, Linda Colangelo, Michael O'Connell … (2009)
            Although chemoradiotherapy plus resection is considered standard treatment for operable rectal carcinoma, the optimal time to administer this therapy is not clear. The NSABP R-03 (National Surgical Adjuvant Breast and Bowel Project R-03) trial compared neoadjuvant versus adjuvant chemoradiotherapy in the treatment of locally advanced rectal carcinoma. Patients with clinical T3 or T4 or node-positive rectal cancer were randomly assigned to preoperative or postoperative chemoradiotherapy. Chemotherapy consisted of fluorouracil and leucovorin with 45 Gy in 25 fractions with a 5.40-Gy boost within the original margins of treatment. In the preoperative group, surgery was performed within 8 weeks after completion of radiotherapy. In the postoperative group, chemotherapy began after recovery from surgery but no later than 4 weeks after surgery. The primary end points were disease-free survival (DFS) and overall survival (OS). From August 1993 to June 1999, 267 patients were randomly assigned to NSABP R-03. The intended sample size was 900 patients. Excluding 11 ineligible and two eligible patients without follow-up data, the analysis used data on 123 patients randomly assigned to preoperative and 131 to postoperative chemoradiotherapy. Surviving patients were observed for a median of 8.4 years. The 5-year DFS for preoperative patients was 64.7% v 53.4% for postoperative patients (P = .011). The 5-year OS for preoperative patients was 74.5% v 65.6% for postoperative patients (P = .065). A complete pathologic response was achieved in 15% of preoperative patients. No preoperative patient with a complete pathologic response has had a recurrence. Preoperative chemoradiotherapy, compared with postoperative chemoradiotherapy, significantly improved DFS and showed a trend toward improved OS.
            Article 0 comments Cited 247 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997.

              Meghan Moran, Gary J Macfarlane, R. Heald … (1998)
              To examine the role of total mesorectal excision in the management of rectal cancer. A prospective consecutive case series. A district hospital and referral center in Basingstoke, England. Five hundred nineteen surgical patients with adenocarcinoma of the rectum treated for cure or palliation. Anterior resections (n = 465) with low stapled anastomoses (407 total mesorectal excisions), abdominoperineal resections (n = 37), Hartmann resections (n = 10), local excisions (n = 4), and laparotomy only (n = 3). Preoperative radiotherapy was used in 49 patients (7 with abdominoperineal resections, 38 with anterior resections, 3 with Hartmann resections, and 1 with laparotomy). Local recurrence and cancer-specific survival. Cancer-specific survival of all surgically treated patients was 68% at 5 years and 66% at 10 years. The local recurrence rate was 6% (95% confidence interval, 2%-10%) at 5 years and 8% (95% confidence interval, 2%-14%) at 10 years. In 405 "curative" resections, the local recurrence rate was 3% (95% confidence interval, 0%-5%) at 5 years and 4% (95% confidence interval, 0%-8%) at 10 years. Disease-free survival in this group was 80% at 5 years and 78% at 10 years. An analysis of histopathological risk factors for recurrence indicates only the Dukes stage, extramural vascular invasion, and tumor differentiation as variables in these results. Rectal cancer can be cured by surgical therapy alone in 2 of 3 patients undergoing surgical excision in all stages and in 4 of 5 patients having curative resections. In future clinical trials of adjuvant chemotherapy and radiotherapy, strategies should incorporate total mesorectal excision as the surgical procedure of choice.
              Article 0 comments Cited 144 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Lippincott Williams & Wilkins (Hagerstown, MD )
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: 11 September 2020
                Publication date (Electronic): 11 September 2020
                Volume: 99
                Issue: 37
                Electronic Location Identifier: e22139
                Affiliations
                [a ]Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University
                [b ]Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China.
                Author notes
                [∗ ]Correspondence: Chong Ma, Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130033, China (e-mail: Machong@ 123456jlu.edu.cn ).
                Author information
                http://orcid.org/0000-0002-9505-0726
                Article
                Publisher ID: MD-D-20-03092 Accession ID: 22139
                DOI: 10.1097/MD.0000000000022139
                PMC ID: 7489661
                PubMed ID: 32925766
                SO-VID: ed61c31e-d366-4268-a42a-a93f091fc67e
                Copyright © Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                Date received : 5 April 2020
                Date revision received : 2 August 2020
                Date accepted : 10 August 2020
                Categories
                Subject: 4500
                Subject: Research Article
                Subject: Systematic Review and Meta-Analysis
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: anastomotic leak,anterior resection,rectal cancer,recurrence,survival
                Data availability:
                Keywords: anastomotic leak, anterior resection, rectal cancer, recurrence, survival

                Comments

                Comment on this article

                scite_

                Similar content369

                See all similar

                Cited by9

                See all cited by

                Most referenced authors974

                See all reference authors