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01.12.2011 | Original Article

The Influence of Fecal Diversion and Anastomotic Leakage on Survival after Resection of Rectal Cancer

verfasst von: Jen-Kou Lin, Te-Cheng Yueh, Shih-Ching Chang, Chun-Chi Lin, Yuan-Tzu Lan, Huann-Sheng Wang, Shung-Haur Yang, Jeng-Kai Jiang, Wei-Shone Chen, Tzu-Chen Lin

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 12/2011

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Abstract

Background

We analyzed factors associated with the occurrence of anastomotic leakage (AL) and its impact on long-term survival in patients who have undergone resection for rectal cancer. We also investigated the effect of fecal diversion on survival.

Method

Clinical data of patients who received surgery for rectal cancer were reviewed. The difference in AL incidence among different groups was compared and survival rates were calculated. Cox’s proportional hazards model was used to compare survival in patients who developed AL or received diversion stoma with those who did not.

Results

Of 999 patients who received resection and anastomosis, 53 patients experienced AL. Multivariate analysis revealed advanced age (P = 0.009) and operative method (P = 0.002) were independent risk factors for AL. Anastomotic leakage was an independent risk factor for overall recurrence (HR 2.30; 95% CI 1.12–4.73). Anastomotic leakage and fecal diversion were independent prognostic factors of overall survival (P = 0.002 and P < 0.001, respectively), cancer-specific survival (P = 0.002 and P < 0.001, respectively), and disease-free survival (P < 0.001, respectively).

Conclusions

Patients who are older and have anastomosis at the anorectal junction or dentate line have an increased risk of AL. A diversion stoma does not appear to decrease the incidence of anastomotic leakage, but may decrease the need of reoperation when leakage occurred. Anastomotic leakage and fecal diversion are independent prognostic factors of overall, cancer-specific, and disease-free survival.

Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998; 85: 355–358.PubMedCrossRef

Pakkasite TE, Luukkonen PE, Jarvien HJ. Anastomotic leakage after anterior resection of the rectum. Eur J Surg 1994; 160: 293–297; discussion 299–300.

Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, Rutten HJ, van de Velde CJ; Dutch Colorectal Cancer Group. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 2005; 92: 211–216.PubMedCrossRef

Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 1997; 185: 105–113.PubMed

Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 2002; 26: 499–502.PubMedCrossRef

Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di Carlo V. Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 2000; 43: 76–82.PubMedCrossRef

Luna-Pérez P, Rodríguez-Ramírez SE, Gutiérrez de la Barrera M, Labastida S. [Multivariate analysis of risk factors associated with dehiscence of colorectal anastomosis after anterior or lower anterior resection for sigmoid or rectal cancer.] Rev Invest Clin 2002; 54: 501–508. [Article in Spanish]PubMed

Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 2004; 6: 462–469.PubMedCrossRef

Konishi T, Watanabe T, Kishimoto J, Nagawa H. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 2006; 202: 439–444.PubMedCrossRef

10.

Alberts JC, Parvaiz A, Moran BJ. Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis 2003; 5: 478–482.PubMedCrossRef

11.

Mäkelä JT, Kiviniemi H, Laitinen S. Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 2003; 46: 653–660.PubMedCrossRef

12.

Law WI, Chu KW, Ho JW, Chan CW. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 2000; 179: 92–96.PubMedCrossRef

13.

Pakkastie TE, Ovaska JT, Pekkala ES, Luukkonen PE, Jarvinen HJ. A randomised study of colostomies in low colorectal anastomoses. Eur J Surg 1997; 163: 929–933.PubMed

14.

Allen-Mersh TG, Sprague DB, Mann CV, Turner MJ. Pelvic drainage after anterior resection of the rectum. Dis Colon Rectum 1989; 32: 223–226.PubMedCrossRef

15.

Beard JD, Nicholson ML, Sayers RD, Lloyd D, Everson NW. Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial. Br J Surg 1990; 77: 1095–1097.PubMedCrossRef

16.

Schmidt O, Merkel S, Hohenberger W. Anastomotic leakage after low rectal stapler anastomosis: significance of intraoperative anastomotic testing. Eur J Surg Oncol 2003; 29: 239–243.PubMedCrossRef

17.

Yalin R, Aktan AO, Yegen C, Dosluoglu H, Okboy N. Importance of testing stapled rectal anastomoses with air. Eur J Surg 1993; 159: 49–51.PubMed

18.

Abulafi AM, Williams NS. Local recurrence of colorectal cancer: the problem, mechanisms, management and adjuvant therapy. Br J Surg 1994; 81: 7–19.PubMedCrossRef

19.

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

20.

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: 1261–1266.PubMedCrossRef

21.

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: 160–163.PubMedCrossRef

22.

Jatzko GR, Jagoditsch M, Lisborg PH. Long-term results of radical surgery for rectal cancer: multivariate analysis of prognostic factors influence survival and local recurrence. Eur J Surg Oncol 1999; 25: 284–291.PubMedCrossRef

23.

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: 51–57.PubMedCrossRef

24.

Branagan G, Finnes D; Wessex Colorectal Cancer Audit Working Group. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 2005; 48: 1021–1026.

25.

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: 902–908. PubMedCrossRef

26.

Lee MR, Hong CW, Yoon SN, Lim SB, Park KJ, Park JG. Risk factors for anastomotic leakage after resection for rectal cancer. Hepatogastroenterology 2006; 53: 682–686.PubMed

27.

Akyol AM, McGregor JR, Galloway DJ, Murray G, George WD. Anastomotic leaks after colorectal cancer surgery: a risk factor for recurrence? Int J Colorectal Dis 1991; 6: 179–183.PubMedCrossRef

28.

Graffner H, Fredlund P, Olsson SA, Oscarson J, Petersson BG. Protective colostomy in low anterior resection of the rectum using EEA stapling instrument. A randomized study. Dis Colon Rectum 1983; 26: 87–90.PubMedCrossRef

29.

Phillips RK, Hittinger R, Blesovsky L, Fry JS, Fielding LP. Local recurrence following ‘curative’ surgery for large bowel cancer: II. The rectum and rectosigmoid. Br J Surg 1984; 71: 17–20.PubMedCrossRef

30.

Chang SC, Lin JK, Yang SH, Jiang JK, Chen WC, Lin TC. Long-term outcome of anastomosis leakage after curative resection for mid and low rectal cancer. Hepatogastroenterology 2003; 50: 1898–1902.PubMed

31.

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: 1150–1154.PubMedCrossRef

32.

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.PubMedCrossRef

33.

Umpleby HC, Fermor B, Symes MO, Williamson RC. Viability of exfoliated colorectal carcinoma cells. Br J Surg 1984; 71: 659–663.PubMedCrossRef

34.

Skipper D, Cooper AJ, Marston JE, Taylor I. Exfoliated cells and in vitro growth in colorectal cancer. Br J Surg 1987; 74: 1049–1052.PubMedCrossRef

35.

Jenner DC, de Boer WB, Clarke G, Levitt MD. Rectal washout eliminates exfoliated malignant cells. Dis Colon Rectum 1998; 41: 1432–1434.PubMedCrossRef

36.

Gertsch P, Baer HU, Kraft R, Maddern GJ, Altermatt HJ. Malignant cells are collected on circular staples. Dis Colon Rectum 1992; 35: 238–241.PubMedCrossRef

37.

DerHagopian RP, Sugarbaker EV, Ketcham A. Inflammatory oncotaxis. JAMA 1978; 240: 374–375.PubMedCrossRef

38.

Shine T, Wallack MK. Inflammatory oncotaxis after testing the skin of the cancer patient. Cancer 1981; 47: 1325–1328.PubMedCrossRef

39.

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: 1066–1075.CrossRef

40.

Karanjia ND, Corder AP, Holdsworth PJ, Heald RJ. Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis. Br J Surg 1991; 78: 196–198.PubMedCrossRef

41.

Mealy K, Burke P, Hyland J. Anterior resection without a defunctioning colostomy: questions of safety. Br J Surg 1992; 79: 305–307.PubMedCrossRef

42.

Meleagros L, Varty PP, Delrio P, Boulos PB. Influence of temporary faecal diversion on long-term survival after curative surgery for colorectal cancer. Br J Surg 1995; 82: 21–25.PubMedCrossRef

43.

Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994; 81: 1224–1226.PubMedCrossRef

44.

Fielding LP, Stewart-Brown S, Hittinger R, Blesovsky L. Covering stoma for elective anterior resection of the rectum: an outmoded operation? Am J Surg 1984; 147: 524–530.PubMedCrossRef

Titel: The Influence of Fecal Diversion and Anastomotic Leakage on Survival after Resection of Rectal Cancer
verfasst von: Jen-Kou Lin
Te-Cheng Yueh
Shih-Ching Chang
Chun-Chi Lin
Yuan-Tzu Lan
Huann-Sheng Wang
Shung-Haur Yang
Jeng-Kai Jiang
Wei-Shone Chen
Tzu-Chen Lin
Publikationsdatum: 01.12.2011
Verlag: Springer-Verlag
Erschienen in: Journal of Gastrointestinal Surgery / Ausgabe 12/2011
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-011-1721-5

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The Influence of Fecal Diversion and Anastomotic Leakage on Survival after Resection of Rectal Cancer