Anastomotic Leakage Is Associated with Impaired Overall and Disease-Free Survival after Curative Rectal Cancer Resection: A Propensity Score Analysis

Publication

Anastomotic Leakage Is Associated with Impaired Overall and Disease-Free Survival after Curative Rectal Cancer Resection: A Propensity Score Analysis

Journal Paper/Review - Oct 28, 2014

Kulu Yakup, Tarantino Ignazio, Warschkow Rene, Kny Sandra, Schneider Martin, Schmied Bruno, Büchler Markus W, Ulrich Alexis

Citation

Kulu Y, Tarantino I, Warschkow R, Kny S, Schneider M, Schmied B, Büchler M, Ulrich A. Anastomotic Leakage Is Associated with Impaired Overall and Disease-Free Survival after Curative Rectal Cancer Resection: A Propensity Score Analysis. Ann Surg Oncol 2014; 22:2059-2067.

Type

Journal Paper/Review (English)

Journal

Ann Surg Oncol 2014; 22

Publication Date

Oct 28, 2014

Issn Electronic

1534-4681

Pages

2059-2067

Brief description/objective

BACKGROUND
Whether anastomotic leakage (AL) has a negative impact on survival remains a matter of debate. This study aimed to assess the impact of AL on the overall and disease-free survival of patients undergoing curative resection of stages 1-3 rectal cancer using propensity-scoring methods.

METHODS
In a single-center study, 570 patients undergoing curative resection of stages 1-3 rectal cancer between January 2002 and December 2011 were assessed. The mean follow-up period was 4.7 ± 2.9 years. Patients who did and did not experience AL were compared using Cox regression and propensity score analyses.

RESULTS
Overall, 51 patients (8.9 %) experienced an AL. The characteristics of the patients were highly biased concerning AL (propensity score, 0.16 ± 0.12 vs. 0.09 ± 0.07; P < 0.001). Anastomotic leakage was uniformly associated with a significantly increased risk of mortality in unadjusted analysis [hazard ratio (HR) 2.30; 95 % confidence interval (CI) 1.40-3.76; P = 0.003], multivariable Cox regression (HR 2.27; 95 % CI 1.33-3.88; P = 0.005), and propensity score-adjusted Cox regression (HR 2.07; 95 % CI 1.21-3.55; P = 0.014). Similarly, disease-free survival was significantly impaired in patients who experienced AL according to unadjusted analysis (HR 1.88; 95 % CI 1.19-2.95; P = 0.011), multivariable Cox regression (HR 1.90; 95 % CI 1.17-3.09; P = 0.014), and propensity score-adjusted Cox regression (HR 2.31; 95 % CI 1.40-3.80; P = 0.002).

CONCLUSIONS
This is the first propensity score-based analysis providing evidence that oncologic outcome may be impaired after curative rectal cancer resection in patients with AL.