title: Long-term outcome of anastomosis leakage after curative resection for mid and low rectal cancer.
abstract: OBJECTIVE
  The aim of this study was to evaluate the relationship of the disease recurrence and prognosis of rectal cancer with anastomosis leakage after curative low anterior resection.
  
  
  METHODS
  The records of 566 patients with primary rectal adenocarcinoma in the Veterans General Hospital-Taipei, Taiwan between 1991 and 1997 were reviewed. Patients who did not have anastomosis (abdominoperineal resection 72, Hartmann's operation 15), did not have curative resection (62) or expired within 30 days after operation (11) were excluded from the study. Another 34 patients were excluded because they did not visit our clinic or could not be reached by telephone or questionnaire after operation. 372 patients who received restorative curative resection with a colorectal anastomosis were analyzed. The product-limit method (Kaplan-Meier) and Cox proportional hazard model were used to analyze survival rate and tumor recurrence.
  
  
  RESULTS
  Twenty-five out of the 406 patients had anastomosis leakage after the operation. The 5-year disease-free, local recurrence-free survival of the leakage group (32.5%, 58.7%) was significantly lower than that of the non-leakage group (71%, 88.3%). The multivariate analysis showed TNM staging (p = 0.0001) and histological differentiation (p = 0.0002) were associated with overall tumor recurrence. The factors affected local tumor recurrence were TNM staging (p = 0.006) and anastomosis leakage (p = 0.014).
  
  
  CONCLUSIONS
  These results suggested that anastomotic leakage after curative rectal surgery is associated with the local tumor recurrence-free survival rate even after adjusting for stage.
authors.affiliation: Division of Colon & Rectal Surgery, Department of Surgery, National Yang-Ming University, Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Chang
authors.forename: Jen-Kou
authors.initials: JK
authors.lastname: Lin
authors.forename: Shung Haur
authors.initials: SH
authors.lastname: Yang
authors.forename: Jen-Kae
authors.initials: JK
authors.lastname: Jiang
authors.forename: Wei-Chone
authors.initials: WC
authors.lastname: Chen
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Lin
mesh_terms: D000206:Actuarial Analysis; D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000714:Anastomosis, Surgical; D039021:Colonic Pouches; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000401:mortality; D015996:Survival Rate; D013624:Taiwan