Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery.
BACKGROUND
The association between diverting stomas and symptomatic anastomotic leakage after rectal cancer surgery was studied, as well as the impact of leakage on local recurrence, distant metastasis, and disease-free, overall and cancer-specific survival.


METHODS
Data from the Swedish Rectal Cancer Trial, Dutch TME trial, CAO/ARO/AIO-94 trial, EORTC 22921 trial and Polish Rectal Cancer Trial were pooled (n = 5187). All eligible patients without distant metastases at the time of low anterior resection were selected (n = 2726); overall survival was studied in patients aged 75 years or less (n = 2480). Multivariable models were used to study the association between diverting stomas and anastomotic leakage, and between leakage and recurrence or survival.


RESULTS
Some 9.7 per cent of patients were diagnosed with a symptomatic anastomotic leak; diverting stomas were negatively associated with leakage (11.6 per cent without and 7.8 per cent with a stoma; P = 0.002). Anastomotic leakage was negatively associated with overall survival in the multivariable analysis (hazard ratio (HR) 1.29 (95 per cent confidence interval 1.02 to 1.63); P = 0.034), but not with cancer-specific survival (HR 1.12 (0.83 to 1.52); P = 0.466).


CONCLUSIONS
Diverting stomas were associated with less symptomatic anastomotic leakage. Oncological outcome was not significantly influenced by leakage, but overall survival was reduced.
den Dulk
M
M
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Marijnen
C A M
CA
Collette
L
L
Putter
H
H
Påhlman
L
L
Folkesson
J
J
Bosset
J-F
JF
Rödel
C
C
Bujko
K
K
van de Velde
C J H
CJ
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D054047:Surgical Stomas; D013529:Surgical Wound Dehiscence / Q000401:mortality*