title: Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery.
abstract: 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.
authors: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors: M
authors: M
authors: den Dulk
authors: C A M
authors: CA
authors: Marijnen
authors: L
authors: L
authors: Collette
authors: H
authors: H
authors: Putter
authors: L
authors: L
authors: Påhlman
authors: J
authors: J
authors: Folkesson
authors: J-F
authors: JF
authors: Bosset
authors: C
authors: C
authors: Rödel
authors: K
authors: K
authors: Bujko
authors: C J H
authors: CJ
authors: van de Velde
mesh_terms: 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*