title: Anastomotic leakage contributes to the risk for systemic recurrence in stage II colorectal cancer.
abstract: OBJECTIVE
  In stage II colorectal cancer (CRC), high-risk patient selection is required, but no candidate markers have been elucidated. Our concern was whether anastomotic leakage (Lk) is a potential available clinicopathological factor for selecting high-risk stage II.
  
  
  METHODS
  Two hundred seven patients with stage II CRC who underwent curative resection were analyzed. Clinical variables were tested for their relationship to survival.
  
  
  RESULTS
  The 5-year disease-free survival rate (DFS) was 87.0%. The univariable prognostic analyses indicated that Lk (P = 0.003) was the only significant factor. The multivariable prognostic analysis revealed that Lk remained to be potently independent [hazard ratio (HR), 4.21, P = 0.021), and the DFS was 58.3% in cases with Lk, while 88.7% in the counterpart. The multivariable logistic regression analysis revealed perioperative blood transfusion (P = 0.001) was independently associated with Lk. Intriguingly, Lk was closely associated with hematogenic recurrence (P = 0.003) rather than peritoneal or local recurrence. Although sustained increase of the serum C-reactive protein at 2 weeks after operation predicted poor prognosis, the mutitivariable analysis including the C-reactive protein level revealed that Lk still indicated the prognostic potential (HR, 3.70, P = 0.075).
  
  
  CONCLUSIONS
  The findings concluded that Lk may be a high risk for systemic recurrence in stage II CRC.
authors.affiliation: Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, 252-0374, Kanagawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Katoh
authors.forename: Keishi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Guoqin
authors.initials: G
authors.lastname: Wang
authors.forename: Takeo
authors.initials: T
authors.lastname: Sato
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology*; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors