title: The influence of fecal diversion and anastomotic leakage on survival after resection of rectal cancer.
abstract: BACKGROUND
  We analyzed factors associated with the occurrence of anastomotic leakage (AL) and its impact on long-term survival in patients who have undergone resection for rectal cancer. We also investigated the effect of fecal diversion on survival.
  
  
  METHODS
  Clinical data of patients who received surgery for rectal cancer were reviewed. The difference in AL incidence among different groups was compared and survival rates were calculated. Cox's proportional hazards model was used to compare survival in patients who developed AL or received diversion stoma with those who did not.
  
  
  RESULTS
  Of 999 patients who received resection and anastomosis, 53 patients experienced AL. Multivariate analysis revealed advanced age (P = 0.009) and operative method (P = 0.002) were independent risk factors for AL. Anastomotic leakage was an independent risk factor for overall recurrence (HR 2.30; 95% CI 1.12-4.73). Anastomotic leakage and fecal diversion were independent prognostic factors of overall survival (P = 0.002 and P < 0.001, respectively), cancer-specific survival (P = 0.002 and P < 0.001, respectively), and disease-free survival (P < 0.001, respectively).
  
  
  CONCLUSIONS
  Patients who are older and have anastomosis at the anorectal junction or dentate line have an increased risk of AL. A diversion stoma does not appear to decrease the incidence of anastomotic leakage, but may decrease the need of reoperation when leakage occurred. Anastomotic leakage and fecal diversion are independent prognostic factors of overall, cancer-specific, and disease-free survival.
authors: Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan. jklin@vghtpe.gov.tw
authors: Jen-Kou
authors: JK
authors: Lin
authors: Te-Cheng
authors: TC
authors: Yueh
authors: Shih-Ching
authors: SC
authors: Chang
authors: Chun-Chi
authors: CC
authors: Lin
authors: Yuan-Tzu
authors: YT
authors: Lan
authors: Huann-Sheng
authors: HS
authors: Wang
authors: Shung-Haur
authors: SH
authors: Yang
authors: Jeng-Kai
authors: JK
authors: Jiang
authors: Wei-Shone
authors: WS
authors: Chen
authors: Tzu-Chen
authors: TC
authors: Lin
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D057868:Anastomotic Leak / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome