title: Multicenter Analysis of Long-Term Oncologic Impact of Anastomotic Leakage After Laparoscopic Total Mesorectal Excision: The Korean Laparoscopic Colorectal Surgery Study Group.
abstract: This study aims to validate the oncologic outcomes of anastomotic leakage (AL) after laparoscopic total mesorectal excision (TME) in a large multicenter cohort. The impact of AL after laparoscopic TME for rectal cancer surgery has not yet been clearly described. This was a multicenter retrospective study of 1083 patients who underwent laparoscopic TME for nonmetastatic rectal cancer (stage 0-III). AL was defined as an anastomotic complication within 30 days of surgery irrespective of requiring a reoperation or interventional radiology. Estimated local recurrence (LR), disease-free survival (DFS), and overall survival (OS) were compared between the leakage group and the no leakage group using the log-rank method. Multivariate Cox-regression analysis was used to adjust confounding for survival. The incidence of AL was 6.4%. Mortality within 30 days of surgery occurred in 1 patient (1.4%) in the leakage group and 2 patients (0.2%) in the no leakage group. The leakage group showed a higher LR rate (6.4% vs 1.8%, P = 0.011). Five-year DFS and OS were significantly lower in the leakage group than the no leakage group (DFS 71.7% vs 82.1%, P = 0.016, OS 81.8% vs 93.5%, P = 0.007). Multivariate analysis showed that AL was an independent poor prognostic factor for DFS and OS (hazard ratio [HR] = 1.6; 95% confidence intervals [CI]: 1.0-2.6; P = 0.042, HR = 2.1; 95% CI: 1.0-4.2; P = 0.028, respectively). AL after laparoscopic TME was significantly associated with an increased rate of LR, systemic recurrence and poor OS.
authors.affiliation: From the Division of Colorectal Surgery, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (JK, SHB); Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea (G-SC, JSP); Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Korea (JHO, MJK); and Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (NKK, KYL).
authors.forename: Jeonghyun
authors.initials: J
authors.lastname: Kang
authors.forename: Gyu-Seog
authors.initials: GS
authors.lastname: Choi
authors.forename: Jae Hwan
authors.initials: JH
authors.lastname: Oh
authors.forename: Nam Kyu
authors.initials: NK
authors.lastname: Kim
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Min Jung
authors.initials: MJ
authors.lastname: Kim
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Baik
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology* / Q000401:mortality; D059186:Chemoradiotherapy, Adjuvant; D003107:Colorectal Surgery / Q000009:adverse effects* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000601:surgery* / Q000628:therapy; D056910:Republic of Korea; D012189:Retrospective Studies