title: The types of anastomotic leakage that develop following anterior resection for rectal cancer demonstrate distinct characteristics and oncologic outcomes.
abstract: OBJECTIVE
  The types of anastomotic leakage that develop following rectal cancer surgery and their impact on long-term outcomes are not well documented. This study aimed to compare the clinical characteristics of various types of anastomotic leakage after anterior resection in rectal cancer patients and evaluate their impact on the long-term oncologic outcomes.
  
  
  METHODS
  This study analyzed data obtained from 2510 consecutive patients who underwent anterior resection for rectal cancers. Of these patients, 141 (5.6 %) developed anastomotic leakage. Three types of leakage were categorized according to presentation: generalized peritonitis (type I), localized peritonitis (type II), and fistula or chronic sinus (type III). The clinical characteristics and oncologic outcomes were compared.
  
  
  RESULTS
  Type I leakage was the most common (I 44.7 %, n = 63; II 30.5 %, n = 43; III 24.8 %, n = 35). Type III occurred more frequently in women (p = 0.001) and patients with low rectal cancer (p < 0.001). Patients with type II or III leakage more frequently underwent radiation therapy (p < 0.001) and diverting ostomy (p < 0.001). Leakage management differed according to the type of leakage (p < 0.001). The local recurrence-free survival rate was significantly lower in patients with type II and III leakage (p = 0.014).
  
  
  CONCLUSIONS
  The clinical characteristics and oncologic results are distinct for each type of anastomotic leakage. Only a type II or III leakage increases the risk of local recurrence. Each type of leakage should thus be considered a different disease entity.
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, South Korea. sblim@amc.seoul.kr.
authors.forename: Seok-Byung
authors.initials: SB
authors.lastname: Lim
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Chan Wook
authors.initials: CW
authors.lastname: Kim
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Yoon
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: In Ja
authors.initials: IJ
authors.lastname: Park
authors.affiliation: Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Asanbyeongwon-gil 86, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
mesh_terms: D000038:Abscess / Q000209:etiology; D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D008297:Male; D009364:Neoplasm Recurrence, Local; D010538:Peritonitis / Q000209:etiology; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors
keywords: Anastomotic leakage; Anterior resection; Oncologic outcome; Type