title: Anastomotic leakage after curative rectal cancer resection has no impact on long-term survival: a propensity score analysis.
abstract: OBJECTIVE
  Anastomotic leakage (AL) is a severe and frequent complication of rectal cancer resection, with an incidence rate of approximately 9 %. Although the impact of AL on morbidity and short-term mortality has been established, the literature is contradictory regarding its influence on long-term, cancer-specific survival. The present investigation assessed the long-term survival of 584 patients with stage I-III rectal cancer.
  
  
  METHODS
  The 10-year overall survival and cancer-specific survival were analyzed in 584 patients from a single tertiary center. All patients had undergone curative rectal cancer resection between 1991 and 2010. Patients with and without AL were compared using both a multivariate Cox hazards model and propensity score analysis.
  
  
  RESULTS
  A total of 64 patients developed AL (11.0 %, 95 % confidence interval (CI) = 8.7 to 13.8 %). The median follow-up was 5.2 years for all patients; and 7.4 years for patients still alive at the end of the investigated period. AL did persistently not impair cancer-specific survival based on unadjusted Cox regression (hazard ratio of death (HR) = 1.27, 95 % CI = 0.65 to 2.48, P = 0.489); risk-adjusted Cox regression (HR = 1.10, 95 % CI = 0.54 to 2.20, P = 0.799); and propensity score matching (HR = 1.18, 95 % CI = 0.57 to 2.43, P = 0.660).
  
  
  CONCLUSIONS
  Based on the present propensity score analysis, the oncologic outcomes in patients undergoing curative rectal cancer resections were not impaired by the development of anastomotic leakage.
authors.affiliation: Department of Surgery, Cantonal Hospital of St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Sabrina M
authors.initials: SM
authors.lastname: Ebinger
authors.affiliation: Department of Surgery, Cantonal Hospital of St. Gallen, 9007, St. Gallen, Switzerland.|Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Warschkow
authors.affiliation: Department of Surgery, University of Heidelberg, 69120, Heidelberg, Germany.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
authors.affiliation: Department of Surgery, Cantonal Hospital of St. Gallen, 9007, St. Gallen, Switzerland.
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.affiliation: Department of Surgery, Cantonal Hospital of St. Gallen, 9007, St. Gallen, Switzerland. Lukas.Marti@kssg.ch.|Department of Surgery, University-Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany. Lukas.Marti@kssg.ch.
authors.forename: Lukas
authors.initials: L
authors.lastname: Marti
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D057216:Propensity Score; D012004:Rectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Anastomotic leackage; Cancer-specific survival; Overall survival; Propensity score matching; Rectal cancer resection