The impact of anastomotic leakage on oncologic outcomes and the receipt and timing of adjuvant chemotherapy after colorectal cancer surgery.
OBJECTIVE
To evaluate the impact of anastomotic leakage on oncologic outcomes in patients with colorectal cancer. We also evaluated the influence of anastomotic leakage on receipt and commencement time of adjuvant chemotherapy.


METHODS
A total of 809 consecutive patients undergoing major resection for colorectal cancer were categorized into leak (n = 33, 4.1%) and non-leak (n = 776, 95.9%) groups.


RESULTS
The 5-year local recurrence rates of stage II disease were 0.6% and 20.0% for non-leak and leak groups respectively (p = 0.046), and the equivalent rates for stage III disease were 9.1% and 59.4% respectively (p < 0.001). For stage III disease, receipt of adjuvant therapy was lower in the leak group (63% vs. 87%, p = 0.007) and mean time to initiation of chemotherapy was longer in the leak group (52 days vs. 37 days) but this did not reach statistical significance (p = 0.080). Older age (hazard ratio [HR] = 2.8), advanced TNM classification (HR = 3.6), and anastomotic leakage (HR = 8.9) were adverse risk factors for local recurrence based on multivariate analysis.


CONCLUSIONS
Anastomotic leakage adversely influenced local recurrence rates in stage II and III disease and was an independent risk factor for local recurrence. Additionally, anastomotic leakage contributed to failure to receive adjuvant chemotherapy in patients with stage III disease.
Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Ik Yong
IY
Kim
Division of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Bo Ra
BR
Kim
Division of Colorectal Surgery, Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. Electronic address: youngwkim@yonsei.ac.kr.
Young Wan
YW
Kim
D000368:Aged; D057868:Anastomotic Leak / Q000453:epidemiology*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents
Anastomotic leakage; Colorectal cancer; Major resection