title: [Impact of anastomotic leakage on long-term survival in mid-to-low rectal cancer].
abstract: BACKGROUND
  The occurrence of anastomotic leakage (AL) after sphincter preserving anterior rectal resection in patients with rectal cancer is associated with increased morbidity and mortality. The impact of AL on long-term survival has, however, still not been sufficiently investigated and is currently the subject of controversial discussion.
  
  
  OBJECTIVE
  The aim of this study was to investigate the impact of AL on long-term survival in patients with Union of International Cancer Control (UICC) (y)0-III stage mid-to-low rectal cancer who underwent sphincter preserving rectal resection.
  
  
  METHODS
  A total of 108 patients with a mid-to-low rectal cancer (UICC stage (y)0-III) who underwent sphincter preserving surgery between January 2003 and October 2010 were identified within the institutional prospective colorectal cancer database. The impact of AL on 5-year overall (OS), cancer specific (CSS) and relapse-free survival (RFS) was investigated.
  
  
  RESULTS
  The overall leakage rate was 17.6 % (grade A 4.6 %, grade B 4.6 % and grade C 8.3 %). After a median follow-up of 70 months (range 24-123 months), patients with an anastomotic leakage had a significantly decreased 5-year OS (63.6 % versus 87.8 %, p = 0.02), CSS (72.2 % versus 93.5 %, p = 0.02) and RFS rate (61.1 % versus 84.2 %, p = 0.01). In univariable Cox regression analysis AL was associated with an unfavorable OS (hazard ratio HR 3.05, 95 % CI: 1.11-8.39, p = 0.03), CSS (HR 4.21, 95 % CI: 1.13-15.70, p = 0.03) and RFS (HR 3.02, 95 % CI: 1.20-7.58, p = 0.02).
  
  
  CONCLUSIONS
  In the study cohort anastomotic leakage after sphincter preserving anterior resection in patients with mid-to-low rectal cancer was associated with a significantly unfavorable impact on overall and oncological survival.
authors.affiliation: Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich. ta.jaeger@salk.at.
authors.forename: T
authors.initials: T
authors.lastname: Jäger
authors.affiliation: Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
authors.forename: C
authors.initials: C
authors.lastname: Nawara
authors.affiliation: Institut für Pathologie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
authors.forename: D
authors.initials: D
authors.lastname: Neureiter
authors.affiliation: Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
authors.forename: J
authors.initials: J
authors.lastname: Holzinger
authors.affiliation: Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.|Universitätsklinik für Visceral-, Transplantations- und Thoraxchirurgie, Department Operative Medizin, Medizinische Universität, Innsbruck, Österreich.
authors.forename: D
authors.initials: D
authors.lastname: Öfner-Velano
authors.affiliation: Universitätsklinik für Chirurgie, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
authors.forename: A
authors.initials: A
authors.lastname: Dinnewitzer
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D057868:Anastomotic Leak / Q000401:mortality*; D001317:Austria; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D017741:Survivors
keywords: Anastomotic leakage; Long term survival; Low anterior resection; Rectal cancer; Sphincter preservation