Anastomotic leakage after colon cancer surgery: A predictor of significant morbidity and hospital mortality, and diminished tumour-free survival
Introduction
In spite of recent developments in diagnosis, treatment and surgical technique, the problem of anastomotic leakage (AL) remains a major one. It is encountered frequently in routine surgical practice, and it is associated with an increase in early post-operative mortality.1, 2, 3, 4 For colorectal cancer, there are indications that AL worsens the long-term oncological result.5, 6, 7 However, until now a corresponding tendency has not been demonstrated for colon carcinoma.8, 9
The objective of this research was to find out the peri-operative effects of AL in a large, multicentric analysis of a representative patient population. In addition, the influence of AL upon the long-term oncological result was investigated.
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Study
In the German multicentric study “Qualitätssicherung Kolon/Rektumkarzinome (Primärtumor)” (Quality Assurance in Primary Colorectal Carcinoma), data for patients with colorectal carcinoma were acquired prospectively by the An-Institut für Qualitätssicherung in der operativen Medizin at the University of Magdeburg. Data acquisition took place over a period of five years, from January 1st 2000 to December 31st 2004. These data represent the state of treatment of these patients in routine clinical
Results
The study population included a total of 28 271 patients treated for colon cancer by resection with anastomosis. Of these, 3.0% (n = 844) developed an AL.
■ Post-operative course of disease
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Hospital mortality
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Hospital mortality was 18.6% (157 of 844) for patients with AL and only 2.6% (700 of 27 427) for patients without AL. The risk of death for patients with AL was thus 7.2 times higher than for those without this complication.
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Morbidity
Of the patients with AL, 62.7% (529/844) developed secondary
Discussion
This study included 844 cases of AL and thus contains a body of data of sufficient size to yield a differentiated analysis of the effects of AL upon the peri-operative result and the oncological outcome.
Conflict of interest
None of the authors of this paper has any financial relationship that could lead, or have led, to a conflict of interest in connection with this work. The authors are employees of the respective institutions to which they are affiliated.
Authors' contributions
All authors contributed to the design of the study. Data were acquired by RK, IG and HL. The analysis was performed by US, RK, HL. The manuscript was drafted by RK, PM, IG and HL; the complete version was prepared by RK. All authors provided revisions where necessary, and all approved the final version.
Acknowledgements
Data for this research were provided by the independently funded An-Institut. We thank the hospitals that participated in the study for providing the data.
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