Anastomotic leakage after colon cancer surgery: A predictor of significant morbidity and hospital mortality, and diminished tumour-free survival

https://doi.org/10.1016/j.ejso.2009.08.011Get rights and content

Abstract

Aim

The objective of this study was to find out the effects of anastomotic leakage (AL) following resection of colon cancer upon perioperative outcome and long-term oncological result.

Patients and methods

Using the database of a country-wide quality assurance study “Quality Assurance in Primary Colorectal Carcinoma” we analysed the data from the complete sub-population of 844 patients who had AL after resection of colon cancer. These were compared with corresponding data from 27 427 similar patients without AL. Hospital mortality, AL-associated post-operative morbidity and long-term outcome were investigated.

Results

Hospital mortality after AL was 18.6%, compared with 2.6% for patients without AI. AL-related secondary complications occurred in 62.7% cases, while patients without AL had a corresponding rate of 19.9%. Those with AL had a poorer long-term oncological result, with a five-year survival rate of 51.0% (p < 0.001) and a five-year tumour-free survival rate of 63.0% (compare 74.6% without AL; p < 0.001).

Conclusions

Post-operative AL after resection of colon cancer is associated with significant morbidity and hospital mortality rates and with a greater risk of a poor oncological outcome.

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.

Section snippets

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

    • -

      Hospital mortality

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.

  • -

    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.

References (13)

  • W.L. Law et al.

    Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy

    J Gastrointest Surg

    (2007)
  • M. Stumpf et al.

    Risk factors for anastomotic leakage after colorectal surgery

    Zentralbl Chir

    (2009)
  • N.C. Buchs et al.

    Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study

    Int J Colorectal Dis

    (2008)
  • I. Kanellos et al.

    The failed intraperitoneal colon anastomosis after colon resection

    Tech Coloproctol

    (2004)
  • A.A. Khan et al.

    The management and outcome of anastomotic leaks in colorectal surgery

    Colorectal Dis

    (2008)
  • C.S. McArdle et al.

    Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer

    Br J Surg

    (2005)
There are more references available in the full text version of this article.

Cited by (134)

View all citing articles on Scopus
View full text