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Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis

Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis
Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis
Objective: To examine the long-term oncological impact of anastomotic leakage (AL) after restorative surgery for colorectal cancer using meta-analytical methods. Outcomes evaluated were local recurrence, distant recurrence, and survival.

Background: Recurrence after potentially curative surgery for colorectal cancer remains a significant clinical problem and has a poor prognosis. AL may be a risk factor for disease recurrence, however available studies have been conflicting. A meta-analysis was conducted to investigate the impact of AL on disease recurrence and long-term survival.

Methods: Studies published between 1965 and 2009 evaluating the long-term oncological impact of AL were identified by an electronic literature search. Outcomes evaluated included local recurrence, distant recurrence, and cancer specific survival. Meta-analysis was performed using the DerSimonian-Laird random-effects model to compute odds ratio and 95% confidence intervals. Study heterogeneity was evaluated using Q statistics and I2 and publication bias assessed with funnel plots and Egger's test.

Results: Twenty-one studies comprising 13 prospective nonrandomized studies, 1 prospective randomized, and 7 retrospective studies met the inclusion criteria, yielding a total of 21,902 patients. For rectal anastomoses, the odd ratios (OR) of developing a local recurrence when there was AL was 2.05 (95% CI = 1.51-2.8; P = 0.0001). For studies describing both colon and rectal anastomoses, the OR of local recurrence when there was an AL was 2.9 (95% CI = 1.78-4.71; P < 0.001). The OR of developing a distant recurrence after AL was 1.38 (95% CI = 0.96-1.99; P = 0.083). Long term cancer specific mortality was significantly higher after AL with an OR of 1.75 (95% CI = 1.47-2.1; P = 0.0001).

Conclusions: AL has a negative prognostic impact on local recurrence after restorative resection of rectal cancer. A significant association between colorectal AL and reduced long-term cancer specific survival was also noted. No association between AL and distant recurrence was found.
0003-4932
890-899
Mirnezami, Alexander
b3c7aee7-46a4-404c-bfe3-f72388e0bc94
Mirnezami, Reza
d0d4ded7-1d72-4ce4-9ce1-eac5ded0232f
Chandrakumaran, Kandiah
f26f4bda-dfcd-439c-b449-3184b7ec7ddb
Sasapu, Kishore
8595f0fa-4399-46f1-887c-dd10963973d6
Sagar, Peter
912c797a-4a9b-43d9-b96b-2ecc4f22016a
Finan, Paul
98995f85-0c4d-44db-bbc0-09a4661bbdb1
Mirnezami, Alexander
b3c7aee7-46a4-404c-bfe3-f72388e0bc94
Mirnezami, Reza
d0d4ded7-1d72-4ce4-9ce1-eac5ded0232f
Chandrakumaran, Kandiah
f26f4bda-dfcd-439c-b449-3184b7ec7ddb
Sasapu, Kishore
8595f0fa-4399-46f1-887c-dd10963973d6
Sagar, Peter
912c797a-4a9b-43d9-b96b-2ecc4f22016a
Finan, Paul
98995f85-0c4d-44db-bbc0-09a4661bbdb1

Mirnezami, Alexander, Mirnezami, Reza, Chandrakumaran, Kandiah, Sasapu, Kishore, Sagar, Peter and Finan, Paul (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Annals of Surgery, 253 (5), 890-899. (doi:10.1097/SLA.0b013e3182128929). (PMID:21394013)

Record type: Article

Abstract

Objective: To examine the long-term oncological impact of anastomotic leakage (AL) after restorative surgery for colorectal cancer using meta-analytical methods. Outcomes evaluated were local recurrence, distant recurrence, and survival.

Background: Recurrence after potentially curative surgery for colorectal cancer remains a significant clinical problem and has a poor prognosis. AL may be a risk factor for disease recurrence, however available studies have been conflicting. A meta-analysis was conducted to investigate the impact of AL on disease recurrence and long-term survival.

Methods: Studies published between 1965 and 2009 evaluating the long-term oncological impact of AL were identified by an electronic literature search. Outcomes evaluated included local recurrence, distant recurrence, and cancer specific survival. Meta-analysis was performed using the DerSimonian-Laird random-effects model to compute odds ratio and 95% confidence intervals. Study heterogeneity was evaluated using Q statistics and I2 and publication bias assessed with funnel plots and Egger's test.

Results: Twenty-one studies comprising 13 prospective nonrandomized studies, 1 prospective randomized, and 7 retrospective studies met the inclusion criteria, yielding a total of 21,902 patients. For rectal anastomoses, the odd ratios (OR) of developing a local recurrence when there was AL was 2.05 (95% CI = 1.51-2.8; P = 0.0001). For studies describing both colon and rectal anastomoses, the OR of local recurrence when there was an AL was 2.9 (95% CI = 1.78-4.71; P < 0.001). The OR of developing a distant recurrence after AL was 1.38 (95% CI = 0.96-1.99; P = 0.083). Long term cancer specific mortality was significantly higher after AL with an OR of 1.75 (95% CI = 1.47-2.1; P = 0.0001).

Conclusions: AL has a negative prognostic impact on local recurrence after restorative resection of rectal cancer. A significant association between colorectal AL and reduced long-term cancer specific survival was also noted. No association between AL and distant recurrence was found.

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Published date: 9 March 2011
Organisations: Cancer Sciences

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Local EPrints ID: 180885
URI: http://eprints.soton.ac.uk/id/eprint/180885
ISSN: 0003-4932
PURE UUID: 33df9876-5dfd-42e4-b3b1-3e89206d04e2

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Date deposited: 12 Apr 2011 10:58
Last modified: 14 Mar 2024 02:53

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Contributors

Author: Reza Mirnezami
Author: Kandiah Chandrakumaran
Author: Kishore Sasapu
Author: Peter Sagar
Author: Paul Finan

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