Introduction: The aim of the study was to determine the impact of anastomotic leakage on long-term outcomes after curative surgery for rectal cancer.
Material and methods: The study included 174 patients who underwent elective, potentially curative open or laparoscopic resection with anastomoses for rectal cancer at the Department of Surgery of the University Hospital Ostrava from 1 January 2001 to 31 December 2009. Anastomotic leakage was defined as clinically or radiologically confirmed signs of local or diffuse peritonitis, gas, pus or stool from the drain, rectoscopy signs of anastomotic insufficiency, or rectovesical or rectovaginal fistula. The Cox proportional hazards model with forward selection was used to determine the influence of predefined baseline characteristics on overall, disease-free survival and recurrence. The results are presented as Hazard Ratio (HR) with 95% Confidence Interval (CI).
Results: Based on the Cox model, anastomotic leakage was not identified as a factor with a significant impact on overall or disease-free survival. Anastomotic leakage, however, has remained an independent risk factor for a higher local recurrence rate (Hazard Ratio: 6.621, 95% CI 1.289-34.020, p=0.024). On the contrary, anastomotic leakage was not identified as a statistically significant prognostic factor for the incidence of distant metastases.
Conclusion: Anastomotic leakage represents an independent risk factor for a higher local recurrence rate after curative resection for rectal cancer.