Adverse Effects of Anastomotic Leakage on Local Recurrence and Survival After Curative Anterior Resection for Rectal Cancer: A Systematic Review and Meta-analysis

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2016 Oct 16

PMID 27743072

Citations 76

Authors

Shuanhu Wang

Jingjing Liu

Shan Wang

Hongyun Zhao

Sitang Ge

Wenbin Wang

Affiliations

Soon will be listed here.

Abstract

Background: Anastomotic leakage is a serious complication associated with anterior resection for rectal cancer, the long-term effects of which are unclear. Therefore, a systematic review and meta-analysis were conducted to evaluate the impact of anastomotic leakage on disease recurrence and survival.

Methods: We searched PubMed, Embase, and the Cochrane Library databases from their inception to January 2016. Studies evaluating the oncologic impact of anastomotic leakage were included in the meta-analysis. Outcome measures were local recurrence, overall survival, cancer-specific survival, and distant recurrence. Pooled hazard ratio (HR) with 95 % confidence interval (CI) was calculated using random effects models.

Results: Fourteen studies containing 11,353 patients met inclusion criteria. Anastomotic leakage was associated with a greater local recurrence (HR 1.71; 95 % CI 1.22-2.38) and decreased in both overall survival (HR 1.67; 95 % CI 1.19-2.35) and cancer-specific survival (HR 1.30; 95 % CI 1.08-1.56); anastomotic leakage did not increase distant recurrence (HR 1.03; 95 % CI 0.76-1.40).

Conclusions: Anastomotic leakage was associated with high local recurrence and poor survival (both overall and cancer-specific), but not with distant recurrence.

Citing Articles

The role of adjuvant chemotherapy in rectal cancer: A nationwide cohort study from the Netherlands.

Darai A, Koeter T, van Erning F, van Alphen R, Verheul H, Verheij M Colorectal Dis. 2025; 27(3):e70054.

PMID: 40059308 PMC: 11891379. DOI: 10.1111/codi.70054.

Risk Factors for Anastomotic Leak in Patients Undergoing Surgery for Rectal Cancer Resection: A Retrospective Analysis.

Doniz Gomez Llanos D, Leal Hidalgo C, Arechavala Lopez S, Padilla Flores A, Correa Rovelo J, Athie Athie A Cureus. 2025; 17(2):e79647.

PMID: 40008105 PMC: 11857925. DOI: 10.7759/cureus.79647.

Comparison of the C-REX LapAid and Circular Stapled Colorectal Anastomoses in an Experimental Model.

Vilhjalmsson D, Gronberg A, Syk I, Thorlacius H Eur Surg Res. 2025; 66(1):9-17.

PMID: 39933492 PMC: 11892461. DOI: 10.1159/000543069.

Suspension and suturing technique can reduce the incidence of anastomotic leakage after rectal cancer excision: a single, prospective, cohort study.

Ge W, Shao L, Chen G, Qiu Y Sci Rep. 2024; 14(1):29197.

PMID: 39587181 PMC: 11589827. DOI: 10.1038/s41598-024-79800-6.

Physical pressure resistance of gastrointestinal anastomotic site via plate of polyglycolic acid promoting fibrosis.

Tanda H, Shibutani M, Natsuki S, Kasashima H, Fukuoka T, Maeda K Sci Rep. 2024; 14(1):26124.

PMID: 39478128 PMC: 11525944. DOI: 10.1038/s41598-024-77894-6.

References

den Dulk M, Marijnen C, Collette L, Putter H, Pahlman L, Folkesson J . Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg. 2009; 96(9):1066-75. DOI: 10.1002/bjs.6694. View

Lin J, Yueh T, Chang S, Lin C, Lan Y, Wang H . The influence of fecal diversion and anastomotic leakage on survival after resection of rectal cancer. J Gastrointest Surg. 2011; 15(12):2251-61. DOI: 10.1007/s11605-011-1721-5. View

Kang C, Halabi W, Chaudhry O, Nguyen V, Pigazzi A, Carmichael J . Risk factors for anastomotic leakage after anterior resection for rectal cancer. JAMA Surg. 2012; 148(1):65-71. DOI: 10.1001/2013.jamasurg.2. View

Merkel S, Wang W, Schmidt O, Dworak O, Wittekind C, Hohenberger W . Locoregional recurrence in patients with anastomotic leakage after anterior resection for rectal carcinoma. Colorectal Dis. 2003; 3(3):154-60. DOI: 10.1046/j.1463-1318.2001.00232.x. View

Nielsen H, Christensen I, Sorensen S, Moesgaard F, Brunner N . Preoperative plasma plasminogen activator inhibitor type-1 and serum C-reactive protein levels in patients with colorectal cancer. The RANX05 Colorectal Cancer Study Group. Ann Surg Oncol. 2000; 7(8):617-23. DOI: 10.1007/BF02725342. View

Jager T, Nawara C, Neureiter D, Holzinger J, Ofner-Velano D, Dinnewitzer A . [Impact of anastomotic leakage on long-term survival in mid-to-low rectal cancer]. Chirurg. 2015; 86(11):1072-82. DOI: 10.1007/s00104-015-0090-0. View

Salvans S, Mayol X, Alonso S, Messeguer R, Pascual M, Mojal S . Postoperative peritoneal infection enhances migration and invasion capacities of tumor cells in vitro: an insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer. Ann Surg. 2014; 260(5):939-43. DOI: 10.1097/SLA.0000000000000958. View

Des Guetz G, Nicolas P, Perret G, Morere J, Uzzan B . Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival? A meta-analysis. Eur J Cancer. 2010; 46(6):1049-55. DOI: 10.1016/j.ejca.2010.01.020. View

Alonso S, Pascual M, Salvans S, Mayol X, Mojal S, Gil M . Postoperative intra-abdominal infection and colorectal cancer recurrence: a prospective matched cohort study of inflammatory and angiogenic responses as mechanisms involved in this association. Eur J Surg Oncol. 2014; 41(2):208-14. DOI: 10.1016/j.ejso.2014.10.052. View

10.

Sayfan J, Averbuch F, Koltun L, Benyamin N . Effect of rectal stump washout on the presence of free malignant cells in the rectum during anterior resection for rectal cancer. Dis Colon Rectum. 2001; 43(12):1710-2. DOI: 10.1007/BF02236855. View

11.

Gertsch P, Baer H, Kraft R, Maddern G, Altermatt H . Malignant cells are collected on circular staplers. Dis Colon Rectum. 1992; 35(3):238-41. DOI: 10.1007/BF02051014. View

12.

Ashraf S, Burns E, Jani A, Altman S, Young J, Cunningham C . The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them?. Colorectal Dis. 2013; 15(4):e190-8. DOI: 10.1111/codi.12125. View

13.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135. View

14.

Smith J, Butte J, Weiser M, DAngelica M, Paty P, Temple L . Anastomotic leak following low anterior resection in stage IV rectal cancer is associated with poor survival. Ann Surg Oncol. 2013; 20(8):2641-6. DOI: 10.1245/s10434-012-2854-9. View

15.

Sedgwick P . How to read a forest plot in a meta-analysis. BMJ. 2015; 351:h4028. DOI: 10.1136/bmj.h4028. View

16.

Jorgren F, Johansson R, Damber L, Lindmark G . Anastomotic leakage after surgery for rectal cancer: a risk factor for local recurrence, distant metastasis and reduced cancer-specific survival?. Colorectal Dis. 2009; 13(3):272-83. DOI: 10.1111/j.1463-1318.2009.02136.x. View

17.

Bell S, Walker K, Rickard M, Sinclair G, Dent O, Chapuis P . Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg. 2003; 90(10):1261-6. DOI: 10.1002/bjs.4219. View

18.

Hayden J, Cote P, Bombardier C . Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006; 144(6):427-37. DOI: 10.7326/0003-4819-144-6-200603210-00010. View

19.

Begg C, Mazumdar M . Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50(4):1088-101. View

20.

Eriksen M, Wibe A, Norstein J, Haffner J, Wiig J . Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis. 2004; 7(1):51-7. DOI: 10.1111/j.1463-1318.2004.00700.x. View