Does anastomotic leakage after rectal cancer resection worsen long-term oncologic outcome?
Does anastomotic leakage after rectal cancer resection worsen long-term oncologic outcome?
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DOI：
10.1007/s00384-020-03577-z
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发表时间：
2020-04-20
影响因子：
2.8
通讯作者：
Kakeji, Yoshihiro
中科院分区：
文献类型：
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作者：
Hasegawa, Hiroshi;Matsuda, Takeru;Kakeji, Yoshihiro
目的吻合口瘘对直肠癌患者长期生存的影响尚存争议。本研究的目的是评估吻合口瘘与长期生存之间的关系。方法在这项多中心回顾性队列研究中，在2007年至2012年期间，395例连续一期至III期直肠癌患者接受了前切除术。比较有渗漏（渗漏（+））和无渗漏（渗漏（-））患者的5年总生存率、5年无病生存率和5年局部无复发生存率。结果395例患者中，吻合口瘘50例（12.7%）。其中34例（68.0%）需要紧急手术治疗，16例（32.0%）可以通过观察等待或经皮引流治疗。中位随访期为62.6个月。两组的5年总生存率无差异（渗漏（+）93.8% vs渗漏（-）89.0%,P = 0.121）。两组的5年无病生存率也无差异（81.6% vs. 80.3%, P = 0.731）， 5年局部无复发生存率也无差异（91.9% vs. 86.1%, P = 0.206）。在多变量Cox回归模型中，BMI bbb25、术前CA19-9 bbb37、病理性T分期、病理性N分期和环切缘（CRM）阳性是无病生存的独立预测因子。此外，病理性T期、病理性N期和CRM阳性是总生存期和局部无复发生存期的唯一独立预测因子。吻合口漏不是总生存率、无病生存率或局部无复发生存率的危险因素。结论吻合口瘘与直肠癌患者长期生存率无显著相关性。
Purpose The influence of anastomotic leakage on long-term survival in patients with rectal cancer is debatable. The aim of this study was to evaluate relationships between anastomotic leakage and long-term survival. Methods In this multicenter retrospective cohort study, 395 consecutive stage I to III rectal cancer patients underwent anterior resection between 2007 and 2012. Five-year overall survival, 5-year disease-free survival, and 5-year local recurrence-free survival were compared between patients with leakage (Leakage (+)) and patients without leakage (Leakage (-)). Results Of 395 patients, 50 (12.7%) had anastomotic leakage. Of these 50, 34 (68.0%) required urgent surgery and 16 (32.0%) could be managed by watchful waiting or with percutaneous drainage. The median follow-up period was 62.6 months. Five-year overall survival did not differ between the two groups (Leakage (+) 93.8% vs. Leakage (-) 89.0%, P = 0.121). Five-year disease-free survival also did not differ between the two groups (81.6% vs. 80.3%, P = 0.731), and neither did 5-year local recurrence-free survival (91.9% vs. 86.1%, P = 0.206). In a multivariable Cox regression model, BMI > 25, preoperative CA19-9 > 37, pathological T stage, pathological N stage, and circumferential resection margin (CRM) positive were independent predictors of disease-free survival. Moreover, pathological T stage, pathological N stage, and CRM positive were the only independent predictors of overall survival and local recurrence-free survival. Anastomotic leakage was not a risk factor for overall survival, disease-free survival, or local recurrence-free survival. Conclusion Anastomotic leakage is not associated with a significant decrease in long-term survival in rectal cancer patients.