Anastomotic leakage after resection for rectal cancer and recurrence-free survival in relation to postoperative C-reactive protein levels

被引：0

作者：

Anders Gerdin ^{[1
]}

Jennifer Park ^{[2
]}

Jenny Häggström ^{[3
]}

Josefin Segelman ^{[4
]}

Peter Matthiessen ^{[5
]}

Marie-Louise Lydrup ^{[6
]}

Martin Rutegård ^{[7
]}

机构：

[1] Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå

[2] Department of Surgery, Sahlgrenska University Hospital, SSORG - Scandinavian Surgical Outcomes Research Group, Sahlgrenska Academy, University of Gothenburg, Gothenburg

[3] Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Umeå

[4] Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna

[5] Department of Surgery, Ersta Hospital, Stockholm

[6] Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro

[7] Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund

来源：

International Journal of Colorectal Disease | / 39卷 / 1期

关键词：

Anastomotic leakage; Mediation analysis; Rectal cancer surgery;

D O I：

10.1007/s00384-024-04766-w

中图分类号：

学科分类号：

摘要：

Background: Anastomotic leakage after rectal cancer surgery is linked to reduced survival and higher recurrence rates. While an aggravated inflammatory response may worsen outcomes, few studies have explored the combined effects of leakage and inflammation. Methods: This is a retrospective multicenter cohort study including patients operated with anterior resection for rectal cancer in Sweden during 2014–2018. Anastomotic leakage within 12 months was exposure and primary outcome was recurrence-free survival. Mediation analysis was performed to evaluate the potential effect of systemic inflammatory response, as measured by the highest postoperative C-reactive protein (CRP) level within 14 days of surgery. Confounders were chosen using a causal diagram. Results: Some 1036 patients were eligible for analysis, of whom 218 (21%) experienced an anastomotic leakage. At the end of follow-up at a median of 61 months after surgery, recurrence-free survival amounted to 82.6% and 77.8% in the group with and without leakage, respectively. The median highest postoperative CRP value after surgery was higher in the leakage group (219 mg/l), compared with the group without leakage (108 mg/l). Leakage did not lead to worse recurrence-free survival (HR 0.66; 95% CI 0.43–0.94), and there was no apparent effect through postoperative highest CRP (HR 1.12; 95% CI 0.93–1.29). Conclusions: In conclusion, anastomotic leakage, with its accompanying CRP increase, was not found to be associated with recurrence-free survival after anterior resection for rectal cancer in this patient cohort. Larger, even more detailed studies are needed to further investigate this topic. © The Author(s) 2024.

引用

共 29 条

[1] Bostrom P., Haapamaki M.M., Rutegard J., Matthiessen P., Rutegard M., Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer, BJS Open, 3, 1, pp. 106-111, (2019)
[2] Borstlap W.A.A., Westerduin E., Aukema T.S., Bemelman W.A., Tanis P.J., Anastomotic leakage and chronic presacral sinus formation after low anterior resection: results from a large cross-sectional study, Ann Surg, 266, 5, pp. 870-877, (2017)
[3] Pommergaard H.C., Gessler B., Burcharth J., Angenete E., Haglind E., Rosenberg J., Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis, Colorectal Dis, 16, 9, pp. 662-671, (2014)
[4] Tsai K.Y., Huang S.H., You J.F., Tang R., Chiang J.M., Yeh C.Y., Et al., Smoking cessation for less than 10 years remains a risk factor of anastomotic leakage in mid-to-low rectal cancer patients undergoing sphincter-preserving surgery, Langenbecks Arch Surg, 407, 3, pp. 1131-1138, (2022)
[5] Lu Z.R., Rajendran N., Lynch A.C., Heriot A.G., Warrier S.K., Anastomotic leaks after restorative resections for rectal cancer compromise cancer outcomes and survival, Dis Colon Rectum, 59, 3, pp. 236-244, (2016)
[6] Behrenbruch C., Shembrey C., Paquet-Fifield S., Molck C., Cho H.J., Michael M., Et al., Surgical stress response and promotion of metastasis in colorectal cancer: a complex and heterogeneous process, Clin Exp Metastasis, 35, 4, pp. 333-345, (2018)
[7] Haldar R., Ricon-Becker I., Radin A., Gutman M., Cole S.W., Zmora O., Et al., Perioperative COX2 and beta-adrenergic blockade improves biomarkers of tumor metastasis, immunity, and inflammation in colorectal cancer: a randomized controlled trial, Cancer, 126, 17, pp. 3991-4001, (2020)
[8] Hain E., Maggiori L., Manceau G., Mongin C., Prost A.L.D.J., Panis Y., Oncological impact of anastomotic leakage after laparoscopic mesorectal excision, Br J Surg, 104, 3, pp. 288-295, (2017)
[9] Denost Q., Rouanet P., Faucheron J.L., Panis Y., Meunier B., Cotte E., Et al., Impact of early biochemical diagnosis of anastomotic leakage after rectal cancer surgery: long-term results from GRECCAR 5 trial, Br J Surg, 108, 6, pp. 605-608, (2021)
[10] McSorley S.T., Watt D.G., Horgan P.G., McMillan D.C., Postoperative systemic inflammatory response, complication severity, and survival following surgery for colorectal cancer, Ann Surg Oncol, 23, 9, pp. 2832-2840, (2016)

← 1 2 3 →