Increased Local Recurrence and Reduced Survival From Colorectal Cancer Following Anastomotic Leak Systematic Review and Meta-Analysis

被引:731
作者
Mirnezami, Alexander [1 ]
Mirnezami, Reza [2 ]
Chandrakumaran, Kandiah [3 ]
Sasapu, Kishore [4 ]
Sagar, Peter [4 ]
Finan, Paul [4 ]
机构
[1] Univ Southampton, Southampton Univ Hosp NHSTrust, Canc Sci Div, Canc Res UK, Southampton SO166YD, Hants, England
[2] Hammersmith Hosp, Dept Surg, London W12 0HS, England
[3] Basingstoke & N Hampshire Hosp NHS Trust, Dept Surg, Basingstoke, Hants, England
[4] Leeds Gen Infirm, John Goligher Colorectal Unit, Leeds, W Yorkshire, England
关键词
TOTAL MESORECTAL EXCISION; LARGE-BOWEL-CANCER; RECTAL-CANCER; ANTERIOR RESECTION; CURATIVE RESECTION; 1ST-LINE TREATMENT; PLUS IRINOTECAN; RISK-FACTORS; INFLAMMATION; SURGERY;
D O I
10.1097/SLA.0b013e3182128929
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To examine the long-termoncological 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 I-2 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.
引用
收藏
页码:890 / 899
页数:10
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