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

• Published in: World Journal of Surgery Vol. 41; no. 1; pp. 277 - 284
• Main Authors: Wang, Shuanhu, Liu, Jingjing, Wang, Shan, Zhao, Hongyun, Ge, Sitang, Wang, Wenbin
• Format: Journal Article Book Review
• Language: English
• Published: Cham Springer International Publishing 01.01.2017; Springer Nature B.V
• Subjects: Abdominal Surgery; Anastomosis, Surgical - adverse effects; Anastomotic Leak - etiology; Anastomotic Leakage; Anterior Resection; Cardiac Surgery; Distant Recurrence; General Surgery; Humans; Local Recurrence; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local; Rectal Cancer; Rectal Neoplasms - mortality; Rectal Neoplasms - surgery; Scientific Review; Surgery; Thoracic Surgery; Vascular Surgery; Local Recurrence; Anterior Resection; Distant Recurrence; Rectal Cancer; Anastomotic Leakage
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-016-3761-1

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.