Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer

Abstract

Abstract Background The impact of anastomotic leakage on immediate postoperative mortality in patients undergoing potentially curative resection for colorectal cancer is well recognized. Its impact on long-term survival is less clear. The aim of the present study was to evaluate the relationship between anastomotic leakage and long-term survival in patients undergoing potentially curative resection for colorectal cancer. Methods A total of 2235 patients who underwent potentially curative resection for colorectal cancer between 1991 and 1994 in Scotland were included in the study. Five-year survival rates and adjusted hazard ratios were calculated. Results Fourteen (16 per cent) of the 86 patients with an anastomotic leak died within 30 days of surgery compared with 83 (3·9 per cent) of 2149 without a leak. The 5-year cancer-specific survival rate, including postoperative deaths, was 42 per cent in patients with an anastomotic leak compared with 66·9 per cent in those with no leak (P < 0·001). Excluding postoperative deaths, respective values were 50 and 68·0 per cent (P < 0·001). The adjusted relative hazard ratios, for patients with an anastomotic leak compared with those without a leak, and excluding 30-day mortality, were 1·61 (95 per cent confidence interval (c.i.) 1·19 to 2·16; P = 0·002) for overall survival and 1·99 (95 per cent c.i. 1·42 to 2·79; P < 0·001) for cancer-specific survival. Conclusion Development of an anastomotic leak is associated with worse long-term survival after potentially curative resection for colorectal cancer.