Multicenter Analysis of Long-Term Oncologic Impact of Anastomotic Leakage After Laparoscopic Total Mesorectal Excision: The Korean Laparoscopic Colorectal Surgery Study Group

Jeonghyun Kang, Gyu-Seog Choi, Jae Hwan Oh, Nam Kyu Kim, Jun Seok Park, Min Jung Kim, Kang Young Lee, Seung Hyuk Baik, Jeonghyun Kang, Gyu-Seog Choi, Jae Hwan Oh, Nam Kyu Kim, Jun Seok Park, Min Jung Kim, Kang Young Lee, Seung Hyuk Baik

Abstract

This study aims to validate the oncologic outcomes of anastomotic leakage (AL) after laparoscopic total mesorectal excision (TME) in a large multicenter cohort. The impact of AL after laparoscopic TME for rectal cancer surgery has not yet been clearly described. This was a multicenter retrospective study of 1083 patients who underwent laparoscopic TME for nonmetastatic rectal cancer (stage 0-III). AL was defined as an anastomotic complication within 30 days of surgery irrespective of requiring a reoperation or interventional radiology. Estimated local recurrence (LR), disease-free survival (DFS), and overall survival (OS) were compared between the leakage group and the no leakage group using the log-rank method. Multivariate Cox-regression analysis was used to adjust confounding for survival. The incidence of AL was 6.4%. Mortality within 30 days of surgery occurred in 1 patient (1.4%) in the leakage group and 2 patients (0.2%) in the no leakage group. The leakage group showed a higher LR rate (6.4% vs 1.8%, P = 0.011). Five-year DFS and OS were significantly lower in the leakage group than the no leakage group (DFS 71.7% vs 82.1%, P = 0.016, OS 81.8% vs 93.5%, P = 0.007). Multivariate analysis showed that AL was an independent poor prognostic factor for DFS and OS (hazard ratio [HR] = 1.6; 95% confidence intervals [CI]: 1.0-2.6; P = 0.042, HR = 2.1; 95% CI: 1.0-4.2; P = 0.028, respectively). AL after laparoscopic TME was significantly associated with an increased rate of LR, systemic recurrence and poor OS.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Five-year overall survival (OS) and disease-free survival (DFS) between the leakage group and the no leakage group. The leakage group showed poor 5-year OS (A) and DFS (B) than the no leakage group (P < 0.05, for all).
FIGURE 2
FIGURE 2
Cumulative 5-year local recurrence rate between the leakage group and the no leakage group. Cumulative 5-year local recurrence rate was significantly higher in the leakage group than the no leakage group (the leakage group vs the no leakage group; 6.4% vs 1.8%, P = 0.011).

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