Department of Surgery, Helsingborg Hospital, Lund University, Helsingborg, Sweden.
Colorectal Dis. 2011 Mar;13(3):272-83. doi: 10.1111/j.1463-1318.2009.02136.x.
The impact of anastomic leakage (AL) on the oncological outcome after anterior resection (AR) for rectal cancer is still controversial. We explored the impact of AL regarding local recurrence (LR), distant metastasis and overall recurrence (OAR). Overall and cancer-specific survival was analysed.
Patients undergoing AR for rectal cancer with a registered AL between 1995 and 1997 and a control group were identified in the Swedish Rectal Cancer Registry. The medical records were retrieved for additional data and validation. Differences in the oncological outcome at 5-year follow-up were analysed with multivariate methods.
After validation, 114 patients with AL and 136 control patients with locally radical surgery for tumours in tumour-node-metastasis stages I-III were analysed. There was no difference detected between patients with AL and control patients regarding rates of LR [8% (9 of 114) vs 9% (12 of 136); P = 0.97], distant metastasis [18% (20 of 114) vs 23% (31 of 136); P = 0.37] and OAR [19% (22 of 114) vs 28% (38 of 136); P = 0.15]. The 5-year cancer-specific survival was almost 80% in both groups. In multivariate analysis, AL was not a risk factor of LR, distant metastasis or OAR and had no impact on 5-year overall or 5-year cancer-specific survival. Irrespective of the occurrence of AL, preoperative radiotherapy (P = 0.055) and rectal washout (P = 0.046) reduced the LR rate, but did not influence survival.
Anastomotic leakage was not proved to be a risk factor of worse oncological outcome. Hence, additional adjuvant treatment or extended follow-up on the basis of the occurrence of AL after AR might not be justified.
吻合口漏（AL）对直肠癌前切除术（AR）后肿瘤学结果的影响仍存在争议。我们探讨了 AL 对局部复发（LR）、远处转移和总体复发（OAR）的影响。分析了总生存率和癌症特异性生存率。
在瑞典直肠癌登记处，确定了 1995 年至 1997 年间接受 AR 治疗且有吻合口漏记录的患者，以及接受局部根治性手术治疗肿瘤处于肿瘤-淋巴结-转移分期 I-III 期的对照组患者。对 5 年随访时的肿瘤学结果进行了多变量分析。
经验证后，共分析了 114 例 AL 患者和 136 例局部根治性手术治疗肿瘤处于肿瘤-淋巴结-转移分期 I-III 期的对照组患者。AL 组和对照组的 LR 发生率[8%（9/114）与 9%（12/136）；P = 0.97]、远处转移率[18%（20/114）与 23%（31/136）；P = 0.37]和 OAR 发生率[19%（22/114）与 28%（38/136）；P = 0.15]无差异。两组的 5 年癌症特异性生存率均接近 80%。多变量分析显示，AL 不是 LR、远处转移或 OAR 的危险因素，也不影响 5 年总生存率和 5 年癌症特异性生存率。无论是否发生 AL，术前放疗（P = 0.055）和直肠冲洗（P = 0.046）均可降低 LR 发生率，但不影响生存率。
吻合口漏未被证实是肿瘤学结果恶化的危险因素。因此，AR 后发生 AL 时，没有理由进行额外的辅助治疗或延长随访。
