Wang Shuanhu, Liu Jingjing, Wang Shan, Zhao Hongyun, Ge Sitang, Wang Wenbin
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.
Department of General Surgery, The Forth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
World J Surg. 2017 Jan;41(1):277-284. doi: 10.1007/s00268-016-3761-1.
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.
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.
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).
Anastomotic leakage was associated with high local recurrence and poor survival (both overall and cancer-specific), but not with distant recurrence.
吻合口漏是直肠癌前切除术相关的严重并发症，其长期影响尚不清楚。因此，进行了一项系统评价和荟萃分析，以评估吻合口漏对疾病复发和生存的影响。
我们检索了PubMed、Embase和Cochrane图书馆数据库，检索时间从建库至2016年1月。评估吻合口漏对肿瘤学影响的研究纳入荟萃分析。观察指标为局部复发、总生存、癌症特异性生存和远处复发。采用随机效应模型计算合并风险比（HR）及95%置信区间（CI）。
14项研究共纳入11353例患者，符合纳入标准。吻合口漏与更高的局部复发相关（HR 1.71；95%CI 1.22 - 2.38），总生存（HR 1.67；95%CI 1.19 - 2.35）和癌症特异性生存均降低（HR 1.30；95%CI 1.08 - 1.56）；吻合口漏未增加远处复发（HR 1.03；95%CI 0.76 - 1.40）。
吻合口漏与高局部复发率及较差的生存（总生存和癌症特异性生存）相关，但与远处复发无关。
