Goto Saori, Hasegawa Suguru, Hida Koya, Uozumi Ryuji, Kanemitsu Yukihide, Watanabe Toshiaki, Sugihara Kenichi, Sakai Yoshiharu
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Surgery, Fukuoka University Hospital, Fukuoka, Japan.
Surgery. 2017 Aug;162(2):317-324. doi: 10.1016/j.surg.2017.03.005. Epub 2017 Apr 19.
In rectal cancer, anastomotic leakage was reported to have a negative impact on both short- and long-term outcomes. However, there is limited data on the impact of anastomotic leakage on oncologic outcomes in patients with colon cancer. We aimed to evaluate the impact of anastomotic leakage on disease recurrence and long-term survival after curative resection of colon cancer.
This multicenter, retrospective cohort study of 4,919 consecutive patients utilized data from the Japanese Society for Cancer of the Colon and Rectum. Multivariable Cox regression analysis was used to adjust for confounding.
The incidence of anastomotic leakage was 2.5% and 30-day mortality was 0.21%. The 5-year overall survival rate was 80.8% in the anastomotic leakage group, compared with 90.3% in the no leak group (P = .001). In the multivariable analysis, anastomotic leakage was significantly associated with reduced overall survival rate (hazard ratio = 1.84; 95% confidence interval, 1.06-2.96). Overall disease recurrence rate was 14.1%: 21.2% in the anastomotic leakage group and 13.9% in the no leak group. There was a significant association between anastomotic leakage and local recurrence (hazard ratio = 4.63; 95% confidence interval, 1.60-10.6). In contrast, anastomotic leakage was not significantly associated with total distant recurrence. However, anastomotic leakage did show a tendency toward increasing peritoneal recurrence, although it did not reach statistical significance (hazard ratio = 2.59; 95% confidence interval, 0.79-6.29).
In our study population, anastomotic leakage was associated with reduced overall survival and with increased rate of local recurrence after curative resection for colon cancer.
在直肠癌中，据报道吻合口漏对短期和长期预后均有负面影响。然而，关于吻合口漏对结肠癌患者肿瘤学预后影响的数据有限。我们旨在评估吻合口漏对结肠癌根治性切除术后疾病复发和长期生存的影响。
这项对4919例连续患者的多中心回顾性队列研究使用了来自日本结直肠癌协会的数据。采用多变量Cox回归分析来调整混杂因素。
吻合口漏的发生率为2.5%，30天死亡率为0.21%。吻合口漏组的5年总生存率为80.8%，无漏组为90.3%（P = 0.001）。在多变量分析中，吻合口漏与总生存率降低显著相关（风险比 = 1.84；95%置信区间，1.06 - 2.96）。总体疾病复发率为14.1%：吻合口漏组为21.2%，无漏组为13.9%。吻合口漏与局部复发之间存在显著关联（风险比 = 4.63；95%置信区间，1.60 - 10.6）。相比之下，吻合口漏与总的远处复发无显著关联。然而，吻合口漏确实显示出腹膜复发增加的趋势，尽管未达到统计学意义（风险比 = 2.59；95%置信区间，0.79 - 6.29）。
在我们的研究人群中，吻合口漏与结肠癌根治性切除术后总生存率降低和局部复发率增加相关。
