Sakamoto Junichi, Tsutsui Atsuko, Hagiwara Chie, Wakabayashi Go
Department of Surgery, Ageo Central General Hospital, Ageo, Japan.
J Anus Rectum Colon. 2025 Jan 25;9(1):61-68. doi: 10.23922/jarc.2024-005. eCollection 2025.
Differences in oncological outcomes between conservative and surgical treatments for anastomotic leakage (AL) in patients undergoing colorectal cancer surgery remain unclear.
From July 2011 to June 2020, 385 patients underwent curative resection with double-stapling anastomosis for left-sided colon and rectal cancers. Among them, 33 patients who experienced AL were retrospectively evaluated and categorized into two groups: conservative (n = 20) and surgical (n = 13). In the surgical group, abdominal lavage using a sufficient amount of normal saline was performed during reoperation. The primary endpoint was the 3-year cumulative incidence of local recurrence (LR).
Seven (21.2%) patients in the conservative group experienced LR, while none in the surgical group. Survival analysis indicated no differences in overall and recurrent-free survival. However, the 3-year cumulative incidence of LR was significantly lower in the surgical group than in the conservative group (0% versus 31.3%, p=0.045).
Differences in AL management were associated with oncological outcomes, specifically a decreased LR. Therefore, surgeons should consider our findings when determining the most appropriate AL treatment to improve oncological outcomes.
在接受结直肠癌手术的患者中，吻合口漏（AL）的保守治疗和手术治疗在肿瘤学结局方面的差异仍不明确。
2011年7月至2020年6月，385例患者接受了左侧结肠癌和直肠癌的双吻合器根治性切除术。其中，对33例发生AL的患者进行回顾性评估，并分为两组：保守治疗组（n = 20）和手术治疗组（n = 13）。手术治疗组在再次手术期间使用足量生理盐水进行腹腔灌洗。主要终点是局部复发（LR）的3年累积发生率。
保守治疗组有7例（21.2%）患者发生LR，而手术治疗组无患者发生LR。生存分析表明，总生存率和无复发生存率无差异。然而，手术治疗组的LR 3年累积发生率显著低于保守治疗组（0%对31.3%，p = 0.045）。
AL处理方式的差异与肿瘤学结局相关，特别是LR发生率降低。因此，外科医生在确定最合适的AL治疗方案以改善肿瘤学结局时应考虑我们的研究结果。
