Influence of Conversion and Anastomotic Leakage on Survival in Rectal Cancer Surgery; Retrospective Cross-sectional Study

Dutch Snapshot Res Grp, Edgar J. B. Furnee*, Tjeerd S. Aukema, Steven J. Oosterling, Wernard A. A. Borstlap, Willem A. Bemelman, Pieter J. Tanis

*Corresponding author for this work

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Abstract

Background Conversion and anastomotic leakage in colorectal cancer surgery have been suggested to have a negative impact on long-term oncologic outcomes. The aim of this study in a large Dutch national cohort was to analyze the influence of conversion and anastomotic leakage on long-term oncologic outcome in rectal cancer surgery. Methods Patients were selected from a retrospective cross-sectional snapshot study. Patients with a benign lesion, distant metastasis, or unknown tumor or metastasis status were excluded. Overall (OS) and disease-free survival (DFS) were compared between laparoscopic, converted, and open surgery as well as between patients with and without anastomotic leakage. Results Out of a database of 2095 patients, 638 patients were eligible for inclusion in the laparoscopic, 752 in the open, and 107 in the conversion group. A total of 746 patients met the inclusion criteria and underwent low anterior resection with primary anastomosis, including 106 (14.2%) with anastomotic leakage. OS and DFS were significantly shorter in the conversion compared to the laparoscopic group (p = 0.025 and p = 0.001, respectively) as well as in anastomotic leakage compared to patients without anastomotic leakage (p = 0.002 and p = 0.024, respectively). In multivariable analysis, anastomotic leakage was an independent predictor of OS (hazard ratio 2.167, 95% confidence interval 1.322-3.551) and DFS (1.592, 1077-2.353). Conversion was an independent predictor of DFS (1.525, 1.071-2.172), but not of OS. Conclusion Technical difficulties during laparoscopic rectal cancer surgery, as reflected by conversion, as well as anastomotic leakage have a negative prognostic impact, underlining the need to improve both aspects in rectal cancer surgery.

Original languageEnglish
Pages (from-to)2007-2018
Number of pages12
JournalJournal of Gastrointestinal Surgery
Volume23
Issue number10
Early online date5-Sep-2018
DOIs
Publication statusPublished - Oct-2019

Keywords

  • Rectal cancer
  • Laparoscopy
  • Conversion
  • Anastomosis
  • Survival
  • LAPAROSCOPIC COLORECTAL RESECTION
  • SHORT-TERM OUTCOMES
  • TOTAL MESORECTAL EXCISION
  • COUNCIL CLASICC TRIAL
  • ONCOLOGIC OUTCOMES
  • COLON-CANCER
  • ADJUVANT CHEMOTHERAPY
  • FOLLOW-UP
  • IMPACT
  • COLECTOMY

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