Influence of Anastomotic Leakage in the Long-term Results of Laparoscopic Treatment of Curative Rectal Cancer.

Cedric Adelsdorfer, MD, Salvadora Delgado, MD, Waldemar Adelsdorfer, MD, Raúl Almenara, MD, David Saavedra, MD, Mihai Pavel, MD, Nils Hidalgo, MD, Antonio M Lacy, MD PhD. Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clínic of Barcelona

 Objective
Assess the impact of AL in local and distance recurrence, and overall and cancer-specific survival, in patients undergoing laparoscopic anterior resection (AR) for rectal cancer.
Methods
Prospective study of patients undergoing laparoscopic rectal AR, in the period from 1998 to September 2010. Differences in long-term oncological results were obtained by multivariate analysis (Cox regression).
Results
390 patients included. AL in 11.5% (45/390). No differences were found between AL patients and those who did not, in local recurrence: 4.4% vs 3.8%, p=0.607; metastasis: 15.5% vs 15.1%, p=0.652, overall recurrence: 17.8% vs 17.6%, p=0.845. Overall 5 years survival in both groups was 65%.Cancer.specific survival in the AL was 85% and 82% in the without dehiscence group, (p = 0.516). In multivariate analysis the AL did not prove a risk factor for recurrence and worse survival. Have proven to be risk factors for local recurrence: compromise of the circumferential margin (p<0.001, HR 5.3 CI 95% 2.6-11.1) and pT3-4 (p=0.002, HR 2.7 CI 95% 1:4-5). Influenced a worse survival, pTNM III-IV (p=0.005; HR 2.2 95% CI 1.2-3.8).
Conclusions
Anastomotic leakage has not proven to be a risk factor for worse long-term oncological outcome in laparoscopic surgery series presented. A higher local recurrence would be associated with the compromise of circumferential margin and pT3-4. pTNM stage III-IV is associated with poor 5 years survival.

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