Marco E Allaix, MD, PhD, Fabrizio Rebecchi, MD, Alberto Arezzo, MD, Simone Arolfo, MD, Mario Morino, MD. Department of Surgical Sciences, University of Torino
Aims: The evidence regarding the impact of anastomotic leak (AL) after anterior resection (AR) for rectal cancer on oncologic outcomes is controversial, and there are no data about the prognostic relevance of the International Study Group of Rectal Cancer (ISREC) AL classification. The aim of this study was to assess the oncologic outcomes in patients with AL after AR for rectal cancer. The prognostic value of the AL grading system was also investigated.
Methods: It is a retrospective analysis of a prospectively collected database including all patients undergoing curative elective AR for rectal cancer (April 1998-September 2013). AL severity was defined according to the ISREC criteria. A multivariable analysis was performed to identify predictors of poor survival.
Results: A total of 532 patients underwent curative AR (69% laparoscopic) for rectal cancer. AL rate was 7.9%. Adjuvant chemotherapy was more likely not administered or delayed in AL patients (47.2% vs. 27.5%, P<0.001). With a median follow-up of 80 (range, 12-266) months, 5-year overall survival (OS) rate was 67.2% in patients with AL and 86.5% in those without AL (P<0.001), while 5-year disease-free survival (DFS) was 45.8% and 80.3, respectively (P<0.001). ISREC grade C patients showed longer OS and DFS than grade B patients, even though the differences were not statistically significant (73% vs. 48.2%, P=0.209, and 62.4% vs. 30.3%; P=0.093 respectively). By multivariate analysis, AL was an independent predictor for poorer OS (HR 2.03; 95%CI 1.17-4.86) and DFS (HR 3.45; 95%CI 1.59-7.44).
Conclusion: AL after curative AR for rectal cancer is associated with poor survival. ISREC grading system does not allow to identify AL patients at higher risk of recurrence. Even AL patients who are treated conservatively experience poor oncologic outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94404
Program Number: S133
Presentation Session: Colorectal I
Presentation Type: Podium