Long-term Oncological Outcomes Following Anastomotic Leak in Rectal Cancer Surgery

BACKGROUND: Anastomotic leak remains a critical complication after restorative rectal cancer surgery and is associated with significant morbidity and mortality rates whereas reported rates range from 4% to 29%. Whether the occurrence of leak may have an impact on long-term oncological outcomes is under debate. OBJECTIVE: To describe the oncological impact of anastomotic leak on patients undergoing sphincter preserving surgery for rectal adenocarcinoma. DESIGN: Retrospective review of a prospectively maintained database. SETTINGS: The study was conducted at a high-volume colorectal center. PATIENTS: Data on patients who underwent restorative surgery for rectal adenocarcinoma from January 2000 until December 2013 were retrospectively analyzed. MAIN OUTCOME MEASURES: Impact of anastomotic leak, defined according to the classification proposed by the International Study Group of Rectal Cancer, on long-term overall survival, disease free survival, disease specific survival and local recurrence. RESULTS: A total of 787 patients undergoing sphincter-preserving surgery for rectal cancer met the inclusion criteria. Forty-two (5.3%) patients presented a symptomatic anastomotic leak. The median follow-up period was 64 months. Fifty-one (6.5%) patients suffered cancer related death, 2 of 42 in the anastomotic leak group. Five-year overall survival, disease specific survival and disease free survival were 88%, 94.7% and 85.3%, respectively. Local recurrence rate was 2%. There was no difference in long-term overall survival, disease specific survival, disease free survival and local recurrence rate between groups. On a multivariable analysis, anastomotic leak did not impact oncological outcomes. LIMITATIONS: This study was limited by retrospective analysis. CONCLUSIONS: The occurrence of anastomotic leak after restorative resection for rectal cancer did not impact long term oncologic outcomes in our cohort of patients. See Video Abstract at http://links.lww.com/DCR/B187.