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Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence?

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Abstract

This study examines anastomotic leaks as a potential influence on the long term outcome of patients with colorectal cancer. 167 patients were studied who had clinical and radiological assessment of anastomotic integrity in the post-operative period, following potentially curative resections for left-sided colonic or rectal cancer. There was no evidence of a leak in 135 of these patients, while the remaining 32 developed a clinical and/or a radiological leak. At the end of a mean follow-up of 25 months, 15 patients with leaks (46.9%) developed tumour recurrence, compared with 25 of those without any leak (18.5%; p<0.001). Cancer specific mortality at 24 months was also significantly higher for patients with leaks (36.9%±9.7% versus 12.6%±3.3%; p<0.001). The influence of anastomotic leaks on the outcome was independent of tumour stage. These results suggest that in patients undergoing surgery for colorectal cancer development of an anastomotic leak is significantly associated with a poorer long-term outcome.

Résumé

Cette étude examine le risque potentiel du lâchage anastomotique sur l'évolution à long terme des patients atteints d'un cancer colo-rectal. 167 malades ont été étudiés chez qui l'examen clinique et radiologique affirmait l'intégrité de l'anastomose dans la période postopératoire après une résection potentiellement curative pour cancer du colon gauche ou du rectum. Il n'y avait aucune évidence de lâchage anastomotique chez 135 de ces patients tandis que pour les 32 restants il existait une fuite clinique ou radiologique. A la fin d'un suivi moyen de 25 mois, 15 des malades avec fuite (46.9%) ont développé une récidive tumorale par comparaison avec 25 de ceux qui n'avaient aucune fuite (18.5%; p<0.001). La mortalité spécifique par cancer à 24 mois était aussi significativement plus élevée pour les patients avec fuite anastomotique (36.9%±9.7% versus 12.6%±3.3%; p<0.001). L'influence de la fuite anastomotique sur l'évolution était indépendante du stade de la tumeur. Ces résultats suggèrent que chez les patients qui subissent une résection chirurgicale pour cancer colo-rectal, l'apparition d'une fuite anastomotique est significativement associée avec une évolution à long terme plus péjorative.

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Akyol, A.M., McGregor, J.R., Galloway, D.J. et al. Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence?. Int J Colorect Dis 6, 179–183 (1991). https://doi.org/10.1007/BF00341385

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