Anastomotic leak and cancer-specific outcomes after curative rectal cancer surgery: a systematic review and meta-analysis

• Published in: Techniques in coloproctology 2020-06, Vol.24 (6), p.513-525
• Main Authors: Karim, A., Cubas, V., Zaman, S., Khan, S., Patel, H., Waterland, P.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Anastomotic Leak - etiology; Cancer surgery; Colorectal cancer; Colorectal Surgery; Disease-Free Survival; Gastroenterology; Humans; Medicine; Medicine & Public Health; Meta-analysis; Neoplasm Recurrence, Local; Odds Ratio; Proctology; Rectal Neoplasms - surgery; Review; Surgery; Systematic review
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-020-02153-5

Background The aim of the present study was to perform a systematic review and meta-analysis of cancer-specific outcomes after curative rectal cancer surgery comparing anastomotic leak (AL) with no leak. Methods PubMed, Medline and Embase databases were searched to identify studies comparing cancer-specific outcomes after rectal cancer surgery in patients with AL and without. A meta-analysis with a random-effects model was used to calculate pooled odds ratios (OR) and confidence intervals (CI) for each outcome measure. Results A total of 18 studies were included for meta-analysis, comprising a total of 18,039 patients after curative rectal resection (1764 AL, 16,275 without AL). The overall rate of AL was 9.8%. After AL and excluding 30-day mortality there was an increased risk of local recurrence (OR 1.50; CI 1.23, 1.82), worse overall survival (OR 0.69; CI 0.60–0.81), decreased disease free survival (OR 0.51; CI 0.36–0.73) and cancer specific survival (OR 0.71; CI 0.54–0.94). Distant recurrence (OR 1.10; CI 0.89–1.37) and overall recurrence (OR 1.33; CI 0.64–2.76) were not significantly different between the two groups. Conclusions AL may negatively impact cancer-specific outcomes after curative rectal cancer surgery and could be considered an independent negative prognostic factor.