Multicenter analysis of long-Term oncologic impact of anastomotic leakage after laparoscopic total mesorectal excision: The Korean laparoscopic colorectal surgery study group

Jeonghyun Kang, Gyu Seog Choi, Jae Hwan Oh, Nam Kyu Kim, Jun Seok Park, Min Jung Kim, Kang Young Lee, Seung Hyuk Baik

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Abstract

This study aims to validate the oncologic outcomes of anastomotic leakage (AL) after laparoscopic total mesorectal excision (TME) in a large multicenter cohort. The impact of AL after laparoscopic TME for rectal cancer surgery has not yet been clearly described. This was a multicenter retrospective study of 1083 patients who underwent laparoscopic TME for nonmetastatic rectal cancer (stage 0-III). AL was defined as an anastomotic complication within 30 days of surgery irrespective of requiring a reoperation or interventional radiology. Estimated local recurrence (LR), disease-free survival (DFS), and overall survival (OS) were compared between the leakage group and the no leakage group using the log-rank method. Multivariate Cox-regression analysis was used to adjust confounding for survival. The incidence of AL was 6.4%. Mortality within 30 days of surgery occurred in 1 patient (1.4%) in the leakage group and 2 patients (0.2%) in the no leakage group. The leakage group showed a higher LR rate (6.4% vs 1.8%, P=0.011). Five-year DFS and OS were significantly lower in the leakage group than the no leakage group (DFS 71.7% vs 82.1%, P=0.016, OS 81.8% vs 93.5%, P=0.007). Multivariate analysis showed that AL was an independent poor prognostic factor for DFS and OS (hazard ratio [HR]=1.6; 95% confidence intervals [CI]: 1.0-2.6; P=0.042, HR=2.1; 95% CI: 1.0-4.2; P=0.028, respectively). AL after laparoscopic TME was significantly associated with an increased rate of LR, systemic recurrence and poor OS.

Original languageEnglish
Article numbere1202
JournalMedicine (United States)
Volume94
Issue number29
DOIs
Publication statusPublished - 2015 Jul 1

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Colorectal Surgery
Anastomotic Leak
Laparoscopy
Disease-Free Survival
Survival
Recurrence
Rectal Neoplasms
Ambulatory Surgical Procedures
Confidence Intervals
Interventional Radiology
Reoperation
Multicenter Studies
Multivariate Analysis
Retrospective Studies
Regression Analysis
Mortality
Incidence

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Kang, Jeonghyun ; Choi, Gyu Seog ; Oh, Jae Hwan ; Kim, Nam Kyu ; Park, Jun Seok ; Kim, Min Jung ; Lee, Kang Young ; Baik, Seung Hyuk. / Multicenter analysis of long-Term oncologic impact of anastomotic leakage after laparoscopic total mesorectal excision : The Korean laparoscopic colorectal surgery study group. In: Medicine (United States). 2015 ; Vol. 94, No. 29.
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title = "Multicenter analysis of long-Term oncologic impact of anastomotic leakage after laparoscopic total mesorectal excision: The Korean laparoscopic colorectal surgery study group",
abstract = "This study aims to validate the oncologic outcomes of anastomotic leakage (AL) after laparoscopic total mesorectal excision (TME) in a large multicenter cohort. The impact of AL after laparoscopic TME for rectal cancer surgery has not yet been clearly described. This was a multicenter retrospective study of 1083 patients who underwent laparoscopic TME for nonmetastatic rectal cancer (stage 0-III). AL was defined as an anastomotic complication within 30 days of surgery irrespective of requiring a reoperation or interventional radiology. Estimated local recurrence (LR), disease-free survival (DFS), and overall survival (OS) were compared between the leakage group and the no leakage group using the log-rank method. Multivariate Cox-regression analysis was used to adjust confounding for survival. The incidence of AL was 6.4{\%}. Mortality within 30 days of surgery occurred in 1 patient (1.4{\%}) in the leakage group and 2 patients (0.2{\%}) in the no leakage group. The leakage group showed a higher LR rate (6.4{\%} vs 1.8{\%}, P=0.011). Five-year DFS and OS were significantly lower in the leakage group than the no leakage group (DFS 71.7{\%} vs 82.1{\%}, P=0.016, OS 81.8{\%} vs 93.5{\%}, P=0.007). Multivariate analysis showed that AL was an independent poor prognostic factor for DFS and OS (hazard ratio [HR]=1.6; 95{\%} confidence intervals [CI]: 1.0-2.6; P=0.042, HR=2.1; 95{\%} CI: 1.0-4.2; P=0.028, respectively). AL after laparoscopic TME was significantly associated with an increased rate of LR, systemic recurrence and poor OS.",
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Multicenter analysis of long-Term oncologic impact of anastomotic leakage after laparoscopic total mesorectal excision : The Korean laparoscopic colorectal surgery study group. / Kang, Jeonghyun; Choi, Gyu Seog; Oh, Jae Hwan; Kim, Nam Kyu; Park, Jun Seok; Kim, Min Jung; Lee, Kang Young; Baik, Seung Hyuk.

In: Medicine (United States), Vol. 94, No. 29, e1202, 01.07.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Multicenter analysis of long-Term oncologic impact of anastomotic leakage after laparoscopic total mesorectal excision

T2 - The Korean laparoscopic colorectal surgery study group

AU - Kang, Jeonghyun

AU - Choi, Gyu Seog

AU - Oh, Jae Hwan

AU - Kim, Nam Kyu

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AU - Kim, Min Jung

AU - Lee, Kang Young

AU - Baik, Seung Hyuk

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N2 - This study aims to validate the oncologic outcomes of anastomotic leakage (AL) after laparoscopic total mesorectal excision (TME) in a large multicenter cohort. The impact of AL after laparoscopic TME for rectal cancer surgery has not yet been clearly described. This was a multicenter retrospective study of 1083 patients who underwent laparoscopic TME for nonmetastatic rectal cancer (stage 0-III). AL was defined as an anastomotic complication within 30 days of surgery irrespective of requiring a reoperation or interventional radiology. Estimated local recurrence (LR), disease-free survival (DFS), and overall survival (OS) were compared between the leakage group and the no leakage group using the log-rank method. Multivariate Cox-regression analysis was used to adjust confounding for survival. The incidence of AL was 6.4%. Mortality within 30 days of surgery occurred in 1 patient (1.4%) in the leakage group and 2 patients (0.2%) in the no leakage group. The leakage group showed a higher LR rate (6.4% vs 1.8%, P=0.011). Five-year DFS and OS were significantly lower in the leakage group than the no leakage group (DFS 71.7% vs 82.1%, P=0.016, OS 81.8% vs 93.5%, P=0.007). Multivariate analysis showed that AL was an independent poor prognostic factor for DFS and OS (hazard ratio [HR]=1.6; 95% confidence intervals [CI]: 1.0-2.6; P=0.042, HR=2.1; 95% CI: 1.0-4.2; P=0.028, respectively). AL after laparoscopic TME was significantly associated with an increased rate of LR, systemic recurrence and poor OS.

AB - This study aims to validate the oncologic outcomes of anastomotic leakage (AL) after laparoscopic total mesorectal excision (TME) in a large multicenter cohort. The impact of AL after laparoscopic TME for rectal cancer surgery has not yet been clearly described. This was a multicenter retrospective study of 1083 patients who underwent laparoscopic TME for nonmetastatic rectal cancer (stage 0-III). AL was defined as an anastomotic complication within 30 days of surgery irrespective of requiring a reoperation or interventional radiology. Estimated local recurrence (LR), disease-free survival (DFS), and overall survival (OS) were compared between the leakage group and the no leakage group using the log-rank method. Multivariate Cox-regression analysis was used to adjust confounding for survival. The incidence of AL was 6.4%. Mortality within 30 days of surgery occurred in 1 patient (1.4%) in the leakage group and 2 patients (0.2%) in the no leakage group. The leakage group showed a higher LR rate (6.4% vs 1.8%, P=0.011). Five-year DFS and OS were significantly lower in the leakage group than the no leakage group (DFS 71.7% vs 82.1%, P=0.016, OS 81.8% vs 93.5%, P=0.007). Multivariate analysis showed that AL was an independent poor prognostic factor for DFS and OS (hazard ratio [HR]=1.6; 95% confidence intervals [CI]: 1.0-2.6; P=0.042, HR=2.1; 95% CI: 1.0-4.2; P=0.028, respectively). AL after laparoscopic TME was significantly associated with an increased rate of LR, systemic recurrence and poor OS.

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