The impact of anastomotic leak on long-term oncological outcomes after low anterior resection for mid-low rectal cancer: extended follow-up of ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2022-06-30

AUTHORS

Quoc Riccardo Bao, Gianluca Pellino, Gaya Spolverato, Angelo Restivo, Simona Deidda, Giulia Capelli, Cesare Ruffolo, Francesco Bianco, Dajana Cuicchi, Elio Jovine, Raffaele Lombardi, Claudio Belluco, Antonio Amato, Filippo La Torre, Corrado Asteria, Aldo Infantino, Tania Contardo, Paola Del Bianco, Paolo Delrio, Salvatore Pucciarelli

ABSTRACT

PurposeThe impact of anastomotic leaks (AL) on oncological outcomes after low anterior resection for mid-low rectal cancer is still debated. The aim of this study was to evaluate overall survival (OS), disease-free survival (DFS), and local and distant recurrence in patients with AL following low anterior resection.MethodsThis is an extension of a multicentre RCT (NCT01110798). Kaplan–Meier method and the log-rank test were used to estimate and compare the 3-, 5-, and 10-year OS and DFS, and local and distant recurrence in patients with and without AL. Predictors of OS and DFS were evaluated using the Cox regression analysis as secondary aim.ResultsFollow-up was available for 311 patients. Of them, 252 (81.0%) underwent neoadjuvant chemoradiotherapy and 138 (44.3%) adjuvant therapy. AL occurred in 63 (20.3%) patients. At a mean follow-up of 69.5 ± 31.9 months, 23 (7.4%) patients experienced local recurrence and 49 (15.8%) distant recurrence. The 3-, 5-, and 10-year OS and DFS were 89.2%, 85.3%, and 70.2%; and 80.7%, 75.1%, and 63.5% in patients with AL, and 88.9%, 79.8% and 72.3%; and 83.7, 74.2 and 62.8%, respectively in patients without (p = 0.89 and p = 0.84, respectively). At multivariable analysis, AL was not an independent predictor of OS (HR 0.65, 95%CI 0.34–1.28) and DFS (HR 0.70, 95%CI 0.39–1.25), whereas positive circumferential resection margins and pathological stage impaired both.ConclusionsIn the context of modern multimodal rectal cancer treatment, AL does not affect long-term OS, DFS, and local and distant recurrence in patients with mid-low rectal cancer. More... »

PAGES

1689-1698

Journal

Author Affiliations

  • General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
  • Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania “Luigi Vanvitelli”, Naples, Italy
  • Colorectal Surgery Unit, A.O.U. Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
  • Department of Abdominal Oncology, Istituto Nazionale Tumori – IRCCS Fondazione G. Pascale, Naples, Italy
  • General Surgery Unit, Department of Alimentary Tract, IRCCS Azienda Ospedaliera Universitaria Di Bologna, Bologna, Italy
  • General Surgery and Emergency, IRCCS Azienda Ospedaliera Universitaria Di Bologna, Bologna, Italy
  • Department of Surgical Oncology, National Cancer Institute, Aviano, PN, Italy
  • Department of Coloproctology, Sanremo Hospital, Sanremo, IM, Italy
  • Division of Emergency and Trauma Surgery, Emergency Department, Policlinico Umberto I, College of Medicine and Dentistry, Sapienza University, Rome, Italy
  • Department of General Surgery, Ospedale Carlo Poma, Mantua, Italy
  • Surgical Unit, Department of General Surgery, Santa Maria Dei Battuti Hospital, San Vito al Tagliamento (PN), Italy
  • Department of Surgery, Regional Centre for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy
  • Clinical Research Unit, Istituto Oncologico Veneto IOV – IRCCS, Padua, Italy
  • Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori – IRCCS Fondazione G. Pascale, Naples, Italy
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00384-022-04204-9

    DOI

    http://dx.doi.org/10.1007/s00384-022-04204-9

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1149110005

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/35773492


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        "description": "PurposeThe impact of anastomotic leaks (AL) on oncological outcomes after low anterior resection for mid-low rectal cancer is still debated. The aim of this study was to evaluate overall survival (OS), disease-free survival (DFS), and local and distant recurrence in patients with AL following low anterior resection.MethodsThis is an extension of a multicentre RCT (NCT01110798). Kaplan\u2013Meier method and the log-rank test were used to estimate and compare the 3-, 5-, and 10-year OS and DFS, and local and distant recurrence in patients with and without AL. Predictors of OS and DFS were evaluated using the Cox regression analysis as secondary aim.ResultsFollow-up was available for 311 patients. Of them, 252 (81.0%) underwent neoadjuvant chemoradiotherapy and 138 (44.3%) adjuvant therapy. AL occurred in 63 (20.3%) patients. At a mean follow-up of 69.5\u2009\u00b1\u200931.9\u00a0months, 23 (7.4%) patients experienced local recurrence and 49 (15.8%) distant recurrence. The 3-, 5-, and 10-year OS and DFS were 89.2%, 85.3%, and 70.2%; and 80.7%, 75.1%, and 63.5% in patients with AL, and 88.9%, 79.8% and 72.3%; and 83.7, 74.2 and 62.8%, respectively in patients without (p\u2009=\u20090.89 and p\u2009=\u20090.84, respectively). At multivariable analysis, AL was not an independent predictor of OS (HR 0.65, 95%CI 0.34\u20131.28) and DFS (HR 0.70, 95%CI 0.39\u20131.25), whereas positive circumferential resection margins and pathological stage impaired both.ConclusionsIn the context of modern multimodal rectal cancer treatment, AL does not affect long-term OS, DFS, and local and distant recurrence in patients with mid-low rectal cancer.", 
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    324 grid-institutes:grid.6292.f schema:alternateName General Surgery Unit, Department of Alimentary Tract, IRCCS Azienda Ospedaliera Universitaria Di Bologna, Bologna, Italy
    325 General Surgery and Emergency, IRCCS Azienda Ospedaliera Universitaria Di Bologna, Bologna, Italy
    326 schema:name General Surgery Unit, Department of Alimentary Tract, IRCCS Azienda Ospedaliera Universitaria Di Bologna, Bologna, Italy
    327 General Surgery and Emergency, IRCCS Azienda Ospedaliera Universitaria Di Bologna, Bologna, Italy
    328 rdf:type schema:Organization
    329 grid-institutes:grid.7763.5 schema:alternateName Colorectal Surgery Unit, A.O.U. Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
    330 schema:name Colorectal Surgery Unit, A.O.U. Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
    331 rdf:type schema:Organization
    332 grid-institutes:grid.7841.a schema:alternateName Division of Emergency and Trauma Surgery, Emergency Department, Policlinico Umberto I, College of Medicine and Dentistry, Sapienza University, Rome, Italy
    333 schema:name Division of Emergency and Trauma Surgery, Emergency Department, Policlinico Umberto I, College of Medicine and Dentistry, Sapienza University, Rome, Italy
    334 rdf:type schema:Organization
    335 grid-institutes:grid.9841.4 schema:alternateName Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania “Luigi Vanvitelli”, Naples, Italy
    336 schema:name Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania “Luigi Vanvitelli”, Naples, Italy
    337 rdf:type schema:Organization
     




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