Work

Differential impact of anastomotic leak on long-term recurrence after surgery for rectal versus colonic cancer: a systematic review and meta-analysis

Year: 2025

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: BACKGROUND: The impact of anastomotic leak (AL) on long-term outcomes following resection for colorectal cancer (CRC) remains a subject of ongoing debate. Recent studies investigating this topic have reported discrepant findings. MATERIALS: Studies investigating the impact of AL on long-term oncological outcomes after CRC resection were identified from the electronic databases to perform meta-analysis. Meta-regression and subgroup analysis were performed to identify and adjust for confounders. RESULTS: A total of 56 studies were enrolled. Meta-analysis showed that AL was associated with an increased local recurrence (LR) in rectal cancer (HR = 2.06, 95% CI: 1.53-2.76, p < 0.001) but not colonic cancer (HR = 1.68, 95% CI: 0.62-4.53, p = 0.309). In contrast, AL was associated with an increased distant recurrence (DR) in colonic cancer (HR = 1.43, 95% CI 1.15-1.78, p = 0.001), but not rectal cancer (HR = 1.07, 95% CI: 0.82-1.39, p = 0.639). AL was associated with worse overall survival (OS) in both rectal (HR = 1.44, 95% CI: 1.23-1.68, p < 0.001) and colonic cancer (HR = 1.67, 95% CI: 1.33-2.09, p < 0.001), as well as lower cancer-specific survival (CSS) in rectal cancer (HR = 1.51, 95% CI: 1.10-2.08, p = 0.011). Additionally, AL was linked to decreased disease-free survival (DFS) in both rectal (HR = 1.56, 95% CI: 1.23-1.98, p < 0.001) and colonic cancer (HR = 1.66, 95% CI: 1.21-2.26, p = 0.002). CONCLUSION: AL has distinct impacts on recurrence patterns in colonic and rectal cancer, and is consistently linked to reduced long-term survival outcomes. These adverse effects may be attributable to interruption or delay of adjuvant therapy following AL.

Source: International Journal of Surgery

DOI: 10.1097/js9.0000000000004235

Authors: Yuchan Yang, Dengyu Feng, Song Li, Jianfeng Gong, Feng Zhu

Institutions: Nanjing General Hospital of Nanjing Military Command, Nanjing Medical University, Nanjing University

Language: English

Topic: Colorectal Cancer Surgical Treatments

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,450