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Inicio Cirugía Española (English Edition) The impact of anastomotic leakage after curative colon cancer resection on long-...
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Vol. 102. Issue 1.
Pages 3-10 (January 2024)
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Vol. 102. Issue 1.
Pages 3-10 (January 2024)
Original article
The impact of anastomotic leakage after curative colon cancer resection on long-term survival: A retrospective cohort study
El impacto de la fuga anastomótica después de la resección curativa del cáncer de colon en la supervivencia a largo plazo: un estudio de cohorte retrospectivo
Francisca Brito da Silvaa,b,
Corresponding author
, Pedro Lopesa, Daniela Cavadasa,b, Beatriz Pereira Gonçalvesb, Margarida Bernardob, Nuno Abecasisb, Manuel Limberta,b, João Maciela,b
a Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
b Department of General Surgery, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023 Lisboa, Portugal
Article information
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Tables (3)
Table 1. Characteristics of patients submitted to curative resection of colon cancer, overall and comparison of patients with (AL) and without (No AL) anastomotic leakage.
Table 2. Multiple logistic regression of independent factors associated with the occurrence of anastomotic leakage after surgery.
Table 3. Cox proportional hazards model of independent factors influencing overall survival.
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Additional material (4)
Abstract
Introduction

Anastomotic leakage (AL) is one of the most feared postoperative complications in colon cancer surgery due to an association with increased morbidity and mortality, although its impact on long-term survival is not consensual. The aim of this study was to investigate the influence of AL on long-term survival of patients undergoing curative colon cancer resection.

Methods

A single-centre retrospective cohort study was designed. Clinical records of all consecutive patients undergoing surgery at our institution between 01/01/2010 and 12/31/2019 were reviewed. Survival analysis was performed by Kaplan–Meier method to estimate overall and conditional survival and Cox regression to search for risk factors impacting survival.

Results

A total of 2351 patients submitted to colorectal surgery were screened for eligibility, of which 686 with colon cancer were included. AL occurred in 57 patients (8,3%) and was associated with higher postoperative morbidity and mortality, length of stay and early readmissions (P < 0,05). Overall survival was inferior in the leakage group (Hazard Ratio 2,08 [1,02–4,24]). Conditional overall survival at 30, 90 days and 6 months was also inferior in the leakage group (P < 0,05), but not at 1 year. Risk factors independently associated with reduced overall survival included AL occurrence, higher ASA classification and delayed/missed adjuvant chemotherapy. AL did not impact local and distant recurrence (P > 0,05).

Conclusion

AL has a negative impact on survival. Its effect is more pronounced on short-term mortality. AL does not appear to be associated with disease progression.

Keywords:
Colon cancer
Anastomotic leakage
Overall survival
Conditional overall survival
Abbreviations:
AL
ISREC
UICC
STROBE
OS
OSC
LR
DR
CCI
ASA
CI
OR
IQR
HR
REF
CEA
Resumen
Objetivo

La fuga anastomótica (FA) es una complicación postoperatoria temida en la cirugía del cáncer de colon por asociación con mayor morbimortalidad, aunque su impacto en la supervivencia a largo plazo no es consensuado. Nuestro objetivo fue investigar el efecto de la FA en la supervivencia a largo plazo de pacientes sometidos a resección curativa del cáncer de colon.

Métodos

Se realizó un estudio de cohorte retrospectivo unicéntrico de pacientes consecutivos intervenidos quirúrgicamente entre 01/01/2010 y el 31/12/2019. El análisis de supervivencia se realizó por el método de Kaplan-Meier para evaluar la supervivencia global (SG) y condicional y una regresión de Cox para evaluar los factores de riesgo con efecto en la supervivencia.

Resultados

De 2351 pacientes sometidos a cirugía colorrectal, se incluyeron 686 con cáncer de colon. FA afectó 57 pacientes (8,3%) y se asoció con mayor morbimortalidad postoperatoria, duración de estancia hospitalaria y reingresos (P < 0,05). La SG fue inferior en el grupo de fuga (Hazard Ratio 2,08 [1,02–4,24]). La SG condicional a los 30, 90 días y 6 meses fue inferior en el grupo de fugas (P < 0,05), pero no a 1 año. Los factores de riesgo que se asociaron con SG reducida incluyeron la FA, clasificación ASA más alta y quimioterapia adyuvante retrasada/perdida. FA no afectó la recurrencia local y distante (P > 0.05).

Conclusiones

FA tiene un impacto negativo en la supervivencia, con efecto más pronunciado sobre la mortalidad a corto plazo, pero no es asociado con la progresión de la enfermedad oncológica.

Palabras clave:
Cáncer del colon
Fuga anastomótica
Supervivencia global
Supervivencia global condicional

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