Anastomotic leakage after colon cancer surgery: A predictor of significant morbidity and hospital mortality, and diminished tumour-free survival

Kube, R.; Mroczkowski, P.; Granowski, D.; Benedix, F.; Sahm, M.; Schmidt, U.; Gastinger, I.; Lippert, H.; for the study group Qualitätssicherung Kolon/Rektum-Karzinome (Primärtumor) (Quality assurance in primary colorectal carcinoma),

doi:10.1016/j.ejso.2009.08.011

« Previous Next »European Journal of Surgical Oncology
Volume 36, Issue 2 , Pages 120-124, February 2010

Anastomotic leakage after colon cancer surgery: A predictor of significant morbidity and hospital mortality, and diminished tumour-free survival

R. Kube
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie Universitätsklinikum A.ö.R. Magdeburg Leipziger Str. 44 D–39120 Magdeburg, Germany
- An-Institut für Qualitätssicherung in der operativen Medizin (gGmbH) an der Otto-von-Guericke Universität Magdeburg (An-Institut), Leipziger Str. 44, D–39120 Magdeburg, Germany
- Corresponding author at: Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum A.ö.R. Leipziger Str. 44, D–39120 Magdeburg, Germany. Tel.: +49 391 67 15532; fax: +49 391 67 15570.
P. Mroczkowski
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie Universitätsklinikum A.ö.R. Magdeburg Leipziger Str. 44 D–39120 Magdeburg, Germany
- An-Institut für Qualitätssicherung in der operativen Medizin (gGmbH) an der Otto-von-Guericke Universität Magdeburg (An-Institut), Leipziger Str. 44, D–39120 Magdeburg, Germany
D. Granowski
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie Universitätsklinikum A.ö.R. Magdeburg Leipziger Str. 44 D–39120 Magdeburg, Germany
- An-Institut für Qualitätssicherung in der operativen Medizin (gGmbH) an der Otto-von-Guericke Universität Magdeburg (An-Institut), Leipziger Str. 44, D–39120 Magdeburg, Germany
F. Benedix
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie Universitätsklinikum A.ö.R. Magdeburg Leipziger Str. 44 D–39120 Magdeburg, Germany
- An-Institut für Qualitätssicherung in der operativen Medizin (gGmbH) an der Otto-von-Guericke Universität Magdeburg (An-Institut), Leipziger Str. 44, D–39120 Magdeburg, Germany
M. Sahm
- DRK Kliniken, Berlin–Köpenick, Salvador-Allende-Straße 2-8 D-12559 Berlin, Germany
U. Schmidt
- StatConsult, Magdeburg, Halberstädter Str. 40a, D-39112 Magdeburg, Germany
I. Gastinger
- Carl-Thiem-Klinikum Cottbus, Chirurgische Klinik, Thiemstraße 111 D-03048 Cottbus, Germany
- An-Institut für Qualitätssicherung in der operativen Medizin (gGmbH) an der Otto-von-Guericke Universität Magdeburg (An-Institut), Leipziger Str. 44, D–39120 Magdeburg, Germany
H. Lippert
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie Universitätsklinikum A.ö.R. Magdeburg Leipziger Str. 44 D–39120 Magdeburg, Germany
- An-Institut für Qualitätssicherung in der operativen Medizin (gGmbH) an der Otto-von-Guericke Universität Magdeburg (An-Institut), Leipziger Str. 44, D–39120 Magdeburg, Germany
for the study group Qualitätssicherung Kolon/Rektum-Karzinome (Primärtumor) (Quality assurance in primary colorectal carcinoma)

Accepted 20 August 2009.

Abstract

Aim

The objective of this study was to find out the effects of anastomotic leakage (AL) following resection of colon cancer upon perioperative outcome and long-term oncological result.

Patients and methods

Using the database of a country-wide quality assurance study “Quality Assurance in Primary Colorectal Carcinoma” we analysed the data from the complete sub-population of 844 patients who had AL after resection of colon cancer. These were compared with corresponding data from 27 427 similar patients without AL. Hospital mortality, AL-associated post-operative morbidity and long-term outcome were investigated.

Results

Hospital mortality after AL was 18.6%, compared with 2.6% for patients without AI. AL-related secondary complications occurred in 62.7% cases, while patients without AL had a corresponding rate of 19.9%. Those with AL had a poorer long-term oncological result, with a five-year survival rate of 51.0% (p<0.001) and a five-year tumour-free survival rate of 63.0% (compare 74.6% without AL; p<0.001).

Conclusions

Post-operative AL after resection of colon cancer is associated with significant morbidity and hospital mortality rates and with a greater risk of a poor oncological outcome.

Keywords: Colonic neoplasm, Colon surgery, Anastomotic leakage, Postoperative complications, Survival analysis