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Meta-Analysis
. 2017 Jan;41(1):277-284.
doi: 10.1007/s00268-016-3761-1.

Adverse Effects of Anastomotic Leakage on Local Recurrence and Survival After Curative Anterior Resection for Rectal Cancer: A Systematic Review and Meta-analysis

Shuanhu Wang  1 , Jingjing Liu  2 , Shan Wang  2 , Hongyun Zhao  2 , Sitang Ge  2 , Wenbin Wang  3
Affiliations
Meta-Analysis

Adverse Effects of Anastomotic Leakage on Local Recurrence and Survival After Curative Anterior Resection for Rectal Cancer: A Systematic Review and Meta-analysis

Shuanhu Wang et al. World J Surg. 2017 Jan.

Abstract

Background: Anastomotic leakage is a serious complication associated with anterior resection for rectal cancer, the long-term effects of which are unclear. Therefore, a systematic review and meta-analysis were conducted to evaluate the impact of anastomotic leakage on disease recurrence and survival.

Methods: We searched PubMed, Embase, and the Cochrane Library databases from their inception to January 2016. Studies evaluating the oncologic impact of anastomotic leakage were included in the meta-analysis. Outcome measures were local recurrence, overall survival, cancer-specific survival, and distant recurrence. Pooled hazard ratio (HR) with 95 % confidence interval (CI) was calculated using random effects models.

Results: Fourteen studies containing 11,353 patients met inclusion criteria. Anastomotic leakage was associated with a greater local recurrence (HR 1.71; 95 % CI 1.22-2.38) and decreased in both overall survival (HR 1.67; 95 % CI 1.19-2.35) and cancer-specific survival (HR 1.30; 95 % CI 1.08-1.56); anastomotic leakage did not increase distant recurrence (HR 1.03; 95 % CI 0.76-1.40).

Conclusions: Anastomotic leakage was associated with high local recurrence and poor survival (both overall and cancer-specific), but not with distant recurrence.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig. 1
Fig. 1
Prisma flow diagram of the literature screening and selection
Fig. 2
Fig. 2
Effect of anastomotic leakage on the risk of local recurrence of rectal cancer after anterior resection
Fig. 3
Fig. 3
Effect of anastomotic leakage on overall survival
Fig. 4
Fig. 4
Effect of anastomotic leakage on cancer-specific survival
Fig. 5
Fig. 5
Effect of anastomotic leakage on distant recurrence
See this image and copyright information in PMC

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