Anastomotic leak and cancer-specific outcomes after curative rectal cancer surgery: a systematic review and meta-analysis

Abstract

Background: The aim of the present study was to perform a systematic review and meta-analysis of cancer-specific outcomes after curative rectal cancer surgery comparing anastomotic leak (AL) with no leak.

Methods: PubMed, Medline and Embase databases were searched to identify studies comparing cancer-specific outcomes after rectal cancer surgery in patients with AL and without. A meta-analysis with a random-effects model was used to calculate pooled odds ratios (OR) and confidence intervals (CI) for each outcome measure.

Results: A total of 18 studies were included for meta-analysis, comprising a total of 18,039 patients after curative rectal resection (1764 AL, 16,275 without AL). The overall rate of AL was 9.8%. After AL and excluding 30-day mortality there was an increased risk of local recurrence (OR 1.50; CI 1.23, 1.82), worse overall survival (OR 0.69; CI 0.60-0.81), decreased disease free survival (OR 0.51; CI 0.36-0.73) and cancer specific survival (OR 0.71; CI 0.54-0.94). Distant recurrence (OR 1.10; CI 0.89-1.37) and overall recurrence (OR 1.33; CI 0.64-2.76) were not significantly different between the two groups.

Conclusions: AL may negatively impact cancer-specific outcomes after curative rectal cancer surgery and could be considered an independent negative prognostic factor.

Keywords: Anastomotic leak; Meta-analysis; Rectal cancer; Recurrence.