Population-based cohort study of the impact on postoperative mortality of anastomotic leakage after anterior resection for rectal cancer

Abstract

BackgroundAnastomotic leakage following anterior resection for rectal cancer may result in death. The aim of this study was to yield an updated, population‐based estimate of postoperative mortality and evaluate possible interacting factors.MethodsThis was a retrospective national cohort study of patients who underwent anterior resection between 2007 and 2016. Data were retrieved from a prospectively developed database. Anastomotic leakage constituted exposure, whereas outcome was defined as death within 90 days of surgery. Logistic regression analyses, using directed acyclic graphs to evaluate possible confounders, were performed, including interaction analyses.ResultsOf 6948 patients, 693 (10·0 per cent) experienced anastomotic leakage and 294 (4·2 per cent) underwent reintervention due to leakage. The mortality rate was 1·5 per cent in patients without leakage and 3·9 per cent in those with leakage. In multivariable analysis, leakage was associated with increased mortality only when a reintervention was performed (odds ratio (OR) 5·57, 95 per cent c.i. 3·29 to 9·44). Leaks not necessitating reintervention did not result in increased mortality (OR 0·70, 0·25 to 1·96). There was evidence of interaction between leakage and age on a multiplicative scale (P = 0·007), leading to a substantial mortality increase in elderly patients with leakage.ConclusionAnastomotic leakage, in particular severe leakage, led to a significant increase in 90‐day mortality, with a more pronounced risk of death in the elderly.

The Clinical and Economic Burden of Colorectal Anastomotic Leaks: Middle-Income Country Perspective

“…In a New Zealand cohort of 233 patients undergoing LAR for benign and malignant diseases, patients who developed AL had higher 30-day mortality as compared to patients without AL (6% versus 1%, p < 0.05) as well as LOS, which was approximately two times higher in AL patients [19]. In another study conducted in Sweden, which included 6,948 patients who underwent anterior resection, the Odds Ratio (OR) for 90-day mortality was 5.57 (95% CI: 3.29–9.44) when patients with major leaks (when a reintervention was performed) versus those with no leaks were compared [23]. From the economic standpoint, our results show a heavy financial burden associated with AL.…”

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

“…Recent studies have reported that the AL rate after rectal cancer surgery is 3% to 26%[ 10 - 12 ]. The occurrence of AL prolongs hospitalization time, increases the economic and mental burden for patients and increases short-term morbidity and mortality[ 13 , 14 ]. Poor blood supply is an important factor in AL.…”

Modified Colon Leakage Score to Predict Anastomotic Leakage in Patients Who Underwent Left-Sided Colorectal Surgery

“…Anastomotic leakage (AL) is one of the most serious and devastating post-operative complications of colorectal cancer surgery. AL has an incidence of 3–27% and a mortality rate of 25–37% [1,2,3,4,5,6]. It is an adverse risk factor for long-term outcomes in these patients [7,8,9,10].…”