Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality After Curative Resection for Colonic Cancer: A Nationwide Cohort Study

Peter-Martin Krarup; Andreas Nordholm-Carstensen; Lars N Jorgensen; Henrik Harling

doi:10.1097/sla.0b013e3182a6f2fc

Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality After Curative Resection for Colonic Cancer: A Nationwide Cohort Study

Peter-Martin Krarup, Andreas Nordholm-Carstensen, Lars N Jorgensen, Henrik Harling

Department of Clinical Medicine

148 Citations (Scopus)

Abstract

OBJECTIVE: To investigate the impact of anastomotic leak (AL) on disease recurrence and long-term mortality in patients alive 120 days after curative resection for colonic cancer. BACKGROUND: There is no solid data as to whether AL after colonic cancer surgery increases the risk of disease recurrence. METHODS: This was a nationwide cohort study of 9333 patients, prospectively registered in the database of the Danish Colorectal Cancer Group and merged with data from the Danish Pathology Registry and the National Patient Registry. Multivariable Cox regression analysis was used to adjust for confounding. RESULTS: The incidence of AL was 6.4%, 744 patients died within 120 days. Of the remaining 8589 patients, 861 (10.0%) developed local recurrence with no association to AL [adjusted hazard ratio (HR) = 0.78; 95% confidence interval (CI): 0.55-1.12; P = 0.184]. Distant recurrence developed in 1281 (14.9%) patients and more frequently after AL (adjusted HR = 1.42; 95% CI: 1.13-1.78; P = 0.003). AL was also associated with increased long-term mortality (adjusted HR = 1.20; 95% CI: 1.01-1.44; P = 0.042). In 2841 patients with stage III cancer, AL was associated with both decreased likelihood of receiving adjuvant chemotherapy (adjusted HR = 0.58; 95% CI: 0.45-0.74; P < 0.001) and a delay to initial administration (16 days; 95% CI: 12-20 days; P < 0.001). CONCLUSIONS: AL was significantly associated with increased rates of distant recurrence and long-term all-cause mortality. Cancelled or delayed administration of adjuvant chemotherapy may partly account for these findings.

Original language	English
Journal	Annals of Surgery
Volume	259
Issue number	5
Pages (from-to)	930-938
Number of pages	9
ISSN	0003-4932
DOIs	https://doi.org/10.1097/sla.0b013e3182a6f2fc
Publication status	Published - May 2014

Keywords

Aged
Aged, 80 and over
Anastomosis, Surgical
Anastomotic Leak
Cause of Death
Colectomy
Colon
Colonic Neoplasms
Confidence Intervals
Denmark
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Prognosis
Proportional Hazards Models
Prospective Studies
Registries
Risk Assessment
Time Factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/sla.0b013e3182a6f2fc

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Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality After Curative Resection for Colonic Cancer : A Nationwide Cohort Study. / Krarup, Peter-Martin; Nordholm-Carstensen, Andreas ; Jorgensen, Lars N et al.

In: Annals of Surgery, Vol. 259, No. 5, 05.2014, p. 930-938.

Research output: Contribution to journal › Journal article › Research › peer-review

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title = "Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality After Curative Resection for Colonic Cancer: A Nationwide Cohort Study",

abstract = "OBJECTIVE: To investigate the impact of anastomotic leak (AL) on disease recurrence and long-term mortality in patients alive 120 days after curative resection for colonic cancer. BACKGROUND: There is no solid data as to whether AL after colonic cancer surgery increases the risk of disease recurrence. METHODS: This was a nationwide cohort study of 9333 patients, prospectively registered in the database of the Danish Colorectal Cancer Group and merged with data from the Danish Pathology Registry and the National Patient Registry. Multivariable Cox regression analysis was used to adjust for confounding. RESULTS: The incidence of AL was 6.4%, 744 patients died within 120 days. Of the remaining 8589 patients, 861 (10.0%) developed local recurrence with no association to AL [adjusted hazard ratio (HR) = 0.78; 95% confidence interval (CI): 0.55-1.12; P = 0.184]. Distant recurrence developed in 1281 (14.9%) patients and more frequently after AL (adjusted HR = 1.42; 95% CI: 1.13-1.78; P = 0.003). AL was also associated with increased long-term mortality (adjusted HR = 1.20; 95% CI: 1.01-1.44; P = 0.042). In 2841 patients with stage III cancer, AL was associated with both decreased likelihood of receiving adjuvant chemotherapy (adjusted HR = 0.58; 95% CI: 0.45-0.74; P < 0.001) and a delay to initial administration (16 days; 95% CI: 12-20 days; P < 0.001). CONCLUSIONS: AL was significantly associated with increased rates of distant recurrence and long-term all-cause mortality. Cancelled or delayed administration of adjuvant chemotherapy may partly account for these findings.",

keywords = "Aged, Aged, 80 and over, Anastomosis, Surgical, Anastomotic Leak, Cause of Death, Colectomy, Colon, Colonic Neoplasms, Confidence Intervals, Denmark, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Neoplasm Recurrence, Local, Neoplasm Staging, Prognosis, Proportional Hazards Models, Prospective Studies, Registries, Risk Assessment, Time Factors",

author = "Peter-Martin Krarup and Andreas Nordholm-Carstensen and Jorgensen, {Lars N} and Henrik Harling",

year = "2014",

month = may,

doi = "10.1097/sla.0b013e3182a6f2fc",

language = "English",

volume = "259",

pages = "930--938",

journal = "Advances in Surgery",

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T1 - Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality After Curative Resection for Colonic Cancer

T2 - A Nationwide Cohort Study

AU - Krarup, Peter-Martin

AU - Nordholm-Carstensen, Andreas

AU - Jorgensen, Lars N

AU - Harling, Henrik

PY - 2014/5

Y1 - 2014/5

N2 - OBJECTIVE: To investigate the impact of anastomotic leak (AL) on disease recurrence and long-term mortality in patients alive 120 days after curative resection for colonic cancer. BACKGROUND: There is no solid data as to whether AL after colonic cancer surgery increases the risk of disease recurrence. METHODS: This was a nationwide cohort study of 9333 patients, prospectively registered in the database of the Danish Colorectal Cancer Group and merged with data from the Danish Pathology Registry and the National Patient Registry. Multivariable Cox regression analysis was used to adjust for confounding. RESULTS: The incidence of AL was 6.4%, 744 patients died within 120 days. Of the remaining 8589 patients, 861 (10.0%) developed local recurrence with no association to AL [adjusted hazard ratio (HR) = 0.78; 95% confidence interval (CI): 0.55-1.12; P = 0.184]. Distant recurrence developed in 1281 (14.9%) patients and more frequently after AL (adjusted HR = 1.42; 95% CI: 1.13-1.78; P = 0.003). AL was also associated with increased long-term mortality (adjusted HR = 1.20; 95% CI: 1.01-1.44; P = 0.042). In 2841 patients with stage III cancer, AL was associated with both decreased likelihood of receiving adjuvant chemotherapy (adjusted HR = 0.58; 95% CI: 0.45-0.74; P < 0.001) and a delay to initial administration (16 days; 95% CI: 12-20 days; P < 0.001). CONCLUSIONS: AL was significantly associated with increased rates of distant recurrence and long-term all-cause mortality. Cancelled or delayed administration of adjuvant chemotherapy may partly account for these findings.

AB - OBJECTIVE: To investigate the impact of anastomotic leak (AL) on disease recurrence and long-term mortality in patients alive 120 days after curative resection for colonic cancer. BACKGROUND: There is no solid data as to whether AL after colonic cancer surgery increases the risk of disease recurrence. METHODS: This was a nationwide cohort study of 9333 patients, prospectively registered in the database of the Danish Colorectal Cancer Group and merged with data from the Danish Pathology Registry and the National Patient Registry. Multivariable Cox regression analysis was used to adjust for confounding. RESULTS: The incidence of AL was 6.4%, 744 patients died within 120 days. Of the remaining 8589 patients, 861 (10.0%) developed local recurrence with no association to AL [adjusted hazard ratio (HR) = 0.78; 95% confidence interval (CI): 0.55-1.12; P = 0.184]. Distant recurrence developed in 1281 (14.9%) patients and more frequently after AL (adjusted HR = 1.42; 95% CI: 1.13-1.78; P = 0.003). AL was also associated with increased long-term mortality (adjusted HR = 1.20; 95% CI: 1.01-1.44; P = 0.042). In 2841 patients with stage III cancer, AL was associated with both decreased likelihood of receiving adjuvant chemotherapy (adjusted HR = 0.58; 95% CI: 0.45-0.74; P < 0.001) and a delay to initial administration (16 days; 95% CI: 12-20 days; P < 0.001). CONCLUSIONS: AL was significantly associated with increased rates of distant recurrence and long-term all-cause mortality. Cancelled or delayed administration of adjuvant chemotherapy may partly account for these findings.

KW - Aged

KW - Aged, 80 and over

KW - Anastomosis, Surgical

KW - Anastomotic Leak

KW - Cause of Death

KW - Colectomy

KW - Colon

KW - Colonic Neoplasms

KW - Confidence Intervals

KW - Denmark

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Neoplasm Recurrence, Local

KW - Neoplasm Staging

KW - Prognosis

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Registries

KW - Risk Assessment

KW - Time Factors

U2 - 10.1097/sla.0b013e3182a6f2fc

DO - 10.1097/sla.0b013e3182a6f2fc

M3 - Journal article

C2 - 24045445

SN - 0003-4932

VL - 259

SP - 930

EP - 938

JO - Advances in Surgery

JF - Advances in Surgery

IS - 5

ER -

Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality After Curative Resection for Colonic Cancer: A Nationwide Cohort Study

Abstract

Keywords

UN SDGs

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