Rathin Gosavi, Raymond Yap, Stephen Bell, Simon Wilkins, Mohammad Asghari-Jafarabadi, Paul McMurrick
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引用次数: 0
Abstract
Background: Anastomotic leak (AL) is a serious complication following colon cancer resection, but its long-term impact on survival and recurrence remains uncertain.
Objective: To evaluate the association between AL and postoperative outcomes, including overall survival (OS), replase-free survival (RFS), and cancer-specific survival (CSS), and to identify factors associated with increased risk of leak.
Methods: This retrospective cohort study included 2217 patients with histologically confirmed Stage I-III colon adenocarcinoma who underwent curative-intent resection with primary anastomosis across three tertiary centres (2009-2025). Patients with benign pathology, carcinoma in situ (Stage 0), metastatic disease, or missing follow-up data were excluded. ALs were defined as clinically and/or radiologically confirmed disruptions occurring within 30 days postoperatively. No leaks were observed beyond this period. Outcomes were compared using Kaplan-Meier estimates and Cox regression models.
Results: ALs, either clinical or radiological, occurred in 2.0% of patients (n = 44). Leaks were associated with significantly increased 30-day mortality (6.8% vs. 0.4%, p < 0.001), reoperation (86.4% vs. 3.4%, p < 0.001), and hospital stay (median 21 vs. 7 days, p < 0.001). In multivariable analysis, AL independently predicted 30-day mortality (AOR 13.6, 95% CI 9.9-18.6) and return to theatre (AOR 396.2, 95% CI 218.8-717.4). AL was associated with worse OS and DFS, but not CSS (p = 0.66).
Conclusions: AL is an independent predictor of postoperative morbidity and long-term nononcologic mortality in colon cancer patients. While OS and DFS were significantly reduced, CSS remained unaffected, a unique finding that challenges assumptions about leak-related oncologic progression. These results suggest that excess mortality stems from systemic complications and care disruption rather than cancer recurrence. Preventive strategies and early leak detection in high-risk patients are essential to improving outcomes.
期刊介绍:
The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.