Objective: 

The aim was to evaluate the impact of anastomotic leak (AL) after colon cancer (CC) and rectal cancer (RC) surgery on 5-year relative survival, disease-free survival (DFS), and disease recurrence.

Background: 

AL after CC and RC resection is a severe postoperative complication with conflicting evidence whether it deteriorates long-term outcomes.

Methods: 

Patients with stage I to IV CC and RC who underwent resection with primary anastomosis were included from the Netherlands Cancer Registry (2008–2018). Relative survival, measured from day of resection, and multivariable relative excess risks (RERs) were analyzed. DFS and recurrence were evaluated in a subset with stage I to III patients operated in 2015. All analyses were performed with patients who survived 90 days postoperatively.

Results: 

A total of 65,299 CC and 22,855 RC patients were included. Five-year relative survival after CC resection with and without AL was 95% versus 100%, 89% versus 94%, 66% versus 76%, and 28% versus 25% for stage I to IV disease. AL was associated with a significantly higher RER for death in stage II and III CC patients. Stage-specific 5-year relative survival in RC patients with and without AL was 97% versus 101%, 90% versus 95%, 74% versus 83%, and 32% versus 41%. AL was associated with a significantly higher RER for death in stage III and IV RC patients. DFS was significantly lower in CC patients with AL, but disease recurrence was not associated with AL after colorectal cancer resection.

Conclusion: 

AL has a stage-dependent negative impact on survival in both CC and RC, but no independent association with disease recurrence.

中文翻译：

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结直肠吻合口漏后的长期肿瘤学结果：一项基于荷兰人群的回顾性研究

客观的： 

目的是评估结肠癌 (CC) 和直肠癌 (RC) 手术后吻合口漏 (AL) 对 5 年相对生存率、无病生存率 (DFS) 和疾病复发的影响。

背景： 

CC 和 RC 切除后的 AL 是一种严重的术后并发症，其是否会恶化长期预后的证据相互矛盾。

方法： 

荷兰癌症登记处 (2008-2018) 纳入了接受一期吻合术切除的 I 至 IV 期 CC 和 RC 患者。分析了从切除日开始测量的相对生存率和多变量相对超额风险 (RER)。在 2015 年手术的 I 至 III 期患者的子集中评估了 DFS 和复发。所有分析均在术后存活 90 天的患者中进行。

结果： 

共纳入 65,299 名 CC 和 22,855 名 RC 患者。对于 I 至 IV 期疾病，CC 切除后有和无 AL的 5 年相对生存率为 95% 对 100%、89% 对 94%、66% 对 76% 和 28% 对 25%。在 II 期和 III 期 CC 患者中，AL 与显着较高的 RER 相关。伴有和不伴有 AL 的 RC 患者的分期 5 年相对生存率分别为 97% 对 101%、90% 对 95%、74% 对 83% 和 32% 对 41%。在 III 期和 IV 期 RC 患者中，AL 与显着较高的 RER 相关。伴有 AL 的 CC 患者的 DFS 显着降低，但结直肠癌切除后疾病复发与 AL 无关。

结论： 

AL 对 CC 和 RC 的生存率具有阶段依赖性的负面影响，但与疾病复发没有独立关联。