• FurnéeEdgar J BEJB0000-0002-3712-3798Department of Abdominal Surgery, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, the Netherlands. edgarfurnee@hotmail.com., Tjeerd S Aukema, Steven J Oosterling, Wernard A A Borstlap, Willem A Bemelman, Pieter J Tanis, and Dutch Snapshot Research Group.
• Department of Abdominal Surgery, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, the Netherlands. edgarfurnee@hotmail.com.
• J. Gastrointest. Surg. 2019 Oct 1; 23 (10): 2007-2018.

BackgroundConversion and anastomotic leakage in colorectal cancer surgery have been suggested to have a negative impact on long-term oncologic outcomes. The aim of this study in a large Dutch national cohort was to analyze the influence of conversion and anastomotic leakage on long-term oncologic outcome in rectal cancer surgery.MethodsPatients were selected from a retrospective cross-sectional snapshot study. Patients with a benign lesion, distant metastasis, or unknown tumor or metastasis status were excluded. Overall (OS) and disease-free survival (DFS) were compared between laparoscopic, converted, and open surgery as well as between patients with and without anastomotic leakage.ResultsOut of a database of 2095 patients, 638 patients were eligible for inclusion in the laparoscopic, 752 in the open, and 107 in the conversion group. A total of 746 patients met the inclusion criteria and underwent low anterior resection with primary anastomosis, including 106 (14.2%) with anastomotic leakage. OS and DFS were significantly shorter in the conversion compared to the laparoscopic group (p = 0.025 and p = 0.001, respectively) as well as in anastomotic leakage compared to patients without anastomotic leakage (p = 0.002 and p = 0.024, respectively). In multivariable analysis, anastomotic leakage was an independent predictor of OS (hazard ratio 2.167, 95% confidence interval 1.322-3.551) and DFS (1.592, 1077-2.353). Conversion was an independent predictor of DFS (1.525, 1.071-2.172), but not of OS.ConclusionTechnical difficulties during laparoscopic rectal cancer surgery, as reflected by conversion, as well as anastomotic leakage have a negative prognostic impact, underlining the need to improve both aspects in rectal cancer surgery.

27 keywords...

hide…