The impact of anastomotic leak and its treatment on cancer recurrence and survival following elective colorectal cancer resection

Aim: Anastomotic leakage is a serious complication in restorative colorectal surgery. Anastomotic leakage and its subsequent management may have long-term impact on survival. This study aims to assess the impact of colorectal anastomotic leak (AL) on overall survival (OS) and disease-free survival (DFS). Methods: A prospective database of 1,048 patients undergoing restorative colorectal cancer resections at St Mark's hospital between October 2004 and October 2013 was examined. Results: The overall leak rate was 99/1,048 (9.4 %). 43 ALs were managed conservatively with antibiotics or radiological drainage and 56 with reoperations. OS was significantly reduced in the AL group treated with a reoperation (HR 2.74, 95 % CI 1.67-4.52, p < 0.001). AL was not significantly associated with worse DFS [conservatively managed AL's vs. no AL - HR 2.07 (95 % CI 1.05-4.10); reoperated AL's vs. no AL - HR 1.56 (95 % CI 0.81-2.99), overall p value = 0.058]. Conclusion: Patients who suffer anastomotic leaks requiring reoperations have worse OS compared to patients who do not leak, but there were no significant differences in DFS between patients who leaked and those who did not.