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The aim of this retrospective cohort-study is to assess the effects of AL and its severity divided according the ISREC-classification on the long-term oncological outcome.
Rectal cancer is one of the most common malignancies in the world. Its costs and cancer-related mortality are increasing worldwide. The surgical treatment was revolutionized in recent years by the total mesorectal excision (TME) technique as well as the laparoscopic, robotic, and transanal approach. But anastomotic leakage (AL) remains one of the most feared complications after low rectal resection regarding postoperative morbidity and mortality as well as functional outcome. Several risk factors causing AL like low level of anastomosis, large tumor mass, male gender, smoking, perioperative bleeding, and preoperative radio-chemotherapy are known. Protective ileo- or colostomy formation and transanal tube placement may decrease the risk of AL and reduces the rate of reoperation due to AL. Diverting results of the association between AL and the long-term oncological outcome (local recurrence, systemic recurrence, survival) are described in the current literature.
The International Study Group of Rectal Cancer (ISREC) provides a classification of AL according to its clinical management:
This classification allows a good stratification regarding postoperative morbidity and mortality. However, the association between the ISREC-classification of AL and the long-term oncological outcome is not yet clear.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| leak | Patients with diagnosed anastomotic leakage after low rectal resection for rectal cancer UICC stage I to III |
| |
| noleak | Patients without anastomotic leakage after low rectal resection for rectal cancer UICC stage I to III |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Anastomotic leakage | Other | Anastomotic leakage was defined as a defect of the intestinal wall at the anastomotic site leading to a communication between the intra- and extraluminal compartments. It was diagnosed by clinical, laboratory, radiological (ultrasound, endosonography, computed tomography), endoscopic, and/or surgical findings. |
| Measure | Description | Time Frame |
|---|---|---|
| Cancer-specific survival | 30 days postoperative to 5 years postoperative |
| Measure | Description | Time Frame |
|---|---|---|
| Overall survival | 30 days postoperative to 5 years postoperative | |
| Disease-free survival | 30 days postoperative to 5 years postoperative | |
| Recurrence-free survival |
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Inclusion Criteria:
Exclusion Criteria:
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Patients operated at the Cantonal Hospital of St. Gallen
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| Name | Affiliation | Role |
|---|---|---|
| Ignazio Tarantino, PD Dr. med. | Klinik für Chirurgie, Cantonal Hospital of St. Gallen | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cantonal Hospital of St. Gallen | Sankt Gallen | 9000 | Switzerland |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 20004450 | Background | Rahbari NN, Weitz J, Hohenberger W, Heald RJ, Moran B, Ulrich A, Holm T, Wong WD, Tiret E, Moriya Y, Laurberg S, den Dulk M, van de Velde C, Buchler MW. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010 Mar;147(3):339-51. doi: 10.1016/j.surg.2009.10.012. Epub 2009 Dec 11. | |
| 41790293 |
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| ID | Term |
|---|---|
| D012004 | Rectal Neoplasms |
| D057868 | Anastomotic Leak |
| ID | Term |
|---|---|
| D015179 | Colorectal Neoplasms |
| D007414 | Intestinal Neoplasms |
| D005770 | Gastrointestinal Neoplasms |
| D004067 | Digestive System Neoplasms |
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|
| 30 days postoperative to 5 years postoperative |
| Derived |
| Ammann Y, Marti L, Warschkow R, Bischofberger S, Reissfelder C, Schmied B, Brunner W, Tarantino I. Does the management of anastomotic leakage after rectal cancer resection affect long-term oncological survival? A retrospective propensity score-adjusted cohort study. Tech Coloproctol. 2026 Mar 6;30(1):40. doi: 10.1007/s10151-026-03289-6. |
| D009371 | Neoplasms by Site |
| D009369 | Neoplasms |
| D004066 | Digestive System Diseases |
| D005767 | Gastrointestinal Diseases |
| D007410 | Intestinal Diseases |
| D012002 | Rectal Diseases |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |