대한대장항문학회

Purpose: Anastomotic leakage (AL) is a serious and life- threatening complication following rectal cancer surgery. The impact on long-term oncologic outcome in patients with AL is not clear. The aim of this retrospective study was to evaluate the risk factors of AL and its impact on long-term prognosis after rectal cancer surgery. Methods: We investigated 1,391 patients who underwent primary resection and anastomosis for rectal cancer between January 1997 and August 2003. Operations were performed as follows: AR (n=164), LAR (n=898), uLAR (n=329). Standard procedures in our clinic were mesorectal excision according to tumor location and autonomic nerve preservation. Median follow-up period was 40.1 months (2∼96 months). Results: AL rate was 2.5% (n=35). Gender (male), age (＞60 years) and uLAR were independent risk factors in multivariate analysis (HR: 3.03, 95% CI: 1.18∼7.22; HR: 2.42, 95% CI: 1.12∼7.83; HR: 2.68, 95% CI: 1.08∼7.09, respectively). Local recurrence in the AL group was significantly higher than that in the non-AL group (P＜0.05), but there was no significant difference in multivariate analysis (P=0.14). Systemic recurrence between both groups was not statistically different. The 5-year overall survival rate was significantly lower in the AL group than in the non-AL group (55.1% vs 74.1%, P＜0.05) and the cancer- specific survival rate was lower in the AL group than in the non-AL group (63.0% vs 78.3%, P=0.05). Conclusions: Age, gender, and anastomotic level were risk factors for AL after rectal cancer surgery and anastomotic leakage was associated with a poor survival. J Korean Soc Coloproctol 2006;22:371-379