Increased local recurrence and reduced survival from XXXX following anastomotic leak: systematic review and meta-analysis.

@entity5 @entity1 @entity834 @entity14
OBJECTIVE: To examine the long-term oncological impact of @entity834 ( @entity834 ) after restorative surgery for @entity14 using meta-analytical methods. Outcomes evaluated were local recurrence, distant recurrence, and survival. BACKGROUND: Recurrence after potentially curative surgery for @entity14 remains a significant clinical problem and has a poor prognosis. @entity834 may be a risk factor for disease recurrence, however available studies have been conflicting. A meta-analysis was conducted to investigate the impact of @entity834 on disease recurrence and long-term survival. METHODS: Studies published between 1965 and 2009 evaluating the long-term oncological impact of @entity834 were identified by an electronic literature search. Outcomes evaluated included local recurrence, distant recurrence, and @entity5 specific survival. Meta-analysis was performed using the DerSimonian-Laird random-effects model to compute odds ratio and 95% confidence intervals. Study heterogeneity was evaluated using Q statistics and I and publication bias assessed with funnel plots and Egger's test. RESULTS: Twenty-one studies comprising 13 prospective nonrandomized studies, 1 prospective randomized, and 7 retrospective studies met the inclusion criteria, yielding a total of 21,902 @entity1 . For rectal anastomoses, the odd ratios (OR) of developing a local recurrence when there was @entity834 was 2.05 (95% CI = 1.51-2.8; P = 0.0001). For studies describing both colon and rectal anastomoses, the OR of local recurrence when there was an @entity834 was 2.9 (95% CI = 1.78-4.71; P < 0.001). The OR of developing a distant recurrence after @entity834 was 1.38 (95% CI = 0.96-1.99; P = 0.083). Long term @entity5 specific mortality was significantly higher after @entity834 with an OR of 1.75 (95% CI = 1.47-2.1; P = 0.0001). CONCLUSIONS: @entity834 has a negative prognostic impact on local recurrence after restorative resection of @entity5 . A significant association between colorectal @entity834 and reduced long-term @entity5 specific survival was also noted. No association between @entity834 and distant recurrence was found.
