Introduction: Colorectal anastomoses frequently become the site of of complications after surgical procedures for colorectal cancer. Anastomotic dehiscence has a significant impact on the whole p postoperative disease course, may influence the overal survival (OS) and disease free interval (DFI). The aim of our study was to analyze clinical and histopathological factors, that could facilitate detection of dehiscences and are related to the prognosis of patients.
Material and methods: The authors performed statistical analysis of a cohort of patients (340 pacients, 207 males, 133 females) who underwent radical resection followed by anastomosis on the large intestine during 2003-2007. The following factors were assessed: age, gender, staging, protective stoma, neoadjuvant chemotherapy, neoadjuvant radiotherapy, adjuvant chemotherapy, adjuvant radiotherapy and anastomotic insufficiency. Complications were evaluated according to Clavien and Dindo classification.
Results: The analysis confirmed the following factors to be statistically significant for prognosis of OS and DFI: In stage T4 subjects, the risk of death was 2.5 x higher and the risk of recurrence was 1.9 x higher than in the lower disease stage subjects. The presence of N2 lymph node metastases increases the risk of death 3.7 x and the risk of recurrence 3.6 x, compared to N0 and N1 cases. The presence of postoperative complications classified asf III.-V. grade according to Clavien and Dindo classification increases the risk of death 4x. The risk of death was 5.5 x higher in patients with dehiscence of anastomosis. The surprising finding was that even protective stoma increases the risk of death 5.4 x. Patients who did not undergo adjuvant chemotherapy were at 2 x higher risk of death. In patients with IIIA, IIIB, IV, V complications, the following factors proved to be statistically significant for prognosis of OS: leakage, protective stoma, adjuvant chemotherapy and adjuvant oncological treatment. In patients with complications I and II, the following factors were proved to be statistically significant for prognosis of OS: staging and lymph nodes metastases. Multivariate analysis CART confirmed significant correlation between the lymph nodes positivity and the Clavien and Dindo classification of complications.
Conclusion: Analysis of clinical and histopathological factors is important for prediction of prognosis in patients with colorectal cancer after radical surgical treatment. Detection and application of these prognostic factors in postoperative period could influence the strategy of treatment and thus the overal survival in patients with radical resections for colorectal carcinoma. Nonadministration of adjutant chemotherapy results in a significant decrease in OS and DFI.