{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T01:39:38Z","timestamp":1790386778537,"version":"4.1.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2009,8,11]],"date-time":"2009-08-11T00:00:00Z","timestamp":1249948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Quality Assurance Fellowship of the European Society of Surgical Oncology"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,8,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The association between diverting stomas and symptomatic anastomotic leakage after rectal cancer surgery was studied, as well as the impact of leakage on local recurrence, distant metastasis, and disease-free, overall and cancer-specific survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from the Swedish Rectal Cancer Trial, Dutch TME trial, CAO\/ARO\/AIO-94 trial, EORTC 22921 trial and Polish Rectal Cancer Trial were pooled (n = 5187). All eligible patients without distant metastases at the time of low anterior resection were selected (n = 2726); overall survival was studied in patients aged 75 years or less (n = 2480). Multivariable models were used to study the association between diverting stomas and anastomotic leakage, and between leakage and recurrence or survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Some 9\u00b77 per cent of patients were diagnosed with a symptomatic anastomotic leak; diverting stomas were negatively associated with leakage (11\u00b76 per cent without and 7\u00b78 per cent with a stoma; P = 0\u00b7002). Anastomotic leakage was negatively associated with overall survival in the multivariable analysis (hazard ratio (HR) 1\u00b729 (95 per cent confidence interval 1\u00b702 to 1\u00b763); P = 0\u00b7034), but not with cancer-specific survival (HR 1\u00b712 (0\u00b783 to 1\u00b752); P = 0\u00b7466).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Diverting stomas were associated with less symptomatic anastomotic leakage. Oncological outcome was not significantly influenced by leakage, but overall survival was reduced.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bjs.6694","type":"journal-article","created":{"date-parts":[[2009,8,11]],"date-time":"2009-08-11T13:15:37Z","timestamp":1249996537000},"page":"1066-1075","source":"Crossref","is-referenced-by-count":239,"title":["Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery"],"prefix":"10.1093","volume":"96","author":[{"given":"M","family":"den Dulk","sequence":"first","affiliation":[{"name":"Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C A M","family":"Marijnen","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"Collette","sequence":"additional","affiliation":[{"name":"Department of Statistics, European Organization for Research and Treatment of Cancer Data Center, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Putter","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L","family":"P\u00e5hlman","sequence":"additional","affiliation":[{"name":"Department of Surgery, Uppsala University Hospital, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Folkesson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Uppsala University Hospital, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J-F","family":"Bosset","sequence":"additional","affiliation":[{"name":"Department of Radiation Therapy, Besan\u00e7on University Hospital, Besan\u00e7on, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"R\u00f6del","sequence":"additional","affiliation":[{"name":"Department of Radiation Therapy, University of Frankfurt, Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Bujko","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C J H","family":"van de Velde","sequence":"additional","affiliation":[{"name":"Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2009,8,11]]},"reference":[{"key":"2021070910383530000_bib1","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s10350-004-6317-7","article-title":"A national strategic change in treatment policy for rectal cancer\u2014implementation of total mesorectal excision as routine treatment in Norway. 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