Defunctioning stoma in anterior resection for rectal cancer does not impact anastomotic leakage: a national population-based cohort study

BMC Surgery

Research

Marie-Louise Lydrup¹  Pamela Buchwald¹  Eihab Munshi² 

[1] Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden;Department of Surgery, Skåne University Hospital, Malmö, Sweden;Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden;Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia;Department of Surgery, Samsung Medical Center, Seoul, South Korea;

关键词: Rectal cancer;    Defunctioning stoma;    Defunctioning loop-ileostomy;    Anastomotic leakage;    Anterior resection;   

DOI  :  10.1186/s12893-023-01998-5

 received in 2022-07-06, accepted in 2023-04-10,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundAnterior resection (AR) is considered the gold standard for curative cancer treatment in the middle and upper rectum. The goal of the sphincter-preserving procedure, such as AR, is vulnerable to anastomotic leak (AL) complications. Defunctioning stoma (DS) became the protective measure against AL. Often a defunctioning loop-ileostomy is used, which is associated with substantial morbidity. However, not much is known if the routine use of DS reduces the overall incidence of AL.MethodsElective patients subjected to AR in 2007–2009 and 2016-18 were recruited from the Swedish colorectal cancer registry (SCRCR). Patient characteristics, including DS status and occurrence of AL, were analyzed. In addition, independent risk factors for AL were investigated by multivariable regression.ResultsThe statistical increase of DS from 71.6% in 2007–2009 to 76.7% in 2016–2018 did not impact the incidence of AL (9.2% and 8.2%), respectively. DLI was constructed in more than 35% of high-located tumors ≥ 11 cm from the anal verge. Multivariable analysis showed that male gender, ASA 3–4, BMI > 30 kg/m2, and neoadjuvant therapy were independent risk factors for AL.ConclusionRoutine DS did not decrease overall AL after AR. A selective decision algorithm for DS construction is needed to protect from AL and mitigate DS morbidities.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

40517_2023_252_Article_IEq112.gif

40517_2023_252_Article_IEq97.gif