Protective ileostomy after low anterior resection for extraperitoneal rectal cancer: does the reversal surgery timing affect closure failure?

被引:3
作者
Batistotti, P. [1 ]
Montale, A. [2 ]
Bruzzone, M. [3 ]
Amato, A. [1 ]
Binda, G. A. [4 ]
机构
[1] Osped Imperia, Gen Surg Dept, Via SantAgata 57, I-18100 Imperia, Italy
[2] EO Ospedali Galliera, Dept Gastroenterol & Digest Endoscopy, Mura Cappuccine 14, I-16128 Genoa, Italy
[3] IRCCS Osped San Martino, Clin Epidemiol Unit, Largo Rosanna Benzi 10, I-16132 Genoa, Italy
[4] Biomed Inst, Gen Surg, Genoa, Italy
关键词
Rectal cancer; Ileostomy; Low anteriore resection; Oncological rectal pathway; DEFUNCTIONING LOOP ILEOSTOMY; QUALITY-OF-LIFE; TEMPORARY STOMA; MORBIDITY; TRIAL; METAANALYSIS; READMISSION; IMPACT; RISK;
D O I
10.1007/s13304-023-01573-w
中图分类号
R61 [外科手术学];
学科分类号
摘要
Loop ileostomy is commonly performed after LAR with TME to temporarily protect the anastomosis. Usually, defunctioning stoma is closed after 1-6 months, although sometimes it becomes definitive de facto. The aim of this study is to investigate the long-term risk of no-reversal of protective ileostomy after LAR for middle-low rectal cancer and the predictive risk factors. A retrospective analysis of a consecutive cohort of patients who underwent curative LAR with covering ileostomy for extraperitoneal rectal cancer in two colorectal units was performed. A different policy for scheduling stoma closure was applied between centers. All the data were collected through an electronic database (Microsoft Excel(& REG;)). Descriptive statistical analysis was performed using Fisher's exact and Student's t test. Multivariate logistic regression analysis was conducted. Two-hundred twenty-two patients were analysed: reversal procedure was carried out in 193 patients, in 29 cases stoma was never closed. The mean interval time from index surgery was 4.9 months (Center1: 3 vs. Center2: 7.8). At the univariate analysis, mean age and tumor stage were significantly higher in the "no-reversal" group. Unclosed ostomies were significantly lower in Center 1 than Center 2 (8% vs. 19.6%). At the multivariate analysis female gender, anastomotic leakage and Center 2 had significant higher risk of unclosed ileostomy. Currently, no clinical recommendations have been established and the policy of scheduling stoma reversal is variable. Our study suggests that an established protocol could avoid closure delay, decreasing permanent stomas. Consequently, ileostomy closure should be weighed as standardized step in cancer therapeutic pathway.
引用
收藏
页码:1811 / 1818
页数:8
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