Outcomes on diverting ostomy formation and reversal after low anterior resection in the older more advanced rectal cancer patient

被引：2

作者：

Ketelaers, S. H. J. ^{[1
]}

Orsini, R. G. ^{[2
]}

Nieuwenhuijzen, G. A. P. ^{[1
]}

Rutten, H. J. T. ^{[1
,3
]}

Burger, J. W. A. ^{[1
]}

Bloemen, J. G. ^{[1
]}

机构：

[1] Catharina Hosp, Dept Surg, POB 1350, NL-5602 ZA Eindhoven, Netherlands

[2] ETZ Elisabeth TweeSteden Hosp, Dept Surg, Tilburg, Netherlands

[3] Maastricht Univ, Dept GROW, Sch Dev Biol & Oncol, Maastricht, Netherlands

来源：

EJSO | 2022年 / 48卷 / 06期

关键词：

Rectal cancer; Ostomy; Colostomy; Ileostomy; Surgery; Elderly; QUALITY-OF-LIFE; ANASTOMOTIC LEAKAGE; LOOP ILEOSTOMY; STOMA REVERSAL; DEFUNCTIONING STOMAS; RISK-FACTORS; COMPLICATIONS; MORTALITY; READMISSION; DEHYDRATION;

D O I：

10.1016/j.ejso.2021.12.020

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: To decrease morbidity caused by anastomotic leakages after a low anterior resection (LAR) with primary anastomosis, a diverting ostomy is often created. Reversal of a diverting ostomy is associated with morbidity, which may result in non-reversal, particularly in the elderly. This study aimed to describe the diverting ostomy-related outcomes in elderly patients with more advanced rectal cancer after LAR. Materials and methods: All rectosigmoid and rectal cancer patients >= 70 years who underwent LAR with primary anastomosis between 2006 and 2019 in the Catharina Hospital (Eindhoven, The Netherlands) were included for analyses. Reversal rates, ostomy-related complications, morbidity and mortality after ostomy reversal, and definitive ostomy rates were evaluated. Results: In total 164 patients were included, of which 150 (91.5%) underwent primary or secondary ostomy creation. Ostomy-related complications were reported in 34.7% (95%-CI 27.1-42.9%). In total, 72.5% (95%-CI 64.2-79.7%) reversed their diverting ostomy. Non-reversal was mostly due to relapsing disease (52.6%). Median time to ostomy reversal was 3.2 months (IQR 2.3-5.0). No or minor complications after ostomy reversal were observed in 84.0% (95%-CI 75.3-90.6%). Over time, ostomy recreation was performed in 15.0% (95%-CI 8.6-23.5%), and ultimately 65.8% (95%-CI 57.8-73.2%) were ostomy-free after the median follow-up of 3.8 years. Conclusion: Although most elderly successfully reversed their diverting ostomy after LAR with limited morbidity, attention should be paid for the risk of non-reversal and ostomy recreation over time. Preoperative patient counselling is important in every individual to be able to decide if LAR with primary anastomosis or a permanent end colostomy is preferred. (C) 2021 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

引用

页码：1414 / 1420

页数：7