Revised risk factors and patient characteristics for failure to close a defunctioning ileostomy following low anterior resection for locally advanced rectal cancer

被引:7
作者
Barenboim, Alex [1 ,2 ]
Geva, Ravit [1 ,2 ]
Tulchinsky, Hagit [1 ,2 ]
机构
[1] Tel Aviv Univ, Sackler Fac Med, Tel Aviv Med Ctr, Colorectal Unit,Div Surg, Tel Aviv, Israel
[2] Tel Aviv Univ, Sackler Fac Med, GIT Malignancies Ctr, Div Oncol, Tel Aviv, Israel
关键词
Rectal cancer; Permanent ileostomy; TOTAL MESORECTAL EXCISION; PERMANENT STOMA; SURGICAL COMPLICATIONS; LOOP ILEOSTOMY; CLASSIFICATION; METAANALYSIS;
D O I
10.1007/s00384-022-04188-6
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Our clinical experience led us to raise questions about the validity of the reported risk factors and patient characteristics associated with permanent stomas after sphincter-preserving resection for rectal cancer. Objective The present retrospective study aimed to identify and compare our center's incidence and risk factors for a permanent ostomy after low anterior resection (LAR) with a diverting stoma for locally advanced mid and low rectal cancer with those in published reports. Patients A total of 239 patients underwent a sphincter-preserving procedure (LAR) for rectal cancer between 2000 and 2018, and 236 of them (age range 33-83 years, 100 males (42%)) were included in the analysis. The study cohort was divided into 2 groups comprised of patients with and without permanent stomas after rectal cancer surgery. Results Only 25 of the 236 operated patients (10.6%) remained with permanent stomas after rectal cancer surgery. Factors associated with stoma non-closure in the multivariate analysis were pathological stage 3 (13 (52%) vs 51 (24.2%) for patients with closed stomas, p = 0.032), disease recurrence (14 (56%) vs 40 (18.9%), respectively, p = 0.048), length of stay > 10 days, p = 0.032), and anastomotic leaks with a Clavien-Dindo score > 2 or reoperations (6 (24%) vs 13 (6.1%), p = 0.019). Conclusions Sphincter-preserving surgery for rectal cancer was associated with a lower incidence of stoma non-closure than published values. The major risk factors for non-closure were aggressive disease and severe complications of surgery.
引用
收藏
页码:1611 / 1619
页数:9
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