A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study

Dulk, Marcel den; Smit, Marije; Peeters, Koen; Kranenbarg, Elma Meershoek-Klein; Rutten, H.J.T.; Wiggers, Theo; Putter, Hein; Velde, Cornelis J.H. van de

doi:10.1016/s1470-2045(07)70047-5

Cited by 274 publications

(239 citation statements)

References 21 publications

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“…Temporary stomas are widely used in colorectal surgery, especially in minimally invasive surgery and above all in rectal surgery. Various studies have reported a complication rate of 21-70% (26) after stoma formation; moreover up to 30% of the "temporary" stomas become definitive (27), and mortality is also reported. A question arises: in the modern era, where patients are treated with a holistic approach, and where many efforts are done to improve their QoL and their outcome, and where "minimally invasivity" is the present of the surgery, can a routine and unselected use of a derivative stoma be considered a standard of care?…”

Section: Discussionmentioning

confidence: 99%

Open sphincter-preserving surgery of extraperitoneal rectal cancer without primary stoma and Fast Track Protocol

Pappalardo¹

2016

Gchir

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Section: Discussionmentioning

confidence: 99%

Open sphincter-preserving surgery of extraperitoneal rectal cancer without primary stoma and Fast Track Protocol

Pappalardo¹

2016

Gchir

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“…However, one should remember that surgical closure of a defunctioning stoma also entails the risk of postoperative complications (18,19). In addition, some of defunctioning stomas never get closed (14,20).…”

Section: Discussionmentioning

confidence: 99%

Risk of Permanent Stoma After Resection of Rectal Cancer Depending on the Distance Between the Tumour Lower Edge and Anal Verge

Rutkowski¹,

Chwaliński²,

Zajâc³

et al. 2011

Polish Journal of Surgery

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The distance between the anal verge and lower edge of rectal cancer is one of the most important factors affecting the feasibility of sphincter-preserving resection. the aim of the study was to assess the risk of permanent stoma after resection of rectal tumour depending on the distance between the tumour and the anal verge. material and methods. The retrospective analysis covered 884 patients after resection of rectal cancer. The distance between the anal verge and the lowest edge of the tumour was measured during endoscopic examination. Surgical technique was similar in all cases. For statistical analysis, the chisquare test and Fisher exact test were used. Results. The overall rate of sphincter-preserving procedures was 71.8%, 90.1% of which were anterior resections. The greatest differences between the rate of anterior resections were noted for the segment between the 4 th and the 5 th centimetres: 30.1% for 4 cm vs 66.7% for 5 cm, p = 0.005. Overall, in 328 patients (37.1%) surgical treatment resulted in a permanent stoma. The number included: 246 (75.0%) patients after abdominosacral resection, 44 (13.4%) patients after the Hartmann procedure, three (0.9%) patients after proctocolectomy, and 28 (8.5%) patients after anterior resection, with a permanent stoma as a result of anastomotic leak. The overall rate of anastomotic leak was 11.7%. Formation of a defunctioning stoma in patients with a low-lying (≤ 6 cm from the anal verge) tumour reduced the risk of symptomatic anastomotic leak: 6.3% vs 20.5%; p = 0.049. Conclusions. Anterior resection of tumours located ≥ 6 cm from the anal verge is feasible in 90%. Anastomotic leak that requires reoperation increases the risk of permanent colostomy. In selected cases, formation of a defunctioning stoma after resection of low-lying rectal cancer can reduce the risk of permanent colostomy. Key words: rectal cancer, tumor position, sphincter saving surgery Maintenance of intestinal continuity is one of the most important issues for the patient with rectal cancer. Concerns about having a permanent intestinal fistula formed sometimes affects the decision whether or not to consent to surgical treatment. When planning treatment, a number of clinical aspects are taken into consideration, such as the patient's general condition, patency of gastrointestinal tract and tumour staging. One of the most important factors affecting the feasibility of a sphincterpreserving surgery is the location of rectal cancer with respect to the anal verge. If sphincters are infiltrated by the cancer, the only method of radical surgical treatment left is abdominoperineal or abdominosacral resection. Local resection of rectal cancer, especially with the use of the TEM technique (transanal endoscopic microsurgery) gives good functional results and entails low risk Unauthenticated Download Date | 5/12/18 10:09 AM

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“…However, other investigators [4, 5] failed to show the advantage of protective stoma on the reoperation rate in patients with anastomotic leakage and no published studies [3, 21] have demonstrated the benefit of protective stoma on mortality rate after leakage. Considering that one-fifth of the temporary stoma might never be reversed [6] and that stomal closure is associated with 3% mortality and 20% morbidity [25], surgeons should deliberate over a decision to create a protective stoma.…”

Section: Discussionmentioning

confidence: 99%

“…Other clinical trials [4, 5] suggested that it did not improve outcomes such as anastomotic leakage and reoperation rate. Although intended to be temporary, one-fifth of these stomas might never be reversed [6]. Having a stoma might lead to limited social activity, depression and poor quality of life [7].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Sphincter-Saving Operation for Rectal Cancer without Protective Stoma and Pelvic Drain, and Risk Factors for Anastomotic Leakage

Lohsiriwat

Lohsiriwat²,

Boonnuch³

et al. 2008

Dig Surg

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Background/Aims: To evaluate the outcomes of sphincter-saving operation for rectal cancer without protective stoma and pelvic drain and to determine factors influencing anastomotic leakage. Methods: We investigated 170 patients undergoing elective sphincter-saving operation without protective stoma and pelvic drain during 2003–2006 in a single institution. Early postoperative outcomes were evaluated. 17 independent patient-, tumor-, and treatment-related variables were analyzed by a multivariate model to determine their association with anastomotic leakage. Results: The patients’ median age was 64 years. Median tumor height was 8 cm (range 3–15) from the anal verge. Overall 30-day mortality rate was 1.2%. Postoperative complications were diagnosed in 38 patients (22%) including 14 cases of anastomotic leakage (8.2%), of which 10 cases (71%) required surgical intervention. Tumor height within 5 cm from the anal verge was the only independent factor for leakage (OR 4.04; 95% CI 1.25–13.08). Conclusion: A sphincter-saving operation without a protective stoma and pelvic drain can be performed safely in the vast majority of rectal cancer patients. Tumor height within 5 cm from the anal verge is an independent risk factor for anastomotic leakage. Thus, the routine use of a protective stoma and pelvic drainage might be unnecessary.

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A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study

Cited by 274 publications

References 21 publications

Open sphincter-preserving surgery of extraperitoneal rectal cancer without primary stoma and Fast Track Protocol

Open sphincter-preserving surgery of extraperitoneal rectal cancer without primary stoma and Fast Track Protocol

Risk of Permanent Stoma After Resection of Rectal Cancer Depending on the Distance Between the Tumour Lower Edge and Anal Verge

Outcomes of Sphincter-Saving Operation for Rectal Cancer without Protective Stoma and Pelvic Drain, and Risk Factors for Anastomotic Leakage

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