Clinical Value of Preventative Ileostomy Following Ultra-Low Anterior Rectal Resection

Gong, Hai Feng; Yu, Yang; Yong, Yao

doi:10.1007/s12013-012-9445-z

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…Further review of the full papers revealed that three studies on AR patients [8-10] and one study on LAR patients [11] were conducted in the same hospital and duplicated the time of the patients in the other four studies; two other studies did not provide a conclusion whether their patients all underwent LAR [12,13]. Thus, the final analysis included 70 studies: 40 on AR patients [2-4,6,14-49], 25 on LAR patients [7, 50-73], and 5 on ULAR patients with AL [74-78] (Figure 1). …”

Section: Resultsmentioning

confidence: 99%

Systematic Review of Anastomotic Leakage Rate According to an International Grading System Following Anterior Resection for Rectal Cancer

Cong

Bian

et al. 2013

PLoS ONE

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BackgroundA generally acceptable definition and a severity grading system for anastomotic leakages (ALs) following rectal resection were not available until 2010, when the International Study Group of Rectal Cancer (ISGRC) proposed a definition and a grading system for AL.MethodsA search for published data was performed using the MEDLINE database (2000 to December 5, 2012) to perform a systematic review of the studies that described AL, grade AL according to the grading system, pool data, and determine the average rate of AL for each grade after anterior resection (AR) for rectal cancer.ResultsA total of 930 abstracts were retrieved; 40 articles on AR, 25 articles on low AR (LAR), and 5 articles on ultralow AR (ULAR) were included in the review and analysis. The pooled overall AL rate of AR was 8.58% (2,085/24,288); the rate of the asymptomatic leakage (Grade A) was 2.57%, that of AL that required active intervention without relaparotomy (Grade B) was 2.37%, and that of AL that required relaparotomy (Grade C) was 5.40%. The pooled rate of AL that required relaparotomy was higher in AR (5.40%) than in LAR (4.70%) and in ULAR (1.81%), which could be attributed to the higher rate of protective defunctioning stoma in LAR (40.72%) and ULAR (63.44%) compared with that in AR (30.11%).ConclusionsThe new grading system is simple that the ALs of each grade can be easily extracted from past publications, therefore likely to be accepted and applied in future studies.

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Section: Resultsmentioning

confidence: 99%

Systematic Review of Anastomotic Leakage Rate According to an International Grading System Following Anterior Resection for Rectal Cancer

Cong

Bian

et al. 2013

PLoS ONE

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“…Possible factors contributing to an increased leakage rate include the reduced blood supply of the anorectal remnant and the large pelvic space after TME, which may predispose a patient to fluid accumulation and pelvic infection [34] . Symptomatic anastomotic leakage is the most feared complication and [22] 2008 256 136 120 LAR 3 12 0 2 Gong et al [23] 2012 62 36 26 uLAR 0 5 0 2 Karahasanoglu et al [24] 2011 77 23 54 LAR 0 3 --Lefebure et al [25] 2008 132 42 90 LAR 3 10 1 5 Ma et al [26] 2013 56 30 26 LAR 2 7 0 5 Matthiessen et al [27] 2007 [29] 2013 836 246 590 uLAR 1 22 --Shiomi et al [30] inherent consequences [38] . Nonetheless, the value of a protective stoma has been the subject of controversy for many years.…”

Section: Discussionmentioning

confidence: 99%

“…We evaluated 18 potential candidate studies in the full text, 7 of which were not published in English. Finally, 11 studies [21][22][23][24][25][26][27][28][29][30][31] were included in this meta-analysis, all of which were published between 2007 and 2014. The flow chart of study selection is presented in Figure 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

Wu¹,

Ma²,

Yu³

2014

WJG

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AIM:To provide a comprehensive evaluation of the role of a protective stoma in low anterior resection (LAR) for rectal cancer. METHODS:The PubMed, EMBASE, and MEDLINE databases were searched for studies and relevant literature published between 2007 and 2014 regarding the construction of a protective stoma during LAR. A pooled risk ratio (RR) with 95% confidence intervals (CIs) was used to assess the outcomes of the studies, including the rate of postoperative anastomotic leakage and reoperations related to leakage. Funnel plots and Egger's tests were used to evaluate the publication biases of the studies. P values < 0.05 were considered statistically significant. RESULTS:A total of 11 studies were included in the meta-analysis. In total, 5612 patients were examined, 2868 of whom had a protective stoma and 2744 of whom did not. The sample size of the studies varied from 34 to 1912 patients. All studies reported the number of patients who developed an anastomotic leakage and required a reoperation related to leakage. A random effects model was used to calculate the pooled RR with the corresponding 95%CI because obvious heterogeneity was observed among the 11 studies (I 2 = 77%). The results indicated that the creation of a protective stoma during LAR significantly reduces the rate of anastomotic leakage and the number of reoperations related to leakage, with pooled RRs of 0.38 (95%CI: 0.30-0.48, P < 0.00001) and 0.37 (95%CI: 0.29-0.48, P < 0.00001), respectively. The shape of the funnel plot did not reveal any evidence of obvious asymmetry. CONCLUSION:The presence of a protective stoma effectively decreased the incidences of anastomotic leakage and reoperation and is recommended in patients undergoing low rectal anterior resections for rectal cancer.

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“…[4][5][6][7][8][9] Given the high anastomotic leak rates, and its implicated associated morbidity and mortality, many surgeons use a diverting ileostomy to mitigate the clinical significance of an anastomotic leak. 1,2,[10][11][12][13] The rationale for creating a diverting ileostomy is to avoid the septic complications associated with highrisk anastomosis. The ultimate goal of a stoma is to reduce the consequence and complications associated with an anastomotic leak.…”

mentioning

confidence: 99%

Morbidity of Diverting Ileostomy for Rectal Cancer: Analysis of the American College of Surgeons National Surgical Quality Improvement Program

Jafari

Halabi

Jafari

et al. 2013

The American Surgeon

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There is controversy regarding the potential benefits of diverting ileostomy after low anterior resection (LAR). This study aims to examine the morbidity associated with diverting ileostomy in rectal cancer. A retrospective review of LAR cases was performed using the American College of Surgeons National Surgical Quality Improvement Program (2005 to 2011). Patients who underwent LAR with and without diversion were selected. Demographics, intraoperative events, and postoperative complications were reviewed. Among the 6337 cases sampled, 991 (16%) received a diverting ileostomy. Patients who were diverted were younger (60 vs 63 years), predominantly male (64 vs 53%), and more likely to have received pre-operative radiation (39 vs 12%). There was no significant difference in steroid use, weight loss, or intraoperative transfusion. Postoperatively, there was no significant difference in length of stay, rate of septic complications, wound infections, and mortality. The rate of reoperation was lower in the diverted group (4.5 vs 6.9%). Diversion was associated with a higher risk-adjusted rate of acute renal failure (OR 2.4; 95% CI (1.2, 4.6); P < 0.05). The use of diverting ileostomy reduces the rate of reoperation but is associated with an increased risk of acute renal insufficiency. These findings emphasize the need for refinement of patient selection and close follow-up to limit morbidity.

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Clinical Value of Preventative Ileostomy Following Ultra-Low Anterior Rectal Resection

Cited by 8 publications

References 10 publications

Systematic Review of Anastomotic Leakage Rate According to an International Grading System Following Anterior Resection for Rectal Cancer

Systematic Review of Anastomotic Leakage Rate According to an International Grading System Following Anterior Resection for Rectal Cancer

Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

Morbidity of Diverting Ileostomy for Rectal Cancer: Analysis of the American College of Surgeons National Surgical Quality Improvement Program

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