Reversal of defunctioning stoma following rectal cancer surgery: are we getting better? A population‐based single centre experience

Gadan, Soran; Lindgren, Rikard; Matthiessen, Peter

doi:10.1111/ans.14990

Cited by 20 publications

(12 citation statements)

References 23 publications

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“…DS reversal was impossible in 8 patients (5.2%) in this study. Gadan reported a reversal impossibility rate of 18% (20/110 cases) (21). The DS reversal rate in our study was higher than that reported in their study; however, DS reversal was achieved within 6 months after surgery in 55 patients (35.9%) and ≥2 years after surgery in many patients.…”

Section: Discussioncontrasting

confidence: 71%

Diverting Stoma Complications in Rectal Cancer Surgery.

Kawai

Sakamoto

Honjo

et al. 2021

Preprint

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Background: A consensus regarding diverting stoma (DS) construction in rectal cancer surgery was reached to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we aimed to examine the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer.Methods: Between 2005 and 2017, we included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer. These participants were divided into two groups: DS (+) and DS (-) groups, and the outcomes, including postoperative complications (POCs), were compared.Results and conclusion: The incidence of ileus was higher in the DS (+) group (P<0.01); however, no patient showed anastomotic leakage of grade3. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction -related stoma outlet syndrome occurred in 19 patients (12.4%). There was no intergroup difference in the incidence of grade 3b POCs. However, the most common reason for reoperation was different in the two groups: anastomotic leakage in 91.7% of patients with 3b POCs in the DS (-) group, and SRCs in 85.7% of patients with 3b POCs in the DS (+) group.In patients with DS, there was an increase in the incidence of overall POCs, severe POCs (grade 3), and bowel obstruction, including stoma outlet syndrome, compared to patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

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Section: Discussioncontrasting

confidence: 71%

Diverting Stoma Complications in Rectal Cancer Surgery.

Kawai

Sakamoto

Honjo

et al. 2021

Preprint

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“…Hence, early stoma reversal can help patients avoid the peristomal skin complications that have a significantly impact on quality of life and avoid long‐term consequences such as incisional hernia and chronic kidney disease. In a small subset of patients, as a result either of anastomotic complications from the index operation, progression of disease or due to multiple co‐morbidities, an ileostomy initially intended to be temporary may prove to be permanent 2,4 …”

Section: Discussionmentioning

confidence: 99%

“…Even a temporary loop ileostomy can detract significantly from a patient's quality of life 2 . Complications from a loop ileostomy such as skin irritation, retraction, prolapse, dehydration and electrolyte disturbance from high stoma output frequently lead to readmissions 2–4 . As many as 85–90% of patients undergoing loop ileostomy construction would not have experienced an anastomotic leak and need not have required their stoma but are still subject to its potential complications 3 .…”

Section: Introductionmentioning

confidence: 99%

The feasibility and safety of early ileostomy reversal: a systematic review and meta‐analysis

Levitt

Platell

2020

ANZ Journal of Surgery

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Background Recent evidence supports the safety of early reversal of a temporary stoma, within 14 days of construction. The aim of this systematic review and meta‐analysis was to evaluate the post‐operative morbidity and overall feasibility of early stoma reversal. Methods Medline and Cochrane databases were searched for studies up to June 2019 that investigated the outcomes of early stoma reversal (EC, defined as closure ≤14 days from the index operation) versus late stoma reversal (LC, ≥8 weeks from the index operation). Meta‐analysis was performed on the respective rates of post‐operative morbidity, anastomotic leak, wound infection, bleeding, sepsis, small bowel obstruction and ileus. Results Nine studies were included (667 patients analysed). Meta‐analysis showed no significant difference in the post‐operative morbidity rate, anastomotic leak rate, rates of small bowel obstruction, bleeding and ileus between EC and LC. However, the wound infection rate was significantly higher after EC than LC; relative difference 0.10 (95% confidence interval 0.00–0.19, P = 0.047). The stoma‐related complication rate was significantly higher after LC than EC; relative difference −0.28 (95% confidence interval ‐0.45 to −0.11, P = 0.001). Conclusion The concept of early stoma reversal is appealing, and this meta‐analysis confirms the safety of early stoma closure with an associated reduction in stoma‐related complications despite higher wound infection rates. However, the results need to be interpreted with caution due to the heterogeneity of the studies included, especially in respect of the definition of complications that were used. Further well‐designed prospective studies are required prior to confident adoption of early stoma closure into clinical practice.

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“…Proximal defunctioning stomas are commonly used to protect against the consequences of a leak 7,8 . Nevertheless, around 20 per cent of defunctioning stomas are never closed or are converted to an end colostomy 1,[9][10][11] , possibly contributing to higher than desired permanent stoma rates.…”

Section: Introductionmentioning

confidence: 99%

Permanent stoma rates after anterior resection for rectal cancer: risk prediction scoring using preoperative variables

Bäck

Häggström

Holmgren

et al. 2021

British Journal of Surgery

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Background A permanent stoma after anterior resection for rectal cancer is common. Preoperative counselling could be improved by providing individualized accurate prediction modelling. Methods Patients who underwent anterior resection between 2007 and 2015 were identified from the Swedish Colorectal Cancer Registry. National Patient Registry data were added to determine presence of a stoma 2 years after surgery. A training set based on the years 2007–2013 was employed in an ensemble of prediction models. Judged by the area under the receiving operating characteristic curve (AUROC), data from the years 2014–2015 were used to evaluate the predictive ability of all models. The best performing model was subsequently implemented in typical clinical scenarios and in an online calculator to predict the permanent stoma risk. Results Patients in the training set (n = 3512) and the test set (n = 1136) had similar permanent stoma rates (13.6 and 15.2 per cent). The logistic regression model with a forward/backward procedure was the most parsimonious among several similarly performing models (AUROC 0.67, 95 per cent c.i. 0.63 to 0.72). Key predictors included co-morbidity, local tumour category, presence of metastasis, neoadjuvant therapy, defunctioning stoma use, tumour height, and hospital volume; the interaction between age and metastasis was also predictive. Conclusion Using routinely available preoperative data, the stoma outcome at 2 years after anterior resection for rectal cancer can be predicted fairly accurately.

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Reversal of defunctioning stoma following rectal cancer surgery: are we getting better? A population‐based single centre experience

Cited by 20 publications

References 23 publications

Diverting Stoma Complications in Rectal Cancer Surgery.

Diverting Stoma Complications in Rectal Cancer Surgery.

The feasibility and safety of early ileostomy reversal: a systematic review and meta‐analysis

Permanent stoma rates after anterior resection for rectal cancer: risk prediction scoring using preoperative variables

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