A Defunctioning Ileostomy Does Not Prevent Clinical Anastomotic Leak After a Low Anterior Resection: A Prospective, Comparative Study

Wong, N. Y.; Eu, Kong‐Weng

doi:10.1007/s10350-005-0146-1

Cited by 215 publications

(148 citation statements)

References 16 publications

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“…The two modus are not quite comparable, because the introduction of TME has resulted in very low anastomoses in patients with a tumour below 10 cm (ultra low tumor is below 4 cm) from the anal verge (wang er al., 2010). In the present register, the tumour level was recorded, our results were similar to those of others showing a higher risk of leakage for low tumours (Gastinger et al, 2005;Wong et al, 2005).…”

Section: Discussionsupporting

confidence: 92%

Risk Assessment on Anastomotic Leakage after Rectal Cancer Surgery: An Analysis of 753 Patients

Liu¹,

Huang²,

Zhou³

2013

Asian Pacific Journal of Cancer Prevention

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Purpose: To investigate the risk factors for anastomotic leakage (AL) after anterior resection for rectal cancer with a double stapling technique. Patients and Methods: Between January 2004 and December 2011, 753 consecutive patients in Jiangsu Cancer Hospital and Research Institute diagnosed with rectal cancer and undergoing anterior resection with a double stapling technique were recruited. All patients experienced a total mesorectal excision (TME) operation. Additionally, decrease of postoperative tumor supplied group of factors (TSGF), which have not been reported before, was proposed as a new indicator for AL. Univariate and multivariate analysis were performed to determine risk factors for AL. Results: AL was detected in 57 (7.6%) of 753 patients with rectal cancer. The diagnosis of anastomotic leakage was confirmed between the 6th and 12th postoperative day (POD; mean 8th POD). After univariate analysis and multivariate analysis, age (p<0.001), gender (p=0.002), level of anastomosis (p < 0.001), preoperative body mass index (BMI) (p = 0.001) and reduction of TSGF in 5th POD was less than 10 m/ml (p < 0.001) were selected as 5 independent risk factors for AL. It was also indicated that a temporary defunctioning transverse ileostomy (p = 0.04) would decrease the occurrence of AL. Conclusion: AL after anterior resection for rectal carcinoma is related to elderly status, low level site of the tumor (below the peritoneal reflection), being male, preoperative BMI and the decrease of TSGF in 5 th POD is less than 10 m/ml. Preventive ileostomy is advisable after TME for low rectal tumors to prevent AL.

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Section: Discussionsupporting

confidence: 92%

Risk Assessment on Anastomotic Leakage after Rectal Cancer Surgery: An Analysis of 753 Patients

Liu¹,

Huang²,

Zhou³

2013

Asian Pacific Journal of Cancer Prevention

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“…324 hasta ise anastomoz kaçağı nedeniyle reopere edilerek sekonder ileostomi iş-lemi yapılmıştır. Her iki grupta da anastomoz kaçağı açı-sından (%3,8 ve %4'sırasıyla) farklılık bulunamamıştır (11). Yine koruyucu ileostomisiz hastalara göre stomalı hastalar mortalite yönünden birkaç çalışmada incelenmiş.…”

Section: Discussionunclassified

Rektum kanserinde neoadjuvan tedavi alan hastalarda total mezorektal eksizyon sonrası koruyucu ileostomi gerekliliği

Kargın¹,

Çakır²,

Küçükkartallar³

et al. 2014

GenelTipDer

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Rektum kanseri tedavisinde koruyucu ileostomi -Kargın ve ark.Genel Tıp Derg 2014;24:105-108 105 GirişSon elli yıldır rektum kanseri tedavisinde cerrahi ve adjuvan kemoradyoterapi (KRT) kullanımındaki gelişmeler bu hastalığın tedavisinde büyük ilerlemeler sağlamıştır. Rektum kanseri için preoperatif KRT kullanımı ise hızla gelişmektedir. Neoadjuvan KRT'nin tümör regresyonu sağlaması, sfinkter koruyucu işlemlerde artışa yol açması ve evre küçültücü özelliği sayesinde tümör rezektabilitesinde artış gibi yararları kanıtlandı (1). Bununla birlikte ARAŞTIRMA Genel Tıp DergisiRektum kanserinde neoadjuvan tedavi alan hastalarda total mezorektal eksizyon sonrası koruyucu ileostomi gerekliliği* Amaç: Rektum kanseri için neoadjuvan kemoradyoterapi kullanımı hızla gelişmektedir. Neoadjuvan tedavilerdeki tüm gelişmelere karşın kemoradyoterapi alan hastalarda cerrahi sonrası komplikasyonlar ise hala tartışmalıdır. Çalışmamızın amacı rektum kanserinde neoadjuvan tedavi sonrası küratif cerrahi uygulanan hastalarda koruyucu ileostomi gerekliliğinin araştırılmasıdır. Gereç ve yöntemler: Kliniğimizde, neoadjuvan tedavi sonrası low anterior rezeksiyon ve total mezorektal eksizyon uygulanan rektum kanserli 19 hastanın verileri retrospektif olarak değerlendirildi. Ameliyat süresi, peroperatif ve postoperatif komplikasyonları, morbidite, mortalite ve hastade kalış süreleri ileostomi durumuna göre kıyaslandı. İstatistiksel analizde ki kare ve Mann Whitney U testleri kullanıldı. Bulgular: İleostomi açılan grupta anastomoz kaçağı 2 hastada görülürken açılmayan grupta 1 hastada anastomoz kaçağı gözlendi. Gruplar arasında postoperatif morbidite açısından anlamlı fark gözlenmedi. Komplikasyon ve hastanede kalış süreleri benzerdi. İleos-tomi açılmayan grupta ameliyat süresi daha kısaydı. Sonuç: Rektum kanserinde neoadjuvan tedavi sonrası küratif rezeksiyon yapılan hastalarda koruyucu ileostominin komplikasyonları ve morbiditeyi artırmadığını düşünmekteyiz. Ancak bu konunun daha geniş serilerde irdelenmesi gerekmektedir. Anahtar sözcükler: Neoadjuvan tedavi, rektum kanseri, koruyucu ileostomi Requirements of protective ileostomy after mesorectal excision in patients with rectal cancer who treated by adjuvant therapyObjectives: The use of neoadjuvant chemoradiation for rectal cancer is developing rapidly. Despite all the advances in neoadjuvant therapy, complications after surgery is still controversial in patients who receiving chemoradiation. The aim of our study is to investigate the necessity of protective ileostomy after neoadjuvant therapy in rectal cancer patients who undergoing curative surgery. Material and methods: Data of 19 rectal cancer patients who were treaded with low anterior resection and total mesorectal excision after neoadjuvant therapy were evaluated retrospectively. Surgical operation time, intraoperative and postoperative complications, morbidity, mortality and length of stay in hospital were compared according to ileostomy state. Chi-square and Mann-Whitney U tests were used as statistical analysis. Results: Anastom...

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“…As some surgeons believe that "the lesser anastomotic site fecal contamination, the lesser chance of anastomotic site leakage", using diverting ileostomy or colostomy would be a constant part of their low or ultralow anterior resection [1][2][3][4][5][6][7][8]; although several recent studies have not confirmed this idea, and only persisted on less complication of the possible leakage such as the pelvic sepsis [11,19] or and less operational needs for further possible leakages [23,28,29].…”

Section: Discussionmentioning

confidence: 99%

“…Diverting stomas for low and ultralow rectal anastomosis are being constructed routinely in some colorectal centers [1][2][3][4][5][6][7][8] based on crediting the fact that creating route diverting stomas, and thereby making a space from the anastomosis, lowers the anastomotic leakage incidence; whereas, some other centers have shown the reverse [9][10][11][12][13]. Furthermore, the stoma itself would increase the morbidity in construction time, life period, and closure time, which also in its place needs reoperation and hospitalization, and so has its own morbidity and mortality [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Low or Ultralow Anterior Resection of Rectal Cancer Without Diverting Stoma: Experience with 28 Patients

2013

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A diverting temporary stoma is frequently used to decrease the chance of anastomosis leakage in the middle and lower rectum cancer surgeries, but its role in preventing the leakage is still doubtful. This study has been designed to evaluate any possible anastomosis complications after a rectum resection and a low or ultralow anastomosis when no diverting stoma is applied in patients with rectal cancer. Twenty-eight patients suffering from rectal cancer were treated by a low anterior resection between the years 2005 and 2008 in Imam Reza University Hospital, Mashhad, Iran. Out of the 28 patients, 6 patients had already undergone a course of neoadjuvant radiotherapy. Anastomosis was performed manually in 23 patients, using a stapler in 5 of them. None of the patients had a diverting stoma. Then, the outcome was evaluated. Fecal incontinence occurred in one of the patients (6.7 %) who had already undergone a course of radiotherapy preoperatively and had a stapler used for anastomosis. No leakage was detected in any of them. The very low incidence of complications in this study, such as those not preventable by a diverting stoma, suggest a very low chance of leakage in low or ultralow anastomosis in patients with rectal cancer and in those who were treated with neoadjuvant radiotherapy.

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A Defunctioning Ileostomy Does Not Prevent Clinical Anastomotic Leak After a Low Anterior Resection: A Prospective, Comparative Study

Cited by 215 publications

References 16 publications

Risk Assessment on Anastomotic Leakage after Rectal Cancer Surgery: An Analysis of 753 Patients

Risk Assessment on Anastomotic Leakage after Rectal Cancer Surgery: An Analysis of 753 Patients

Rektum kanserinde neoadjuvan tedavi alan hastalarda total mezorektal eksizyon sonrası koruyucu ileostomi gerekliliği

Low or Ultralow Anterior Resection of Rectal Cancer Without Diverting Stoma: Experience with 28 Patients

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