Effects of a Diverting Stoma on Symptomatic Anastomotic Leakage after Low Anterior Resection for Rectal Cancer: A Propensity Score Matching Analysis of 1,014 Consecutive Patients

Shiomi, Akio; Ito, Masaaki; Maeda, Kotaro; Kinugasa, Yusuke; Ota, Mitsuyoshi; Yamaue, Hiroki; Shiozawa, Manabu; Horie, Hisanaga; Kuriu, Yoshiaki; Saitô, Norio

doi:10.1016/j.jamcollsurg.2014.10.017

Cited by 183 publications

(117 citation statements)

References 26 publications

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“…Postsurgery, AL complications (i.e., CTCAE v4.0 !Grade 4) occurred significantly less frequently in the DS group (0%) than in the non-DS group (5.7%; p = 0.02). However, there was no significant between-group difference in the rate of AL at CTCAE v4.0 !Grade 1-4 containing symptomatic leakage (p = 0.29), as in a previous study 10) . Postoperative ileus occurred in seven patients (7.6%) in the DS group and three patients in the non-DS group (3.4%; AL: anastomotic leakage, SRC: stoma-related complication, HR: hazard ratio, CI: confidence interval p = 0.22).…”

Section: Defunctioning Stoma Prevented Severe Anastomotic Leakagessupporting

confidence: 75%

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Defunctioning loop ileostomy with restorative proctocolectomy for rectal cancer: Friend or foe?

Munakata

Ito

Sugimoto

et al. 2017

J Anus Rectum Colon

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Abstract:Objectives: Temporary ileostomy is used to decrease morbidity from anastomotic leakages (ALs). However, ileostomies are associated with complications (i.e., stoma-related complications; SRCs), ileus due to stenosis, dehydration, and the need for a second operation. Here we retrospectively evaluated the impact of SRCs on the treatment of rectal cancer. Methods: We identified 180 consecutive patients who underwent curative resection for rectal cancer at Juntendo University Hospital between January 2006 and December 2014. We divided the patients into groups with and without defunctioning stoma (DS), and we compared the patient age and gender, tumor location, approach (laparotomy/laparoscopy), surgical procedure, distance of the tumor from the margin of the anus, T factor, stage, duration of postoperative hospital stay, and postoperative complications between these groups. Univariate and multivariate analyses were performed to determine the risk factors for postoperative hospital stay. Results: The symptomatic leakage rate in the DS group (n = 92) was not significantly different from that of the non-DS group (n = 88; p = 0.29). However, Grade !4 AL occurred significantly less frequently in the DS group (0%) than in the non-DS group (5.7%; p = 0.02). SRCs occurred in 14 DS-group patients (15.2%). The multivariate analysis demonstrated that both AL (odds ratio [OR] 9.24; confidence interval [CI] 4.91-19.4) and SRC (OR 1.84; CI 1.03-3.54) were independently predictive of short-term outcomes. Conclusions: The benefit of a DS is balanced against the risk of leakage and SRCs at rectal resection. Surgeons should focus on not only the consequences of AL, but also SRC risk.

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Section: Defunctioning Stoma Prevented Severe Anastomotic Leakagessupporting

confidence: 75%

“…These data suggest that the occurrence and management of AL are widely known by surgeons, because several studies showed that anastomotic dehiscence is the most serious complication of rectal resection 1,10) . However, little has been published discussing AL and SRCs at the same time.…”

Section: Discussionmentioning

confidence: 86%

Defunctioning loop ileostomy with restorative proctocolectomy for rectal cancer: Friend or foe?

Munakata

Ito

Sugimoto

et al. 2017

J Anus Rectum Colon

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“…Another study32, however, found no difference in defaecatory function or postoperative complications in a relatively small randomized trial. Shiomi and co‐workers33 reported that the incidence of anastomotic leakage was lower for low than for high tie in a prospective multicentre cohort study. A randomized multicentre study34 is currently in progress.…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer

et al. 2018

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BackgroundThe optimal level for inferior mesenteric artery ligation during anterior resection for rectal cancer is controversial. The aim of this randomized trial was to clarify whether the inferior mesenteric artery should be tied at the origin (high tie) or distal to the left colic artery (low tie).MethodsPatients were allocated randomly to undergo either high‐ or low‐tie ligation and were stratified by surgical approach (open or laparoscopic). The primary outcome was the incidence of anastomotic leakage. Secondary outcomes were duration of surgery, blood loss and 5‐year overall survival.ResultsSome 331 patients entered the trial between June 2006 and September 2012. The trial was stopped prematurely as recruitment was slow. Seven patients were excluded after randomization but before operation because of procedural changes. High tie and low tie were performed in 164 and 160 patients respectively. The incidence of anastomotic leakage was not significantly different (17·7 versus 16·3 per cent respectively; P = 0·731). The incidence of severe complications requiring intervention was 2·4 versus 5·0 per cent for high and low tie respectively (P = 0·222). In multivariable analysis, risk factors for anastomotic leakage included male sex (odds ratio 4·36, 95 per cent c.i. 1·56 to 12·18) and distance of the tumour from the anal verge (odds ratio 0·99, 0·98 to 1·00). At 5 years there were no significant differences in overall (87·2 versus 89·4 per cent respectively; P = 0·386) and disease‐free (76·3 versus 77·6 per cent; P = 0·765) survival.ConclusionThe level of ligation of the inferior mesenteric artery does not significantly influence the rate of anastomotic leakage. Registration number: NCT01861678 ( https://clinicaltrials.gov).

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“…A temporary ileostomy may decrease the risk of anastomotic leak, which is a lethal complication [12345]. This may limit the septic sequence in cases of anastomotic leak and may help the diseased anastomosis to heal the area of inflammation [16].…”

Section: Introductionmentioning

confidence: 99%

Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer

et al. 2017

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PurposeThe current study aims to analyze the risk factors for the failure of ileostomy reversal after laparoscopic low anterior resection for rectal cancer.MethodsAll patients who underwent a laparoscopic low anterior resection for rectal cancer with a diverting ileostomy between 2007 and 2014 were abstracted. The patients who underwent and did not undergo a diverting ileostomy procedure were compared regarding patient, tumor, treatment related parameters, and survival.ResultsAmong 160 (103 males [64.4%], mean [± standard deviation] age was 58.1 ± 11.9 years) patients, stoma reversal was achieved in 136 cases (85%). Anastomotic stricture (n = 13, 52.4%) was the most common reason for stoma reversal. These were the risk factors for the failure of stoma reversal: Male sex (P = 0.035), having complications (P = 0.01), particularly an anastomotic leak (P < 0.001), or surgical site infection (P = 0.019) especially evisceration (P = 0.011), requirement for reoperation (P = 0.003) and longer hospital stay (P = 0.004). Multivariate analysis revealed that male sex (odds ratio [OR], 7.82; P = 0.022) and additional organ resection (OR, 6.71; P = 0.027) were the risk factors. Five-year survival rates were similar (P = 0.143).ConclusionFifteen percent of patients cannot receive a stoma reversal after laparoscopic low anterior resection for rectal cancer. Anastomotic stricture is the most common reason for the failure of stoma takedown. Having complications, particularly an anastomotic leak and the necessity of reoperation, limits the stoma closure rate. Male sex and additional organ resection are the risk factors for the failure in multivariate analyses. These patients require a longer hospitalization period, but have similar survival rates as those who receive stoma closure procedure.

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Effects of a Diverting Stoma on Symptomatic Anastomotic Leakage after Low Anterior Resection for Rectal Cancer: A Propensity Score Matching Analysis of 1,014 Consecutive Patients

Cited by 183 publications

References 26 publications

Defunctioning loop ileostomy with restorative proctocolectomy for rectal cancer: Friend or foe?

Defunctioning loop ileostomy with restorative proctocolectomy for rectal cancer: Friend or foe?

Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer

Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer

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