High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population‐based multicentre study

Holmgren, Klas; Hultberg, Daniel Kverneng; Haapamäki, Markku M; Matthiessen, Peter; Rutegård, Jörgen; Rutegård, Martin

doi:10.1111/codi.13771

Cited by 71 publications

(92 citation statements)

References 28 publications

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“…Anastomotic leakage has previously been reported to constitute a major risk factor for permanent stoma after anterior resection ; permanent stoma rates vary from 22% to 56% after symptomatic anastomotic leakage . The relatively high frequency of permanent stoma in our study might in part be related to our long follow‐up time and the high proportion of cases of late leakage in our cohort .…”

Section: Discussionmentioning

confidence: 64%

“…Studies that specifically target nonclosure of defunctioning stomas after anterior resection report comorbidity, surgical complications (especially in terms of anastomotic leakage) and metastatic disease as risk factors for nonclosure . When considering all kinds of permanent stoma after anterior resection (remaining defunctioning stomas as well as secondary stomas), surgical complications, especially in terms of anastomotic leakage, comorbidity, older age, metastatic disease, local recurrence, coloanal anastomosis and neoadjuvant chemoradiation, are reported as risk factors for permanent stoma .…”

Section: Discussionmentioning

confidence: 99%

“…A defunctioning stoma is intended to be temporary and bowel continuity is restored if anastomotic integrity is achieved. Despite this, 6–24% of patients end up with a permanent stoma after anterior resection, either a new secondary stoma of any kind or the existing defunctioning stoma . Symptomatic anastomotic leakage is strongly associated with permanent stoma after anterior resection; rates vary from 22% to 56% .…”

Section: Introductionmentioning

confidence: 99%

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High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer

Jutesten

Draus

Frey³

et al. 2018

Colorectal Disease

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Aim This study investigates how often bowel continuity was restored after anastomotic leakage in anterior resection for rectal cancer and assesses the clinical factors associated with permanent stoma. Method The Swedish Colorectal Cancer Registry was used to identify cases of anastomotic leakage registered in southern Sweden between January 2001 and December 2011. Patient characteristics, surgical details and clinical information about the anastomotic leakages were retrieved from medical records. Results Of the 1442 patients operated on with anterior resection in 11 hospitals, 144 (10%) were diagnosed with anastomotic leakage after anterior resection for rectal cancer. After a median follow‐up of 87 months (range 21–165), the overall rate of permanent stoma among patients with anastomotic leakage was 65%. Age ≥ 70 years (P = 0.02) and re‐laparotomy (P < 0.001) were independently related to permanent stoma. Compared with nondefunctioned patients with anastomotic leakage, defunctioned patients with anastomotic leakage at the index procedure less often required re‐laparotomy at some point during the entire clinical course (P < 0.001), but nondefunctioned and defunctioned patients with anastomotic leakage both had permanent stoma to the same extent (67% and 62%, respectively). Conclusion Anastomotic leakage is highly associated with permanent stoma after anterior resection, especially in patients aged ≥ 70 years. In this cohort of patients with anastomotic leakage, 65% had permanent stoma at long‐term follow‐up. A defunctioning stoma ameliorates the clinical course but does not affect the end result of bowel continuity in established anastomotic leakage after anterior resection.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer

Jutesten

Draus

Frey³

et al. 2018

Colorectal Disease

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“…Low anterior resection (LAR) with total mesorectal excision is the standard of care for cancer of the mid and low rectum. However, low anastomoses are at high risk of postoperative complications and anastomotic leakage (AL) that, in turn, have a negative impact on bowel function and the likelihood of a permanent stoma. After LAR and colorectal anastomosis, patients often have increased stool frequency, urgency, stool fractionation and faecal incontinence.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical AL has a negative impact on postoperative mortality, risk of permanent stoma, bowel function and quality of life. All this considered, the authors hypothesized that CJP reconstruction after LAR for rectal cancer may reduce the incidence of AL compared with the standard SCRA, and may improve bowel function and quality of life.…”

Section: Introductionmentioning

confidence: 99%

Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

Pucciarelli

Bianco

Pace

et al. 2019

British Journal of Surgery

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Background Colonic J pouch reconstruction has been found to be associated with a lower incidence of anastomotic leakage than straight anastomosis. However, studies on this topic are underpowered and retrospective. This randomized trial evaluated whether the incidence of anastomotic leakage was reduced after colonic J pouch reconstruction compared with straight colorectal anastomosis following anterior resection for rectal cancer. Methods This multicentre RCT included patients with rectal carcinoma who underwent low anterior resection followed by colorectal anastomosis. Patients were assigned randomly to receive a colonic J pouch or straight colorectal anastomosis. The main outcome measure was the occurrence of major anastomotic leakage. The incidence of global (major plus minor) anastomotic leakage and general complications were secondary outcomes. Risk factors for anastomotic leakage were identified by regression analysis. Results Of 457 patients enrolled, 379 were evaluable (colonic J pouch arm 190, straight colorectal arm 189). The incidence of major and global anastomotic leakage, and general complications was 14·2, 19·5 and 34·2 per cent respectively in the colonic J pouch group, and 12·2, 19·0 and 27·0 per cent in the straight colorectal anastomosis group. No statistically significant differences were observed between the two arms. In multivariable logistic regression analysis, male sex (odds ratio 1·79, 95 per cent c.i. 1·02 to 3·15; P = 0·042) and high ASA fitness grade (odds ratio 2·06, 1·15 to 3·71; P = 0·015) were independently associated with the occurrence of anastomotic leakage. Conclusion Colonic J pouch reconstruction does not reduce the incidence of anastomotic leakage and postoperative complications compared with conventional straight colorectal anastomosis. Registration number NCT01110798 (http://www.clinicaltrials.gov/).

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Less Invasive Primary Treatment for Colorectal Cancer After Implementation of National Screening: A Nationwide Cohort Study

Dressler,

Njor,

Jørgensen

et al. 2023

World j. surg.

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Background The effect of organized colorectal cancer (CRC) screening on type of primary treatment remains sparsely investigated. This study evaluated the difference in primary treatment strategy between patients diagnosed with screen-detected (SD-CRC) and non-screen-detected colorectal cancer (NSD-CRC) in a national CRC screening program. Methods This was a retrospective national register-based cohort study. Data on patients aged between 50 and 75 years and diagnosed with SD-CRC or NSD-CRC were retrieved from the national colorectal cancer screening database and the Danish Colorectal Cancer Group database. Outcomes related to surgical invasiveness were compared between the two cohorts. Differences were expressed as relative risks using log-binomial generalized linear regression models. UICC stage IV specific outcomes were analyzed using the same method. All analyses were adjusted for sex, age, type of cancer (colonic/rectal), and Charlson comorbidity index. ResultsThe study included 4707 patients with SD-CRC and 7328 with NSD-CRC. Therapeutic flexible endoscopy (SD-CRC: n = 636 vs. NSD-CRC: n = 334, RR: 2.50, P \ 0.001), (robotic-assisted) laparoscopic resection ((n = 616 vs. n = 773, RR: 1.27, P \ 0.001), n = 2759 vs. n = 3471, RR: 1.11, P \ 0.001), and radical resection (n = 3890 vs. n = 4834, RR: 1.02, P = 0.002) were significantly more frequent in the SD-CRC group. The rates of emergency priority (n = 32 vs. n = 562, RR: 0.09, P \ 0.001), open surgery (n = 391 vs. n = 1410, RR: 0.53, P \ 0.001), supplementary organ resection (n = 259 vs. n = 860, RR: 0.56, P \ 0.001), and stoma formation (n = 526 vs. n = 1040, RR: 0.89, P = 0.007) were significantly lower in the SD-CRC group. The rate of patients undergoing surgery with UICC stage IV disease was significantly higher in the SD-CRC group (SD-CRC: n = 262, NSD-CRC: n = 994, RR: 1.43, P \ 0.001). Conclusion SD-CRC remained associated with less invasive primary surgical treatment following adjustment for potential healthy user bias. UICC stage IV disease may be less advanced in patients with SD-CRC.

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High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population‐based multicentre study

Abstract: Stoma permanence is common after anterior resection, while anastomotic leakage and advanced tumour stage decrease the chances of a stoma-free outcome. Stoma reversal surgery entails a significant risk of major complications.

Cited by 71 publications

References 28 publications

High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer

High risk of permanent stoma after anastomotic leakage in anterior resection for rectal cancer

Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer

Less Invasive Primary Treatment for Colorectal Cancer After Implementation of National Screening: A Nationwide Cohort Study

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