Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit

Smedh, K.; Olsson, L.; Johansson, Henry; Aberg, C; Andersson, Maria

doi:10.1046/j.1365-2168.2001.01675.

Cited by 50 publications

(48 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, some interesting comparisons may be made. For example, when the present figures were compared with those of Smedh et al 4 , whose patients from 1995 are included in the present ROC register but not in this validation study, it was apparent that their results were not particularly good before validation. However, provided that their frequencies were correct, the results presented by Smedh and colleagues were better than the general results in the region when the frequencies were adjusted with respect to the proportion of missed registrations calculated in the present study.…”

Section: Discussionmentioning

confidence: 85%

Registration and validity of surgical complications in colorectal cancer surgery

Gunnarsson

Seligsohn

Jestin

et al. 2003

British Journal of Surgery

100

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 85%

Registration and validity of surgical complications in colorectal cancer surgery

Gunnarsson

Seligsohn

Jestin

et al. 2003

British Journal of Surgery

100

View full text Add to dashboard Cite

show abstract

“…[1][2][3] Improved results have also been demonstrated by centralization of surgery and educational programs for colorectal surgeons. 4,5 Despite these important advances, postoperative morbidity and early mortality after anterior resection of the rectum remain important issues. 6 The overall early postoperative mortality rate is reported to be between 1% and 8%.…”

mentioning

confidence: 99%

“…6 The overall early postoperative mortality rate is reported to be between 1% and 8%. 4 Symptomatic anastomotic leakage is the most feared complication and has been reported to occur in between 1% and 24%, [7][8][9][10][11][12] and when present, the associated risk of postoperative mortality is increased to between 6% and 22%. 11 One can anticipate that anastomotic leakage occurs in a medically fragile patient, or after a technically difficult operation, or if intraoperative adverse events were present.…”

mentioning

confidence: 99%

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

Matthiessen

Hallböök²,

Rutegård³

et al. 2007

Annals of Surgery

980

327

View full text Add to dashboard Cite

Objective: The aim of this randomized multicenter trial was to assess the rate of symptomatic anastomotic leakage in patients operated on with low anterior resection for rectal cancer and who were intraoperatively randomized to a defunctioning stoma or not. Summary Background Data: The introduction of total mesorectal excision surgery as the surgical technique of choice for carcinoma in the lower and mid rectum has led to decreased local recurrence and improved oncological results. Despite these advances, perioperative morbidity remains a major issue, and the most feared complication is symptomatic anastomotic leakage. The role of the defunctioning stoma in regard to anastomotic leakage is controversial and has not been assessed in any randomized trial of sufficient size. Methods: From December 1999 to June 2005, a total of 234 patients were randomized to a defunctioning loop stoma or no loop stoma. Loop ileostomy or loop transverse colostomy was at the choice of the surgeon. Inclusion criteria for randomization were expected survival Ͼ6 months, informed consent, anastomosis Յ7 cm above the anal verge, negative air leakage test, intact anastomotic rings, and absence of major intraoperative adverse events. Results: The overall rate of symptomatic leakage was 19.2% (45 of 234). Patients randomized to a defunctioning stoma (n ϭ 116) had leakage in 10.3% (12 of 116) and those without stoma (n ϭ 118) in 28.0% (33 of 118) (odds ratio ϭ 3.4; 95% confidence interval, 1.6 -6.9; P Ͻ 0.001). The need for urgent abdominal reoperation was 8.6% (10 of 116) in those randomized to stoma and 25.4% (30 of 118) in those without (P Ͻ 0.001). After a follow-up of median 42 months (range, 6 -72 months), 13.8% (16 of 116) of the initially defunctioned patients still had a stoma of any kind, compared with 16.9% (20 of 118) those not defunctioned (not significant). The 30-day mortality after anterior resection was 0.4% (1 of 234) and after elective reversal a defunctioning stoma 0.9% (1 of 111). Median age was 68 years (range, 32-86 years), 45.3% (106 of 234) were females, 79.1% (185 of 234) had preoperative radiotherapy, the level of anastomosis was median 5 cm, and intraoperative blood loss 550 mL, without differences between the groups. Conclusion: Defunctioning loop stoma decreased the rate of symptomatic anastomotic leakage and is therefore recommended in low anterior resection for rectal cancer.

show abstract

“…Internationale Daten zeigen eindeutig eine bessere Lebensqualität, mehr sphinktererhaltende Operationen und bessere Überlebensraten aufgrund von weniger Lokalrezidiven in speziell trainierten und geschulten Abteilungen [20,21,22,23,24]. Dies gilt besonders für das (tief sitzende) Rektumkarzinom, nicht eindeutig für das Kolonkarzinom [25].…”

Section: Psychosoziale Einschränkungenunclassified

Rektumkarzinom und Lebensqualität

Hackl

Pfeifer

2010

coloproctology

View full text Add to dashboard Cite

Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of a colorectal unit

Abstract: The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half.

Cited by 50 publications

References 18 publications

Registration and validity of surgical complications in colorectal cancer surgery

Registration and validity of surgical complications in colorectal cancer surgery

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

Rektumkarzinom und Lebensqualität

Contact Info

Product

Resources

About