What Is the Risk for a Permanent Stoma After Low Anterior Resection of the Rectum for Cancer? A Six-Year Follow-Up of a Multicenter Trial

Lindgren, Rikard; Hallböök, Olof; Rutegård, Jörgen; Sjödahl, Rune; Matthiessen, Peter

doi:10.1007/dcr.0b013e3181fd2948

Cited by 215 publications

(209 citation statements)

References 20 publications

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“…However, after correcting for those patients who died or were lost to follow-up before reversal, the 57% rate of stoma reversal remains below the range previously reported. These previous evaluations of stoma reversal have found that receipt of post-operative chemotherapy, 7,10 increasing age, 7 metastatic disease, 8 comorbidities, 7 and perioperative complications, 8,9,11 were associated with non-reversal. Our multivariable results corroborated the influence of older age and greater comorbidity on non-reversal, but we also found male gender (similar to diverticulitis 26 ) and higher income increased a patient's chance of reversal.…”

Section: Discussionmentioning

confidence: 93%

“…And while we used initial length of stay as a surrogate for immediate postoperative complications, we were unable to identify or adjust for those patients with anastomotic leak or stricture which could significantly influence reversal rates. 11 Finally, we could not reliably distinguish between loop or end stomas based on billing codes, which may significantly influence rates of reversal.…”

Section: Discussionmentioning

confidence: 95%

“…6 Prior studies suggest that up to 32% of patients who undergo "temporary" diverting stoma during their resection for rectal cancer never undergo reversal. 5,[7][8][9][10] Previously identified predictors of delay or failure in reversal include post-operative chemotherapy, 7,10 increasing age, 7 metastatic disease, 8 comorbidities 7 and perioperative complications 8,9,11,12 , but only two studies have reported factors associated with ileostomy reversal failure after multivariable adjustment. 7,9 Additionally, while higher volume hospitals have been associated with decreased rates of permanent colostomy in rectal cancer patients, 13 little is known about the role of institution in reversal of temporary stoma patients.…”

Section: Introductionmentioning

confidence: 99%

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Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

Dodgion¹,

Neville²,

Lipsitz³

et al. 2010

JCO

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Objective-For low-lying rectal cancers, proximal diversion can reduce anastomotic leak after sphincter preserving surgery; however, evidence suggests that such temporary diversions are often not reversed. We aimed to evaluate non-reversal and delayed stoma reversal in elderly patients undergoing low anterior resection (LAR). The authors report no conflict of interest. Design-SEER-MedicareAuthor Contributions: Dodgion -study design, analysis and interpretation of data, manuscript preparation. Neville -acquisition of data, manuscript preparation. Lipsitz -study design, analysis and interpretation of data, manuscript preparation. Schrag -study design, interpretation of data, manuscript preparation. Breen -study design, interpretation of data, manuscript preparation. Greenberg -study design, analysis and interpretation of data, manuscript preparation and project oversight.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

Dodgion¹,

Neville²,

Lipsitz³

et al. 2010

JCO

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“…This was followed by a discussion regarding the consequences of leakage, which include a decrease in overall survival and a possible decrease in cancerfree survival. Also discussed, was a Swedish nationwide multicenter randomized control trial (RCT) showing that 56% of patients with symptomatic anastomotic leakage received a permanent stoma [6].…”

Section: Doctor Hans Schardey and Doctor James Fleshman Presentationmentioning

confidence: 99%

Proceedings of the First International Summit on Intestinal Anastomotic Leak, Chicago, Illinois, October 4–5, 2012

Shogan

Schardey³

et al. 2014

Surgical Infections

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Objective: The first international summit on anastomotic leak was held in Chicago in October, 2012 to assess current knowledge in the field and develop novel lines of inquiry. The following report is a summary of the proceedings with commentaries and future prospects for clinical trials and laboratory investigations. Background: Anastomotic leakage remains a devastating problem for the patient, and a continuing challenge to the surgeon operating on high-risk areas of the gastrointestinal tract such as the esophagus and rectum. Despite the traditional wisdom that anastomotic leak is because of technique, evidence to support this is weak-to-non-existent.Outcome data continue to demonstrate that expert high-volume surgeons working in high-volume centers continue to experience anastomotic leaks and that surgeons cannot predict reliably which patients will leak. Methods: A one and one-half day summit was held and a small working group assembled to review current practices, opinions, scientific evidence, and potential paths forward to understand and decrease the incidence of anastomotic leak. Results: Results of a survey of the opinions of the group demonstrated that the majority of participants believe that anastomotic leak is a complicated biologic problem whose pathogenesis remains ill-defined. The group opined that anastomotic leak is underreported clinically, it is not because of technique except when there is gross inattention to it, and that results from animal models are mostly irrelevant to the human condition. Conclusions: A fresh and unbiased examination of the causes and strategies for prevention of anastomotic leak needs to be addressed by a continuous working group of surgeons, basic scientists, and clinical trialists to realize a real and significant reduction in its incidence and morbidity. Such a path forward is discussed.

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“…Positive intraoperative leak tests are addressed during surgery through additional suturing, sealant, re-anastomosis, or diversion and stoma creation [9]. Conversely, leaks identified post-operatively, that cannot be treated with antibiotics, require secondary procedures including percutaneous or surgical draining of abscesses or secondary surgery to correct the leak [6], the need for creation of a permanent stoma is also increased in these cases [10]. Prevention of mortality due to anastomotic leak is largely dependent upon early detection and treatment of leaks [6,11].…”

Section: Introductionmentioning

confidence: 99%

Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

Schiff¹,

Brady²,

Ghosh³

et al. 2016

J Surg Surgical Res

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048 AbstractPurpose: Anastomotic leak following colorectal resection surgery is associated with high rates of morbidity, infection, and escalated healthcare expenditures. One method to prevent leaks includes early detection through intra-operative testing. This study employed systematic review of the literature to estimate the rate of intra-operative anastomotic leaks in colorectal resection surgery. Method:The Medline and Embase databases were searched to identify articles published between January 1 st , 2003 and August 8 th , 2015 reporting on intra-operative leaks in colorectal resection. The rate of intra-operative testing, intra-and post-operative anastomotic leaks, and surgical methodology were extracted from the final sample of 13 articles.Results: A total of 167 intra-operative leaks were reported within 2,598 colorectal resection surgeries that used intra-operative testing, yielding an average leak rate of 6.4%. Use of laparoscopic techniques was significantly associated with a reduced rate of intra-operative leak (p<0.001). Eight articles reported on the rate of post-operative anastomotic leak in relation to intraoperative testing. Within this sample of 2,098 cases a non-significant trend towards a lower leak rate in the tested population was identified (4.3% v. 6.8%, p=0.051); cases whose leak test was initially positive exhibited a significantly higher rate of post-operative leaks compared to cases with a negative leak test (p=0.006). Conclusion:Intra-operative anastomotic leak testing allows surgeons to address leaks at the time of surgery, and may help to prevent complications in colorectal resection surgery. This study identified a mean intra-operative leak rate of 6.4% in colorectal resection surgery.

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What Is the Risk for a Permanent Stoma After Low Anterior Resection of the Rectum for Cancer? A Six-Year Follow-Up of a Multicenter Trial

Abstract: One patient of 5 ended up with a permanent stoma after low anterior resection of the rectum for cancer, and half of the patients with a permanent stoma had previous symptomatic anastomotic leakage.

Cited by 215 publications

References 20 publications

Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

Proceedings of the First International Summit on Intestinal Anastomotic Leak, Chicago, Illinois, October 4–5, 2012

Intra-Operative Anastomotic Leak Rates and Testing Methodology in Colorectal Resection Surgery

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