Defunctioning stoma in anterior resection for rectal cancer does not impact anastomotic leakage : a national population-based cohort study
(2023) In BMC Surgery 23(1).- Abstract
Background: Anterior resection (AR) is considered the gold standard for curative cancer treatment in the middle and upper rectum. The goal of the sphincter-preserving procedure, such as AR, is vulnerable to anastomotic leak (AL) complications. Defunctioning stoma (DS) became the protective measure against AL. Often a defunctioning loop-ileostomy is used, which is associated with substantial morbidity. However, not much is known if the routine use of DS reduces the overall incidence of AL. Methods: Elective patients subjected to AR in 2007–2009 and 2016-18 were recruited from the Swedish colorectal cancer registry (SCRCR). Patient characteristics, including DS status and occurrence of AL, were analyzed. In addition, independent risk... (More)
Background: Anterior resection (AR) is considered the gold standard for curative cancer treatment in the middle and upper rectum. The goal of the sphincter-preserving procedure, such as AR, is vulnerable to anastomotic leak (AL) complications. Defunctioning stoma (DS) became the protective measure against AL. Often a defunctioning loop-ileostomy is used, which is associated with substantial morbidity. However, not much is known if the routine use of DS reduces the overall incidence of AL. Methods: Elective patients subjected to AR in 2007–2009 and 2016-18 were recruited from the Swedish colorectal cancer registry (SCRCR). Patient characteristics, including DS status and occurrence of AL, were analyzed. In addition, independent risk factors for AL were investigated by multivariable regression. Results: The statistical increase of DS from 71.6% in 2007–2009 to 76.7% in 2016–2018 did not impact the incidence of AL (9.2% and 8.2%), respectively. DLI was constructed in more than 35% of high-located tumors ≥ 11 cm from the anal verge. Multivariable analysis showed that male gender, ASA 3–4, BMI > 30 kg/m2, and neoadjuvant therapy were independent risk factors for AL. Conclusion: Routine DS did not decrease overall AL after AR. A selective decision algorithm for DS construction is needed to protect from AL and mitigate DS morbidities.
(Less)
- author
- Munshi, Eihab LU ; Lydrup, Marie Louise LU and Buchwald, Pamela LU
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Anastomotic leakage, Anterior resection, Defunctioning loop-ileostomy, Defunctioning stoma, Rectal cancer
- in
- BMC Surgery
- volume
- 23
- issue
- 1
- article number
- 167
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:37340428
- scopus:85163203032
- ISSN
- 1471-2482
- DOI
- 10.1186/s12893-023-01998-5
- language
- English
- LU publication?
- yes
- id
- 043c5084-9c15-4ac5-a65e-eba45f21f4c5
- date added to LUP
- 2023-08-24 14:41:09
- date last changed
- 2024-04-20 01:36:01
@article{043c5084-9c15-4ac5-a65e-eba45f21f4c5, abstract = {{<p>Background: Anterior resection (AR) is considered the gold standard for curative cancer treatment in the middle and upper rectum. The goal of the sphincter-preserving procedure, such as AR, is vulnerable to anastomotic leak (AL) complications. Defunctioning stoma (DS) became the protective measure against AL. Often a defunctioning loop-ileostomy is used, which is associated with substantial morbidity. However, not much is known if the routine use of DS reduces the overall incidence of AL. Methods: Elective patients subjected to AR in 2007–2009 and 2016-18 were recruited from the Swedish colorectal cancer registry (SCRCR). Patient characteristics, including DS status and occurrence of AL, were analyzed. In addition, independent risk factors for AL were investigated by multivariable regression. Results: The statistical increase of DS from 71.6% in 2007–2009 to 76.7% in 2016–2018 did not impact the incidence of AL (9.2% and 8.2%), respectively. DLI was constructed in more than 35% of high-located tumors ≥ 11 cm from the anal verge. Multivariable analysis showed that male gender, ASA 3–4, BMI > 30 kg/m<sup>2</sup>, and neoadjuvant therapy were independent risk factors for AL. Conclusion: Routine DS did not decrease overall AL after AR. A selective decision algorithm for DS construction is needed to protect from AL and mitigate DS morbidities.</p>}}, author = {{Munshi, Eihab and Lydrup, Marie Louise and Buchwald, Pamela}}, issn = {{1471-2482}}, keywords = {{Anastomotic leakage; Anterior resection; Defunctioning loop-ileostomy; Defunctioning stoma; Rectal cancer}}, language = {{eng}}, number = {{1}}, publisher = {{BioMed Central (BMC)}}, series = {{BMC Surgery}}, title = {{Defunctioning stoma in anterior resection for rectal cancer does not impact anastomotic leakage : a national population-based cohort study}}, url = {{http://dx.doi.org/10.1186/s12893-023-01998-5}}, doi = {{10.1186/s12893-023-01998-5}}, volume = {{23}}, year = {{2023}}, }