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Defunctioning stoma in anterior resection for rectal cancer does not impact anastomotic leakage : a national population-based cohort study

Munshi, Eihab LU ; Lydrup, Marie Louise LU and Buchwald, Pamela LU (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.

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author
; and
organization
publishing date
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 &gt; 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}},
}