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Diverting ostomy prior to neoadjuvant treatment in rectal cancer should be used selectively : A retrospective single-center cohort study

Valdimarsson, Valentinus LU orcid ; Munshi, Eihab Adil LU ; Lydrup, Marie-Louise LU ; Jutesten, Henrik LU ; Samuelsson, Carolina LU and Buchwald, Pamela LU (2024) In Scandinavian Journal of Surgery
Abstract
Background:
Rectal cancer patients commonly benefit from neoadjuvant therapy before resection surgery. For these patients, an elective ostomy diversion is frequently considered, despite the absence of conclusive evidence when a diversion is advantageous. This is a retrospective observational single-center study on a 4-year consecutive rectal cancer cohort undergoing neoadjuvant therapy, aiming at improving the understanding of risks and benefits associated with ostomy diversion.
Material and Method:
Baseline characteristics, tumor-specific data, clinical events, and outcomes were collected using the Swedish Colorectal Cancer Registry and medical records.
Results:
Thirty-two (30.2%) of the 106 included patients presented... (More)
Background:
Rectal cancer patients commonly benefit from neoadjuvant therapy before resection surgery. For these patients, an elective ostomy diversion is frequently considered, despite the absence of conclusive evidence when a diversion is advantageous. This is a retrospective observational single-center study on a 4-year consecutive rectal cancer cohort undergoing neoadjuvant therapy, aiming at improving the understanding of risks and benefits associated with ostomy diversion.
Material and Method:
Baseline characteristics, tumor-specific data, clinical events, and outcomes were collected using the Swedish Colorectal Cancer Registry and medical records.
Results:
Thirty-two (30.2%) of the 106 included patients presented with endoscopic impassable tumors at diagnosis, of which 18 (56.2%) had diverting ostomy. Three out of 14 with impassable tumor and no diversion developed a bowel obstruction. None of the patients with an endoscopically passable tumor at diagnosis (n = 74) experienced a bowel obstruction. The elective diversions (n = 40) were not associated with serious complications (Clavien–Dindo grade ⩾ 3b). Patients with a diverting ostomy (n = 30) had similar time intervals from diagnosis to neoadjuvant treatment and to definite tumor resection as those without diversion but experienced more complex primary tumor resections in terms of blood loss and operation time.
Conclusion:
An elective diverting ostomy is a relatively safe procedure in rectal cancer patients requiring neoadjuvant therapy. More than one out of five non-diverted patients with endoscopically impassable rectal tumors developed bowel obstruction and would potentially have benefited from an elective diversion. (Less)
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author
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organization
publishing date
type
Contribution to journal
publication status
epub
subject
in
Scandinavian Journal of Surgery
publisher
Finnish Surgical Society
external identifiers
  • pmid:38751171
  • scopus:85193407550
ISSN
1799-7267
DOI
10.1177/14574969241252481
language
English
LU publication?
yes
id
93932055-03ab-48d1-83aa-818ed879ef79
date added to LUP
2024-05-26 20:14:23
date last changed
2024-06-14 12:42:24
@article{93932055-03ab-48d1-83aa-818ed879ef79,
  abstract     = {{Background:<br/>Rectal cancer patients commonly benefit from neoadjuvant therapy before resection surgery. For these patients, an elective ostomy diversion is frequently considered, despite the absence of conclusive evidence when a diversion is advantageous. This is a retrospective observational single-center study on a 4-year consecutive rectal cancer cohort undergoing neoadjuvant therapy, aiming at improving the understanding of risks and benefits associated with ostomy diversion.<br/>Material and Method:<br/>Baseline characteristics, tumor-specific data, clinical events, and outcomes were collected using the Swedish Colorectal Cancer Registry and medical records.<br/>Results:<br/>Thirty-two (30.2%) of the 106 included patients presented with endoscopic impassable tumors at diagnosis, of which 18 (56.2%) had diverting ostomy. Three out of 14 with impassable tumor and no diversion developed a bowel obstruction. None of the patients with an endoscopically passable tumor at diagnosis (n = 74) experienced a bowel obstruction. The elective diversions (n = 40) were not associated with serious complications (Clavien–Dindo grade ⩾ 3b). Patients with a diverting ostomy (n = 30) had similar time intervals from diagnosis to neoadjuvant treatment and to definite tumor resection as those without diversion but experienced more complex primary tumor resections in terms of blood loss and operation time.<br/>Conclusion:<br/>An elective diverting ostomy is a relatively safe procedure in rectal cancer patients requiring neoadjuvant therapy. More than one out of five non-diverted patients with endoscopically impassable rectal tumors developed bowel obstruction and would potentially have benefited from an elective diversion.}},
  author       = {{Valdimarsson, Valentinus and Munshi, Eihab Adil and Lydrup, Marie-Louise and Jutesten, Henrik and Samuelsson, Carolina and Buchwald, Pamela}},
  issn         = {{1799-7267}},
  language     = {{eng}},
  month        = {{05}},
  publisher    = {{Finnish Surgical Society}},
  series       = {{Scandinavian Journal of Surgery}},
  title        = {{Diverting ostomy prior to neoadjuvant treatment in rectal cancer should be used selectively : A retrospective single-center cohort study}},
  url          = {{http://dx.doi.org/10.1177/14574969241252481}},
  doi          = {{10.1177/14574969241252481}},
  year         = {{2024}},
}