BACKGROUND: In many patients with rectal cancer, defunctioning stomas are created to limit the consequences of anastomotic leakage. Although intended to be temporary, a substantial proportion of these stomas might never be reversed for various reasons. We aimed to describe stoma policy by use of data from the total mesorectal excision (TME) trial in patients with rectal cancer and to identify factors that limit stoma reversal. METHODS: 924 Dutch patients with rectal cancer who underwent a low anterior resection were selected from the TME trial, a prospective, randomised multicentre trial studying the effects of short-term preoperative radiotherapy in 1861 patients who underwent TME. Creation of stomas and time to stoma reversal were analysed retrospectively by use of multivariate analysis. FINDINGS: In 523 of 924 (57%) patients, a primary stoma (defined as a stoma created at the time of TME) was constructed after a low anterior resection. Geographical differences in the number of primary stomas constructed were reported throughout the Netherlands. 19% of stomas that were created were never reversed. Postoperative complications and secondary constructed stomas (defined as a stoma created during a second or subsequent procedure after TME) were associated with a high likelihood of a permanent stoma. However, perioperative complications were not a limiting factor for stoma closure. INTERPRETATION: Postoperative complications are an important limiting factor for stoma reversal because, after occurrence of these complications, patients and surgeons might be reluctant to reverse the stoma, so a substantial proportion of these stomas are never closed. Future guidelines for stoma creation and closure should consider these factors.
BACKGROUND: In many patients with rectal cancer, defunctioning stomas are created to limit the consequences of anastomotic leakage. Although intended to be temporary, a substantial proportion of these stomas might never be reversed for various reasons. We aimed to describe stoma policy by use of data from the total mesorectal excision (TME) trial in patients with rectal cancer and to identify factors that limit stoma reversal. METHODS: 924 Dutch patients with rectal cancer who underwent a low anterior resection were selected from the TME trial, a prospective, randomised multicentre trial studying the effects of short-term preoperative radiotherapy in 1861 patients who underwent TME. Creation of stomas and time to stoma reversal were analysed retrospectively by use of multivariate analysis. FINDINGS: In 523 of 924 (57%) patients, a primary stoma (defined as a stoma created at the time of TME) was constructed after a low anterior resection. Geographical differences in the number of primary stomas constructed were reported throughout the Netherlands. 19% of stomas that were created were never reversed. Postoperative complications and secondary constructed stomas (defined as a stoma created during a second or subsequent procedure after TME) were associated with a high likelihood of a permanent stoma. However, perioperative complications were not a limiting factor for stoma closure. INTERPRETATION: Postoperative complications are an important limiting factor for stoma reversal because, after occurrence of these complications, patients and surgeons might be reluctant to reverse the stoma, so a substantial proportion of these stomas are never closed. Future guidelines for stoma creation and closure should consider these factors.
Authors: Angela Fischer; Ignazio Tarantino; René Warschkow; Jochen Lange; Andreas Zerz; Franc H Hetzer Journal: Int J Colorectal Dis Date: 2010-02-03 Impact factor: 2.571
Authors: Seok In Seo; Chang Sik Yu; Gwon Sik Kim; Jong Lyul Lee; Yong Sik Yoon; Chan Wook Kim; Seok-Byung Lim; Jin Cheon Kim Journal: World J Surg Date: 2013-10 Impact factor: 3.352
Authors: A Mariani; D Moszkowicz; C Trésallet; F Koskas; L Chiche; R Lupinacci; F Menegaux Journal: Tech Coloproctol Date: 2014-01-17 Impact factor: 3.781
Authors: Sang Woo Lim; Hun Jin Kim; Chang Hyun Kim; Jung Wook Huh; Young Jin Kim; Hyeong Rok Kim Journal: Langenbecks Arch Surg Date: 2012-12-09 Impact factor: 3.445
Authors: Louis de Mestier; Gilles Manceau; Cindy Neuzillet; Jean Baptiste Bachet; Jean Philippe Spano; Reza Kianmanesh; Jean Christophe Vaillant; Olivier Bouché; Laurent Hannoun; Mehdi Karoui Journal: World J Gastrointest Oncol Date: 2014-06-15