K Anderin1, U O Gustafsson2, A Thorell3, J Nygren3. 1. Department of Surgical Gastroenterology, Karolinska University Hospital, Sweden; Department of Clinical Sciences Danderyds Hospital, Karolinska Institutet, Sweden. Electronic address: kajsa.anderin@karolinska.se. 2. Department of Clinical Sciences Danderyds Hospital, Karolinska Institutet, Sweden; Department of Surgery, Danderyds Hospital, Sweden. 3. Department of Clinical Sciences Danderyds Hospital, Karolinska Institutet, Sweden; Department of Surgery, Ersta Hospital, Sweden.
Abstract
BACKGROUND: Anastomotic leakage (AL) is a serious complication after low anterior resection (LAR) with total mesorectal excision (TME) for rectal cancer. Whether the Enhanced Recovery After Surgery (ERAS)-protocol influences the risk of short-term morbidity in relation to the use of a diverting stoma is unclear. METHODS: Between 2002 and 2011, 287 consecutive patients underwent LAR with TME for rectal cancer at Ersta Hospital, Sweden. All patients were treated according to the ERAS program and thereby included. Between 2002 and 2006 15% had a diverting stoma compared to 91 %, 2007 to 2011. RESULTS: One hundred and thirty-nine patients were operated with a diverting stoma at primary surgery (S+), 148 patients were not (S-). The groups were comparable regarding pre- and peroperative data and patients' characteristics. Postoperative morbidity within 30 days after surgery (S+ 53% vs. S- 43%) and hospital stay (S+ 11 days vs. S- 9 days) did not differ. AL occurred in 22% of all patients. In a multivariate analysis, no significant difference in AL was found in relation to the use of a diverting stoma (S+ vs. S-, OR 0.64, 95% CI 0.34-1.19). Eleven patients (8%) in the S+ group underwent relaparotomy versus 22 (15%) in the S- group (p = 0.065). Total overall compliance to the ERAS program was 65%. Patients in S- had faster postoperative recovery. CONCLUSION: A diverting stoma did not affect postoperative morbidity in this large cohort of patients undergoing LAR within an ERAS program. However, the routine use of a diverting stoma could be expected to delay postoperative recovery.
BACKGROUND: Anastomotic leakage (AL) is a serious complication after low anterior resection (LAR) with total mesorectal excision (TME) for rectal cancer. Whether the Enhanced Recovery After Surgery (ERAS)-protocol influences the risk of short-term morbidity in relation to the use of a diverting stoma is unclear. METHODS: Between 2002 and 2011, 287 consecutive patients underwent LAR with TME for rectal cancer at Ersta Hospital, Sweden. All patients were treated according to the ERAS program and thereby included. Between 2002 and 2006 15% had a diverting stoma compared to 91 %, 2007 to 2011. RESULTS: One hundred and thirty-nine patients were operated with a diverting stoma at primary surgery (S+), 148 patients were not (S-). The groups were comparable regarding pre- and peroperative data and patients' characteristics. Postoperative morbidity within 30 days after surgery (S+ 53% vs. S- 43%) and hospital stay (S+ 11 days vs. S- 9 days) did not differ. AL occurred in 22% of all patients. In a multivariate analysis, no significant difference in AL was found in relation to the use of a diverting stoma (S+ vs. S-, OR 0.64, 95% CI 0.34-1.19). Eleven patients (8%) in the S+ group underwent relaparotomy versus 22 (15%) in the S- group (p = 0.065). Total overall compliance to the ERAS program was 65%. Patients in S- had faster postoperative recovery. CONCLUSION: A diverting stoma did not affect postoperative morbidity in this large cohort of patients undergoing LAR within an ERAS program. However, the routine use of a diverting stoma could be expected to delay postoperative recovery.
Authors: Magdalena Pisarska; Natalia Gajewska; Piotr Małczak; Michał Wysocki; Jan Witowski; Grzegorz Torbicz; Piotr Major; Magdalena Mizera; Marcin Dembiński; Marcin Migaczewski; Andrzej Budzyński; Michał Pędziwiatr Journal: Oncotarget Date: 2018-04-17
Authors: Audrey Chm Jongen; Joanna Wam Bosmans; Serdar Kartal; Tim Lubbers; Meindert Sosef; Gerrit D Slooter; Jan H Stoot; Frederik-Jan van Schooten; Nicole D Bouvy; Joep Pm Derikx Journal: JMIR Res Protoc Date: 2016-06-09