BACKGROUND: Anastomotic leakage (AL) is one of the most serious complications after low anterior resection (LAR) for rectal cancer, and the significance of diverting stoma to prevent AL is still controversial. The aim of this study is to clarify the potential benefits and safety of diverting ileostomy (DI) following laparoscopic LAR in rectal cancer patients. METHODS: This was a retrospective cohort study of 417 rectal cancer patients who underwent laparoscopic LAR in a single institute. The risk factors for AL and the DI-related morbidity were assessed. RESULTS: DI was performed in 226 patients (54.2%). The incidence rates of symptomatic AL showed no significant difference between patients with and without DI (8.4% vs. 10.0%, p = 0.612). AL requiring a surgical intervention was relatively lower in patients with DI than in those without DI (1.8% vs. 4.7%, p = 0.097). DI construction was an independent risk factor for AL requiring a surgical intervention (OR 3.47, p = 0.041), as was the serum albumin level (p = 0.003), and being male was a relative risk factor (p = 0.058). Focusing on sex, the rate of AL requiring a surgical intervention was significantly different in male (1.7 and 7.9%, p = 0.021) but not in female patients (1.9 and 1.1%, p = 1.000) with and without DI. The DI construction-related morbidity was 9.7%, and no patient required a reoperation. Of 226 patients with DI, 209 (92.5%) underwent stoma closure 118 days (median 30-509 days) after LAR. The stoma closure-related morbidity was 9.1% and 1 patient (0.5%) required a reoperation due to anastomotic leakage. CONCLUSIONS: DI following laparoscopic LAR can decrease the risk of AL, requiring a surgical intervention, especially in male patients with malnutrition. However, due to DI-related morbidity, DI is not recommended in female patients.
BACKGROUND:Anastomotic leakage (AL) is one of the most serious complications after low anterior resection (LAR) for rectal cancer, and the significance of diverting stoma to prevent AL is still controversial. The aim of this study is to clarify the potential benefits and safety of diverting ileostomy (DI) following laparoscopic LAR in rectal cancerpatients. METHODS: This was a retrospective cohort study of 417 rectal cancerpatients who underwent laparoscopic LAR in a single institute. The risk factors for AL and the DI-related morbidity were assessed. RESULTS:DI was performed in 226 patients (54.2%). The incidence rates of symptomatic AL showed no significant difference between patients with and without DI (8.4% vs. 10.0%, p = 0.612). AL requiring a surgical intervention was relatively lower in patients with DI than in those without DI (1.8% vs. 4.7%, p = 0.097). DI construction was an independent risk factor for AL requiring a surgical intervention (OR 3.47, p = 0.041), as was the serum albumin level (p = 0.003), and being male was a relative risk factor (p = 0.058). Focusing on sex, the rate of AL requiring a surgical intervention was significantly different in male (1.7 and 7.9%, p = 0.021) but not in female patients (1.9 and 1.1%, p = 1.000) with and without DI. The DI construction-related morbidity was 9.7%, and no patient required a reoperation. Of 226 patients with DI, 209 (92.5%) underwent stoma closure 118 days (median 30-509 days) after LAR. The stoma closure-related morbidity was 9.1% and 1 patient (0.5%) required a reoperation due to anastomotic leakage. CONCLUSIONS:DI following laparoscopic LAR can decrease the risk of AL, requiring a surgical intervention, especially in male patients with malnutrition. However, due to DI-related morbidity, DI is not recommended in female patients.
Authors: Jun Seok Park; Gyu-Seog Choi; Seon Hahn Kim; Hyeong Rok Kim; Nam Kyu Kim; Kang Young Lee; Sung Bum Kang; Ji Yeon Kim; Kil Yeon Lee; Byung Chun Kim; Byung Noe Bae; Gyung Mo Son; Sun Il Lee; Hyun Kang Journal: Ann Surg Date: 2013-04 Impact factor: 12.969
Authors: Martijn Hgm van der Pas; Eva Haglind; Miguel A Cuesta; Alois Fürst; Antonio M Lacy; Wim Cj Hop; Hendrik Jaap Bonjer Journal: Lancet Oncol Date: 2013-02-06 Impact factor: 41.316
Authors: M den Dulk; C A M Marijnen; L Collette; H Putter; L Påhlman; J Folkesson; J-F Bosset; C Rödel; K Bujko; C J H van de Velde Journal: Br J Surg Date: 2009-09 Impact factor: 6.939