Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer

Mustafa Haksal; Nuri Okkabaz; Ali Emre Atici; Osman Civil; Yasar Ozdenkaya; Ayhan Erdemir; Nihat Aksakal; Mustafa Oncel

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자료유형: 학술저널

저자정보: Mustafa Haksal (Kartal Education and Research Hospital) Nuri Okkabaz (Kartal Education and Research Hospital) Ali Emre Atici (Kartal Education and Research Hospital) Osman Civil (Kartal Education and Research Hospital) Yasar Ozdenkaya (Medipol University) Ayhan Erdemir (Kartal Education and Research Hospital) Nihat Aksakal (Kartal Education and Research Hospital) Mustafa Oncel (Medipol University)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.92 No.1

발행연도: 2017.1

수록면: 35 - 41 (7page)

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Purpose: The current study aims to analyze the risk factors for the failure of ileostomy reversal after laparoscopic low anterior resection for rectal cancer.
Methods: All patients who underwent a laparoscopic low anterior resection for rectal cancer with a diverting ileostomy between 2007 and 2014 were abstracted. The patients who underwent and did not undergo a diverting ileostomy procedure were compared regarding patient, tumor, treatment related parameters, and survival.
Results: Among 160 (103 males [64.4%], mean [± standard deviation] age was 58.1 ± 11.9 years) patients, stoma reversal was achieved in 136 cases (85%). Anastomotic stricture (n = 13, 52.4%) was the most common reason for stoma reversal. These were the risk factors for the failure of stoma reversal: Male sex (P = 0.035), having complications (P = 0.01), particularly an anastomotic leak (P < 0.001), or surgical site infection (P = 0.019) especially evisceration (P = 0.011), requirement for reoperation (P = 0.003) and longer hospital stay (P = 0.004). Multivariate analysis revealed that male sex (odds ratio [OR], 7.82; P = 0.022) and additional organ resection (OR, 6.71; P = 0.027) were the risk factors. Five-year survival rates were similar (P = 0.143).
Conclusion: Fifteen percent of patients cannot receive a stoma reversal after laparoscopic low anterior resection for rectal cancer. Anastomotic stricture is the most common reason for the failure of stoma takedown. Having complications, particularly an anastomotic leak and the necessity of reoperation, limits the stoma closure rate. Male sex and additional organ resection are the risk factors for the failure in multivariate analyses. These patients require a longer hospitalization period, but have similar survival rates as those who receive stoma closure procedure.

#Ileostomy #Laparoscopy #Rectal neoplasms

참고문헌 (25)

참고문헌 신청

[학술지(정기간행물)] - Chow A / 2009 / The morbidity surrounding reversal of defunctioning ileostomies : a systematic review of 48 studies including 6, 107 cases / Int J Colorectal Dis 24 : 711 ~ 723

[학술지(정기간행물)] - Shiomi A / 2015 / Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer : a propensity score matching analysis of 1, 014 consecutive patients / J Am Coll Surg 220 : 186 ~ 194

[학술지(정기간행물)] - Tilney HS / 2007 / Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses / World J Surg 31 : 1142 ~ 1151

[학술지(정기간행물)] - Saghir JH / 2001 / Factors that predict complications after construction of a stoma : a retrospective study / Eur J Surg 167 : 531 ~ 534

[학술지(정기간행물)] - Huser N / 2008 / Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery / Ann Surg 248 : 52 ~ 60

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