Selective treatment of rectal cancer with single-stage coloanal or ultralow colorectal anastomosis does not adversely affect morbidity and mortality
Selective treatment of rectal cancer with single-stage coloanal or ultralow colorectal anastomosis does not adversely affect morbidity and mortality
复制标题
采用单期结肠或超低位结直肠吻合术选择性治疗直肠癌不会对发病率和死亡率产生不利影响
DOI：
10.1007/s00384-007-0274-2
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发表时间：
2007
影响因子：
2.8
通讯作者：
Ravin R. Kumar
中科院分区：
文献类型：
--
作者：
A. Kong;Justin T. Kim;Alicia Holt;V. Konyalian;R. Huynh;S. Udani;M. Stamos;Ravin R. Kumar
背景与目的低位直肠癌的手术治疗通常包括低位盆腔吻合术与低位结肠直肠吻合术或低位结肠直肠吻合术。低位盆腔吻合术的吻合口漏率为4%至26%。许多外科医生选择常规创建一个转移造口，以减少发病率的程度，如果吻合口泄漏发生。我们研究的目的是确定我们的选择转移政策是否安全。材料与方法回顾性分析66例直肠癌患者行直肠切除术和盆腔低位吻合术（距肛缘小于6cm，伴或不伴转移造口）。临时转移造口是主治医生根据主观标准自行决定的。主要结果为术后并发症。结果/发现49例患者（78%术前放疗）接受一期手术治疗，17例（53%术前放疗）接受近端转移重建。单阶段手术患者的平均吻合高度为肛门边缘以上3.8 cm，而两阶段手术患者的平均吻合高度为2.6 cm （p= 0.076）。未行分流术的患者并发症发生率较低（29% vs 47%,p= 16）。单期和两期吻合口相关并发症发生率分别为8%和18% （p= 0.27）。解释/结论低位盆腔吻合术在直肠癌患者中可以作为单期手术安全地进行，保留对特定病例的分流。
Background and aimsThe surgical treatment of low rectal cancer commonly includes low pelvic anastomoses with coloanal or ultralow colorectal anastomoses. Anastomotic leak rates in low pelvic anastomoses range from 4 to 26%. Many surgeons opt to routinely create a diverting ostomy to reduce the extent of morbidity should an anastomotic leak occur. The intent of our study was to determine if our policy of selected diversion is safe.Materials and methodsA retrospective chart review of 66 rectal cancer patients who underwent proctectomy and low pelvic anastomoses—less than 6 cm from anal verge, with or without a diverting ostomy—was undertaken. Temporary diverting stomas were utilized at the discretion of the attending surgeon primarily based on subjective criteria. The main outcome was postoperative complications.Results/findingsForty-nine patients (78% preoperatively irradiated) were treated with a one-stage operation, whereas 17 (53% preoperatively irradiated) underwent reconstruction with proximal diversion. The mean anastomotic height for patients with a single stage procedure was 3.8 cm above the anal verge versus 2.6 for patients with a two-stage procedure (p= 0.076). Complication rates were lower in patients who did not undergo diversion (29% vs 47%,p= 16). With regard to anastomotic-associated complications for single stage versus two stage, complication rates were 8% versus 18%, respectively (p= 0.27).Interpretation/conclusionLow pelvic anastomoses in rectal cancer patients can be safely performed as a single-stage procedure, reserving the use of diversion for select cases.