Postoperative Morbidity with Diversion after Low Anterior Resection in the Era of Neoadjuvant Therapy: A Single Institution Experience
Postoperative Morbidity with Diversion after Low Anterior Resection in the Era of Neoadjuvant Therapy: A Single Institution Experience
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DOI：
10.1016/j.jamcollsurg.2009.03.020
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发表时间：
2009-07-01
影响因子：
5.2
通讯作者：
Cima, Robert R.
中科院分区：
文献类型：
--
作者：
Tsikitis, Vassiliki L.;Larson, David W.;Cima, Robert R.
背景：人们提倡使用功能缺损的造口来减轻直肠癌切除术后吻合口破裂的不良后遗症。本研究的目的是报告我们在新辅助治疗时代的吻合口裂开和低位前切除术的总体发病率的经验，在新辅助治疗时代，使用粪便分流是低位（< 5厘米）直肠吻合术的标准手术策略的一部分。研究设计：本回顾性病例系列包括1996年至2007年间接受新辅助治疗并以治愈为目的切除直肠癌的患者。结果：237例患者（男性159例，女性78例），平均年龄59岁（SD +/- 12.7岁），接受5-氟尿嘧啶输注化疗和45 - 54 Gy的外束放疗。57%的患者行前切除术，43%行结肠肛管吻合术。吻合口裂开9例（3.8%）。吻合口瘘7例（2.1%）诊断为盆腔脓肿，2例（0.8%）需再次探查。术后早期总发病率为26%，无术后死亡率。193例患者中有191例进行了回肠造口术逆转，发病率最低（漏出率0.5%）。结论：在接受新辅助治疗的腺癌患者中，结直肠肛管吻合术术后低发病率是可能的。失功能造口是安全的，可以减轻低位直肠吻合术后吻合口破裂的严重后遗症。[J]中华外科杂志，2009;29:114-118。(C) 2009年由美国外科医师学会发布)
BACKGROUND: The use of defunctioning stomas has been advocated to mitigate the adverse sequela from anastomotic dehiscence after rectal cancer resection. The aim of this study was to report our experience with anastomotic dehiscence and overall morbidity of low anterior resections in the era of neoadjuvant therapy, where the use of fecal diversion is part of the standard operative strategy for low (< 5 cm) rectal anastomoses.STUDY DESIGN: This retrospective case series included patients who were treated with neoadjuvant therapy and had rectal cancer resection with curative intent, from 1996 to 2007.RESULTS: Two hundred thirty-seven patients (159 men, 78 women) with mean age of 59 years (SD +/- 12.7 years), received 5-flurouracil-based infusional chemotherapy and external-beam radiation in the range of 45 to 54 Gy. Fifty-seven percent of patients underwent anterior resection and 43% had coloanal anastomosis. Anastomotic dehiscence occurred in 9 patients (3.8%). Seven of the anastomotic leaks were diagnosed as pelvic abscesses (2.1%) and 2 patients needed reexploration (0.8%). Early overall postoperative morbidity was 26%, and there was no postoperative mortality. One hundred ninety-one of 193 patients had their ileostomy reversed, with minimal morbidity (0.5% leak rate).CONCLUSIONS: Low postoperative morbidity after colorectal and coloanal anastomosis for adenocarcinoma is possible in patients who have received neoadjuvant therapy. Defunctioning stomas are safe and may mitigate the serious sequela of anastomotic dehiscence after low rectal anastomoses. (J Am Coll Surg 2009;209:114-118. (C) 2009 by the American College of Surgeons)