The effect of diverting stoma on long-term morbidity and risk for permanent stoma after low anterior resection for rectal cancer
The effect of diverting stoma on long-term morbidity and risk for permanent stoma after low anterior resection for rectal cancer
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DOI：
10.1016/j.ejso.2016.04.001
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发表时间：
2016-06-01
期刊：
影响因子：
3.8
通讯作者：
Nygren, J.
中科院分区：
文献类型：
--
作者：
Anderin, K.;Gustafsson, U. O.;Nygren, J.
背景：吻合口漏（AL）是直肠癌低位前切除术（LAR）后的严重并发症。据报道，改道袢回肠造口术可减少早期临床 AL，从而降低短期发病率。目前尚不清楚 LAR 进行的回肠袢造口术是否会影响长期发病率。方法：2002 年至 2011 年，瑞典 Ersta 医院连续 287 名患者接受了 LAR 手术。 LAR 后随访时间为 3 年。由于惯例的改变，2002-2006 年期间有 15% 的航班在 LAR 改道，2007-2011 年期间则有 91% 的航班改道。对初次手术时有或没有改道的患者的长期发病率和永久性造口数据进行了比较。结果：在 LAR 期间，139 名患者进行了改道 (S+)，148 名患者未进行改道 (S-)。早期和晚期 AL 的总发生率，S+ 患者为 26%，S- 患者为 30%，p < 0.25。 6% 的患者发现晚期 AL（LAR 后 > 30 天），15% 的患者在术后晚期再次入院，两组之间没有差异。与 S- 相比，S+ 的总住院时间（LAR 后 30 天至 3 年）更长，平均为 7 天与 4 天（p < 0.001）。六分之一的人最终形成了永久性造口（17% S+，14% S-，p 0.47）。临床 AL 是一个独立的危险因素，也是两组中永久造口的最常见原因。结论：LAR 处的转向环回肠造口术并未降低长期发病率，但在 3 年随访期间与更长的总住院时间相关。 (C) 2016 Elsevier Ltd. 保留所有权利。
Background: Anastomotic leakage (AL) is a severe complication after low anterior resection (LAR) in rectal cancer surgery. A diverting loop ileostomy has been reported to reduce early clinical AL and thereby decrease short-term morbidity. Less is known if long-term morbidity is affected by a loop ileostomy constructed at LAR.Methods: At Ersta Hospital, Sweden, 287 consecutive patients were operated on with LAR, 2002-2011. Follow-up time was 3 years after LAR. Due to a shift in routines, 15% were diverted at LAR, 2002-2006 and 91%, 2007-2011. Data on long-term morbidity and permanent stoma in patients with or without a diversion at primary surgery were compared.Results: During LAR, 139 patients were diverted (S+), 148 were not (S-). Total rate of AL, both early and late, was 26% in S+ and 30% in S-, p 0.25. Late AL (>30 days after LAR) was found in 6% and 15% were readmitted in the late postoperative period with no difference between the groups. Total length of hospital stay (30 days-3 years after LAR) was longer among S+ compared to S-, mean 7 vs. 4 days (p < 0.001). One out of six ended up with a permanent stoma (17% S+, 14% S-, p 0.47). Clinical AL was an independent risk factor and the most common cause for a permanent stoma in both groups.Conclusion: A diverting loop ileostomy at LAR did not reduce long-term morbidity but was associated with a longer total length of hospital stay during a 3-year follow up. (C) 2016 Elsevier Ltd. All rights reserved.