Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery

Background: Defunctioning stoma is widely used to reduce anastomotic complications in rectal cancer surgery. However, the complications of stoma and stoma reversal surgery should not be underestimated. Furthermore, in some patients, stoma reversal failed. Here, we investigated the complications of d...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Lin Zhang, Wei Zheng, Jian Cui, Yun-Long Wu, Tian-Lei Xu, Hai-Zeng Zhang
Formato:	article
Lenguaje:	EN
Publicado:	KeAi Communications Co., Ltd. 2020
Materias:	Rectal cancer Low anterior resection Anastomotic complications Defunctioning stoma Stoma reversal surgery Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/fd804134062641cebc81b9c612bcce55
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:fd804134062641cebc81b9c612bcce55
record_format	dspace
spelling	oai:doaj.org-article:fd804134062641cebc81b9c612bcce552021-12-02T13:47:29ZRisk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery2095-882X10.1016/j.cdtm.2020.02.004https://doaj.org/article/fd804134062641cebc81b9c612bcce552020-09-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2095882X20300177https://doaj.org/toc/2095-882XBackground: Defunctioning stoma is widely used to reduce anastomotic complications in rectal cancer surgery. However, the complications of stoma and stoma reversal surgery should not be underestimated. Furthermore, in some patients, stoma reversal failed. Here, we investigated the complications of defunctioning stoma surgery and subsequent reversal surgery and identify risk factors associated with the failure of getting stoma reversed. Methods: In total, 154 patients who simultaneously underwent low anterior resection and defunctioning stoma were reviewed. Patients were divided into two groups according to whether their stoma got reversed or not. The reasons that patients received defunctioning stoma and experienced stoma-related complications and the risk factors for failing to get stoma reversed were analysed. Results: The mean follow-up time was 47.54 (range 4.0–164.0) months. During follow-up, 19.5% of the patients suffered stoma-related long-term complications. Only 79 (51.3%) patients had their stomas reversed. The morbidity of complications after reversal surgery was 45.6%, and these mainly consisted of incision-related complications. Multivariate analyses showed that pre-treatment comorbidity (HR = 3.17, 95% CI 1.27–7.96, P = 0.014), postoperative TNM stage (HR = 2.55, 95% CI 1.05–6.18, P = 0.038), neoadjuvant therapy (HR = 2.75, 95% CI 1.07–7.05, P = 0.036), anastomosis-related complications (HR = 4.52, 95% CI 1.81–11.29, P = 0.001), and disease recurrence (HR = 24.83, 95% CI 2.90–213.06, P = 0.003) were significant independent risk factors for a defunctioning stoma to be permanent. Conclusions: Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage, but the stoma itself and its reversal procedure are associated with high morbidity of complications, and many defunctioning stomas eventually become permanent. Therefore, surgeons should carefully assess preoperatively and perform defunctioning stomas in very high risk patients. In addition, doctors should perform stoma reversal surgery more actively to prevent temporary stomas from becoming permanent.Lin ZhangWei ZhengJian CuiYun-Long WuTian-Lei XuHai-Zeng ZhangKeAi Communications Co., Ltd.articleRectal cancerLow anterior resectionAnastomotic complicationsDefunctioning stomaStoma reversal surgeryMedicine (General)R5-920ENChronic Diseases and Translational Medicine, Vol 6, Iss 3, Pp 188-197 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Rectal cancer Low anterior resection Anastomotic complications Defunctioning stoma Stoma reversal surgery Medicine (General) R5-920
spellingShingle	Rectal cancer Low anterior resection Anastomotic complications Defunctioning stoma Stoma reversal surgery Medicine (General) R5-920 Lin Zhang Wei Zheng Jian Cui Yun-Long Wu Tian-Lei Xu Hai-Zeng Zhang Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery
description	Background: Defunctioning stoma is widely used to reduce anastomotic complications in rectal cancer surgery. However, the complications of stoma and stoma reversal surgery should not be underestimated. Furthermore, in some patients, stoma reversal failed. Here, we investigated the complications of defunctioning stoma surgery and subsequent reversal surgery and identify risk factors associated with the failure of getting stoma reversed. Methods: In total, 154 patients who simultaneously underwent low anterior resection and defunctioning stoma were reviewed. Patients were divided into two groups according to whether their stoma got reversed or not. The reasons that patients received defunctioning stoma and experienced stoma-related complications and the risk factors for failing to get stoma reversed were analysed. Results: The mean follow-up time was 47.54 (range 4.0–164.0) months. During follow-up, 19.5% of the patients suffered stoma-related long-term complications. Only 79 (51.3%) patients had their stomas reversed. The morbidity of complications after reversal surgery was 45.6%, and these mainly consisted of incision-related complications. Multivariate analyses showed that pre-treatment comorbidity (HR = 3.17, 95% CI 1.27–7.96, P = 0.014), postoperative TNM stage (HR = 2.55, 95% CI 1.05–6.18, P = 0.038), neoadjuvant therapy (HR = 2.75, 95% CI 1.07–7.05, P = 0.036), anastomosis-related complications (HR = 4.52, 95% CI 1.81–11.29, P = 0.001), and disease recurrence (HR = 24.83, 95% CI 2.90–213.06, P = 0.003) were significant independent risk factors for a defunctioning stoma to be permanent. Conclusions: Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage, but the stoma itself and its reversal procedure are associated with high morbidity of complications, and many defunctioning stomas eventually become permanent. Therefore, surgeons should carefully assess preoperatively and perform defunctioning stomas in very high risk patients. In addition, doctors should perform stoma reversal surgery more actively to prevent temporary stomas from becoming permanent.
format	article
author	Lin Zhang Wei Zheng Jian Cui Yun-Long Wu Tian-Lei Xu Hai-Zeng Zhang
author_facet	Lin Zhang Wei Zheng Jian Cui Yun-Long Wu Tian-Lei Xu Hai-Zeng Zhang
author_sort	Lin Zhang
title	Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery
title_short	Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery
title_full	Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery
title_fullStr	Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery
title_full_unstemmed	Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery
title_sort	risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery
publisher	KeAi Communications Co., Ltd.
publishDate	2020
url	https://doaj.org/article/fd804134062641cebc81b9c612bcce55
work_keys_str_mv	AT linzhang riskfactorsfornonclosureofdefunctioningstomaandstomarelatedcomplicationsamonglowrectalcancerpatientsaftersphincterpreservingsurgery AT weizheng riskfactorsfornonclosureofdefunctioningstomaandstomarelatedcomplicationsamonglowrectalcancerpatientsaftersphincterpreservingsurgery AT jiancui riskfactorsfornonclosureofdefunctioningstomaandstomarelatedcomplicationsamonglowrectalcancerpatientsaftersphincterpreservingsurgery AT yunlongwu riskfactorsfornonclosureofdefunctioningstomaandstomarelatedcomplicationsamonglowrectalcancerpatientsaftersphincterpreservingsurgery AT tianleixu riskfactorsfornonclosureofdefunctioningstomaandstomarelatedcomplicationsamonglowrectalcancerpatientsaftersphincterpreservingsurgery AT haizengzhang riskfactorsfornonclosureofdefunctioningstomaandstomarelatedcomplicationsamonglowrectalcancerpatientsaftersphincterpreservingsurgery
_version_	1718392534918496256

Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery

Ejemplares similares