Long-term restoration of bowel continuity after rectal cancer resection and the influence of surgical technique: A nationwide cross-sectional study.

Autor: Hazen SJA; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands., van Geffen EGM; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands., Sluckin TC; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands., Beets GL; Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.; GROW School of Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands., Belgers HJ; Surgery, Zuyderland Medical Center, Heerlen, The Netherlands., Borstlap WAA; Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands., Consten ECJ; Surgery, Meander Medical Center, Amersfoort, The Netherlands.; Surgery, University Medical Centre Groningen, Groningen, The Netherlands., Dekker JT; Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands., Hompes R; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands., Tuynman JB; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands., van Westreenen HL; Surgery, Isala Hospital, Zwolle, The Netherlands., de Wilt JHW; Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands., Tanis PJ; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.; Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., Kusters M; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.; Treatment and Quality of Life, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2024 Jun; Vol. 26 (6), pp. 1153-1165. Date of Electronic Publication: 2024 May 05.
DOI: 10.1111/codi.17015
Abstrakt: Aim: Literature on nationwide long-term permanent stoma rates after rectal cancer resection in the minimally invasive era is scarce. The aim of this population-based study was to provide more insight into the permanent stoma rate with interhospital variability (IHV) depending on surgical technique, with pelvic sepsis, unplanned reinterventions and readmissions as secondary outcomes.
Method: Patients who underwent open or minimally invasive resection of rectal cancer (lower border below the sigmoid take-off) in 67 Dutch centres in 2016 were included in this cross-sectional cohort study.
Results: Among 2530 patients, 1470 underwent a restorative resection (58%), 356 a Hartmann's procedure (14%, IHV 0%-42%) and 704 an abdominoperineal resection (28%, IHV 3%-60%). Median follow-up was 51 months. The overall permanent stoma rate at last follow-up was 50% (IHV 13%-79%) and the unintentional permanent stoma rate, permanent stoma after a restorative procedure or an unplanned Hartmann's procedure, was 11% (IHV 0%-29%). A total of 2165 patients (86%) underwent a minimally invasive resection: 1760 conventional (81%), 170 transanal (8%) and 235 robot-assisted (11%). An anastomosis was created in 59%, 80% and 66%, with corresponding unintentional permanent stoma rates of 12%, 24% and 14% (p = 0.001), respectively. When corrected for age, American Society of Anesthesiologists classification, cTNM, distance to the anorectal junction and neoadjuvant (chemo)radiotherapy, the minimally invasive technique was not associated with an unintended permanent stoma (p = 0.071) after a restorative procedure.
Conclusion: A remarkable IHV in the permanent stoma rate after rectal cancer resection was found. No beneficial influence of transanal or robot-assisted laparoscopy on the unintentional permanent stoma rate was found, although this might be caused by the surgical learning curve. A reduction in IHV and improving preoperative counselling for decision-making for restorative procedures are required.
(© 2024 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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