Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients
| Autor: | Maciej Grajek, Adam Idasiak, Agnieszka Czarniecka, Marcin Zeman, Marek Czarnecki, Andrzej Chmielarz |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Low anterior resection Colorectal cancer medicine.medical_treatment lcsh:Surgery Anastomotic Leak Anastomosis Fibrinogen lcsh:RC254-282 Loop ileostomy Stoma 03 medical and health sciences Ileostomy 0302 clinical medicine Surgical oncology Risk Factors medicine Anastomotic leakage Humans Risk factor Rectal cancer Retrospective Studies business.industry Rectal Neoplasms Incidence (epidemiology) Research Anastomosis Surgical Surgical Stomas Permanent stoma lcsh:RD1-811 medicine.disease lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens Prognosis Surgery Oncology 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology business medicine.drug |
| Zdroj: | World Journal of Surgical Oncology World Journal of Surgical Oncology, Vol 18, Iss 1, Pp 1-9 (2020) |
| DOI: | 10.21203/rs.3.rs-32646/v2 |
| Popis: | Background One of the most severe complications of low anterior rectal resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the prevalence of AL requiring surgical intervention. However, up to one-third of temporary stomas may never be closed. The first aim of the study was to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study was to assess preoperative PS risk factors in patients with LI. Methods A total of 286 consecutive patients who underwent low anterior rectal resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and the values of selected peripheral blood parameters were analysed. Results PS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p < 0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p < 0.001). In the LI group, the only significant risk factor for PS in the multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.007, 97.5% CI 1.002–1.013, p = 0.013). Conclusions Although protective LI may reduce the incidence of symptomatic AL, it can be related to a higher risk of PS in this group of patients. The preoperative plasma fibrinogen concentration can be a risk factor for PS in LI patients and may be a useful variable in decision-making models. |
| Databáze: | OpenAIRE |
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