Comparison of a low Hartmann's procedure with low colorectal anastomosis with and without defunctioning ileostomy after radiotherapy for rectal cancer: results from a national registry

Autor: Jonker, F.H., Tanis, P.J., Coene, P.P., Gietelink, L., Harst, E. van der, Krieken, J.H. van, Meijerink, W.J.H.J.
Přispěvatelé: Surgery, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Amsterdam Gastroenterology Endocrinology Metabolism
Rok vydání: 2016
Předmět:
Male
Colorectal cancer
medicine.medical_treatment
Cancer development and immune defence Radboud Institute for Molecular Life Sciences [Radboudumc 2]
Anastomotic Leak
030230 surgery
0302 clinical medicine
Postoperative Complications
Hospital Mortality
Registries
Rectal cancer
Digestive System Surgical Procedures
Netherlands
Aged
80 and over

Ileostomy
total mesorectal excision
Anastomosis
Surgical

Gastroenterology
Colostomy
Middle Aged
Total mesorectal excision
Neoadjuvant Therapy
medicine.anatomical_structure
Treatment Outcome
030220 oncology & carcinogenesis
Urological cancers Radboud Institute for Health Sciences [Radboudumc 15]
Female
Reoperation
medicine.medical_specialty
Abdominal Abscess
end-colostomy
Colon
Rectum
Lower risk
03 medical and health sciences
SDG 3 - Good Health and Well-being
medicine
Humans
Surgical Wound Infection
radiotherapy
Aged
Retrospective Studies
business.industry
Rectal Neoplasms
Postoperative complication
low anterior resection
medicine.disease
Surgery
Multivariate Analysis
business
Complication
Zdroj: Colorectal Disease, 18(8), 785-792. Wiley-Blackwell Publishing Ltd
Colorectal Disease, 18(8), 785-794. Wiley
Colorectal Disease, 18, 8, pp. 785-92
Colorectal Disease, 18, 785-92
Colorectal disease, 18(8), 785-792. Wiley-Blackwell
ISSN: 1462-8910
Popis: Contains fulltext : 172178.pdf (Publisher’s version ) (Closed access) AIM: This study used a national registry to compare the outcome after a low Hartmann's procedure (LHP), defined as removal of most of the rectum to leave a short anorectal stump and an end colostomy, and low anterior resection (LA) with or without a diverting ileostomy (DI) in rectal cancer patients all of whom had received preoperative neoadjuvant radiotherapy (RT). METHOD: Patients who underwent LHP or LA with or without DI for rectal cancer after RT between 2009 and 2013 were identified from the Dutch Surgical Colorectal Audit. The postoperative outcome was compared between the three groups and risk of complications, reoperation and mortality were analysed in a multivariable model. RESULTS: The study included 4288 patients were included, of whom 27.8% underwent LHP, 20.2% LA and 52.0% LA with DI. Thirty-day mortality was higher after LHP (3.2% vs 1.3% and 1.3% for LA with or without DI, P < 0.001), but LHP was not an independent predictor of mortality in multivariable analysis. LHP and LA with DI were associated with a lower rate of abdominal infective complications (6.5% and 10.1% vs 16.2%, P < 0.001) and reoperation (7.3% and 8.1% vs 16.5%, P < 0.001). In multivariable analysis, LHP (OR 0.35, 95% CI 0.26-0.47) and LA with DI (OR 0.43, 95% CI 0.33-0.54) were associated with a lower risk of reoperation than LA alone. LHP was associated with a lower risk of any postoperative complication than LA with or without DI (OR 0.81, 95% CI 0.66-0.98). CONCLUSION: LHP and LA with DI were associated with fewer infective complications and reoperations than LA alone. The rate of any complication was less after LHR than LA with or without DI.
Databáze: OpenAIRE