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. |
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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 |
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