Diverting ileostomy versus no diversion after low anterior resection for rectal cancer: A prospective, randomized, multicenter trial
Autor: | Karl Mrak, Jörg Tschmelitsch, Florian Pedross, Michael Jagoditsch, Andreas Heuberger, Anton Klingler, Dominik Weihs, Thomas Eberl, Stefan Uranitsch |
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Rok vydání: | 2016 |
Předmět: |
Adult
Male medicine.medical_specialty Colon medicine.medical_treatment Colonic Pouches Anastomotic Leak 030230 surgery Anastomosis 03 medical and health sciences Ileostomy 0302 clinical medicine Colon surgery Multicenter trial medicine Humans Prospective Studies Prospective cohort study Aged Aged 80 and over Intention-to-treat analysis Rectal Neoplasms Proctocolectomy business.industry Anastomosis Surgical Proctocolectomy Restorative Rectum Middle Aged digestive system diseases Intention to Treat Analysis Surgery Treatment Outcome 030220 oncology & carcinogenesis Multivariate Analysis Female Pouch business |
Zdroj: | Surgery. 159:1129-1139 |
ISSN: | 0039-6060 |
Popis: | Background This study sought to determine whether a protective diverting ileostomy improves short-term outcomes in patients with rectal resection and colonic J-pouch reconstruction for low anastomoses. Criteria for the use of a proximal stoma in rectal resections with colonic J-pouch reconstruction have not been defined sufficiently. Methods In a multicenter prospective study, rectal cancer patients with anastomoses below 8 cm treated with low anterior resection and colonic J-pouch were randomized to a defunctioning loop ileostomy or no ileostomy. The primary study endpoint was the rate of anastomotic leakage, and the secondary endpoints were surgical complications related to primary surgery, stoma, or stoma closure. Results From 2004 to 2014, a total of 166 patients were randomized to 1 of the 2 study groups. In the intention-to-treat analysis, the overall leakage rate was 5.8% in the stoma group and 16.3% in the no stoma group ( P = .0441). However, some patients were not treated according to randomization and only 70% of our patients with low anastomoses received a pouch. Therefore, we performed a second analysis as to actual treatment. In this analysis, as well, leakage rates ( P = .044) and reoperation rates for leakage ( P = .021) were significantly higher in patients without a stoma. In multivariate analysis, male gender ( P = .0267) and the absence of a stoma ( P = .0092) were significantly associated with anastomotic leakage. Conclusion Defunctioning loop ileostomy should be fashioned in rectal cancer patients with anastomoses below 6 cm, particularly in male patients, even if reconstruction was done with a J-pouch. |
Databáze: | OpenAIRE |
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