Laparoscopic diverting ileostomy in rectal cancer surgery
Authors:
P. Ihnát 1,2; P. Vávra 1,2; P. Guňková 1,2; A. Zatloukal 2; S. Czudek 1,2; P. Zonča 1,2
Authors place of work:
Katedra chirurgických oborů, LF Ostravské univerzity
vedoucí katedry: doc. MUDr. P. Vávra, Ph. D.
1; Chirurgická klinika, FN Ostrava
přednosta: doc. MUDr. P. Zonča, Ph. D., FRCS
2
Published in the journal:
Rozhl. Chir., 2017, roč. 96, č. 3, s. 120-124.
Category:
Original articles
Summary
Introduction:
Low anterior resection (LAR) with total mesorectal excision (TME) represents the gold standard for patients with low rectal carcinoma. Protective ileostomy (PI) is commonly performed during LAR in an effort to protect low rectal anastomosis. The aim of this study is to analyse outcomes in our own patient population, focusing on morbidity associated with PI.
Method:
A retrospective clinical study of patients operated on between 2013 and 2015 was conducted in University Hospital Ostrava. All patients after LAR with PI due to low rectal cancer were included. The study design did not require randomisation.
Results:
A total of 52 patients who underwent LAR with PI were included. Mean tumour height was 9.1±2.3 cm. 15.4% of the patients were classified as ASA I, 53.8% were classified as ASA II and 32.7% of the patients as ASA III. 30-day postoperative morbidity was 38.5%, and complications associated with PI (within 30 days after LAR) occurred in 7 (13.5%) patients. Three of these patients underwent urgent surgical revision due to small bowel obstruction (PI semirotation around its longitudinal axis in two patients and volvulus of the small bowel around PI in one patient).
Mean time interval between PI creation and reversal was 252 days. During this period, complications associated with PI were detected in 25 (48.1%) patients; seven patients had more than one complication. Minor complications (such as peristomal dermatitis, stoma herniation or bleeding, wound infection after stoma reversal) were observed in 17 (32.7%) patients. Major complications (small bowel obstruction at the site of PI, dehydration due to high stoma output, intraabdominal abscess after stoma reversal) occurred in 8 (15.4%) patients.
Conclusions:
PI offers protection to low colorectal or coloanal anastomosis in rectal cancer surgery. However, this benefit is counterbalanced by a high risk of various complications which may occur during the whole period when PI is present. The decision for diversion should therefore be made only after careful consideration.
Key words:
rectal cancer – low anterior resection – laparoscopy – protective ileostomy – stoma complications
Zdroje
1. How P, Shihab O, Tekkis P, et al. A systematic review of cancer related patient outcomes after anterior resection and abdominoperineal excision for rectal cancer in the total mesorectal excision era. Surg Oncol 2011;20:149−55.
2. Herzog T, Belyaev O, Chromik AM, et al. TME quality in rectal cancer surgery. Eur J Med Res 2010;15:292−6.
3. Ihnát P, Delongová P, Horáček J, et al. The impact of standard protocol implementation on the quality of colorectal cancer pathology reporting. World J Surg 2015;39:259−65.
4. Paun BC, Cassie S, MacLean AR, et al. Postoperative complications following surgery for rectal cancer. Ann Surg 2010;251:807−18.
5. Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak. Ann Surg 2011;253:890−9.
6. Matthiessen P, Hallbook O, Andersson M, et al. Risk factors for anastomotic leakage after anterior resection of the rectum. Color Dis 2004;6:462−9.
7. Marusch F, Koch A, Schmidt U, et al. Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum 2002;45:1164−71.
8. Gastinger I, Marusch F, Steinert R, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 2005;92:1137−42.
9. Hűser N, Michalski CW, Erkan M, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 2008;248:52−60.
10. Jafari MD, Halabi WJ, Jafari F, et al. Morbidity of diverting ileostomy for rectal cancer: analysis of the American College of Surgeons National Surgical Quality Improvement Program. Ann Surg 2013;79:1034−9.
11. Hanna MH, Vinci A, Pigazzi A. Diverting ileostomy in colorectal surgery: when is it necessary? Langengecks Arch Surg 2015;400:145−52.
12. Nastro P, Knowles CH, McGrath A, et al. Complications of intestinal stomas. Br J Surg 2010;97:1885−9.
13. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicenter, randomised controlled trial. Lancet 2005;305:1718−26.
14. Abraham NS, Young JM, Solomon MJ. Meta-analysis of short term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 2004;91:1111−24.
15. Janson M, Lindholm E, Anderberg B, et al. Randomized trial of health-related quality of life after open and laparoscopic surgery for colon cancer. Surg Endosc 2007;21:747−53.
16. Ihnát P, Martínek L, Mitták M, et al. Quality of life after laparoscopic and open resection of colorectal cancer. Dig Surg 2014;31:161−8.
17. Floodeen H, Linggren R, Matthiessen P. When are defunctioning stomas in rectal cancer surgery really reversed? Results from a population-based single center experience. Scand J Surg 2013;102:246−50.
18. Seo SI, Yu CS, Kim GS, et al. The role of diverting stoma after an ultra-low anterior resection for rectal cancer. Ann Coloproctol 2013;29:66−71.
19. Poon RT, Chu KW, Ho JW, et al. Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg 1999;23:463−7.
20. Nurkin S, Kakarla VR, Ruiz DE, et al. The role of faecal diversion in low rectal cancer: a review of 1791 patients having rectal resection with anastomosis for cancer, with and without a proximal stoma. Color Dis 2013;15:e309−e316.
21. Leester B, Asztalos I, Polnyib C. Septic complications after low anterior rectal resection – is diverting stoma still justified? Acta Chir Iugosl 2002;49:67−71.
22. Rullier E, Laurent C, Garrelon JL, et al. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998;85:355−8.
23. Wong NY, Eu KW. A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 2005;48:2076−9.
24. Montedori A, Cirocchi R, Farinella E, et al. Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database of Syst Rev 2010; DOI:10.1002/14651858,(5):CD006878.
25. Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum 1998;41:1562−72.
26. Harris DA, Egbeare D, Jones S, et al. Complications and mortality following stoma formation. Ann R Coll Surg Engl 2005;87:427−31.
27. Ihnát P, Guňková P, Peteja M, et al. Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc 2016;30:4809−16.
28. Gessler B, Haglind E, Angenete E. Loop ileostomies in colorectal cancer patients – morbidity and risk factors for nonreversal. J Surg Res 2012;178:708−14.
29. Åkesson O, Syk I, Lindmark G, et al. Morbidity related to defunctioning loop ileostomy in low anterior resection. Int J Colorectal Dis 2012;27:1619−23.
30. Robertson I, Leung E, Hughes D, et al. Prospective analysis of soma-related complications. Color Dis 2005;7:279−85.
31. Ihnát P, Vávra P, Guňková P, et al. 3D high resolution anorectal manometry in functional anorectal evaluation. Rozhl Chir 2014;93:524−9.
32. Waterland P, Goonetilleke K, Naumann DN, et al. Defunctioning ileostomy reversal rates and reasons for delayed reversal: does delay impact on complications of ileostomy reversal? A study of 170 defunctioning ileostomies. J Clin Med Res 2015;7:685−9.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
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