Abstract
PurposeA substantial part (21–35%) of defunctioning stomas created during resection for colorectal cancer will never be reversed. Known risk factors for non-closure are age, peri- or postoperative complications, comorbidity, and tumor stage. However, studies performed to identify these risk factors mostly focus on rectal cancer and include both preoperative and postoperative factors. This study aims to identify preoperative risk factors for non-reversal of intended temporary stomas created during acute resection of left-sided obstructive colon cancer (LSOCC) with primary anastomosis.MethodsAll patients who underwent emergency resection for LSOCC with primary anastomosis and a defunctioning stoma between 2009 and 2016 were selected from the Dutch ColoRectal Audit, and additional data were collected in the local centers. Multivariable analysis was performed to identify independent preoperative factors for non-closure of the stoma.ResultsA total of 155 patients underwent acute resection for LSOCC with primary anastomosis and a defunctioning stoma. Of these, 51 patients (32.9%) did not have their stoma reversed after a median of 53 (range 7–104) months of follow-up. In multivariable analysis, hemoglobin < 7.5 mmol/L (odds ratio (OR) 4.79, 95% confidence interval (95% CI) 1.60–14.38, p = 0.005), estimated glomerular filtration rate (eGFR) ≤ 45 mL/min/1.73 m2 (OR 4.64, 95% CI 1.41–15.10, p = 0.011), and metastatic disease (OR 6.12, 95% CI 2.35–15.94, p < 0.001) revealed to be independent predictors of non-closure.ConclusionsAnemia, impaired renal function, and metastatic disease at presentation were found to be independent predictors for non-reversal of intended temporary stomas in patients who underwent acute resection for LSOCC. In patients who have an increased risk of non-reversal, the surgeon should consider a Hartmann’s procedure.
Highlights
Many patients who undergo resection for colorectal cancer, in particular those with severe comorbidities, neo-adjuvant chemoradiation, and/or low anastomosis, receive a defunctioning stoma to reduce the clinical consequences of anastomotic complications
This study aims to identify independent preoperative predictors for non-closure of an intended temporary defunctioning stoma that was constructed following emergency resection for a left-sided obstructive colon cancer (LSOCC) with primary anastomosis, in order to aid clinical decisionmaking and, in addition, to assist informing patients on their individual probability that their stoma could potentially be reversed in the future or not
155 patients underwent resection with construction of a primary anastomosis and defunctioning stoma (Fig. 1); a loop ileostomy was constructed in 117 patients (75.5%) and a loop colostomy in 38 patients (25%)
Summary
Many patients who undergo resection for colorectal cancer, in particular those with severe comorbidities, neo-adjuvant chemoradiation, and/or low anastomosis, receive a defunctioning stoma to reduce the clinical consequences of anastomotic complications. For patients with left-sided obstructive colon cancer, the various treatment modalities are available, including colonic stenting, diversion with a stoma only or “blowhole,” resection with end-colostomy, and resection with primary anastomosis with or without diverting stoma. In the case of resection with primary anastomosis and a diverting stoma, most of the stomas created in these circumstances are intended to be temporary; 21–35% of these stomas will never be reversed [2, 3]. Since end colostomies are associated with less serious complications, these stomas may be preferred in the subgroup of patients who have a high risk of non-closure
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