Stoma In Low Anterior Resection Research Articles

Clinical control study of defunctioning and non-defuncioning stoma in low anterior resection for rectal cancer

Objective To compare the clinical data and postoperative complications between defunctioning stoma and non-defunctioning stoma in laparoscopic low anterior resection for rectal carcinoma, and study the clinical significance of non-defunctioning stoma. Methods The clinical data of 70 cases who accepted laparoscopic low anterior resection was collected. According to the operative methods, all patients were divided into two groups, defu ctioning stoma group included 42 cases and non-defunctioning stoma group induded 28 cases. The situation of postoper rative complications of patients boh two groups were compared by SPSS 19.0. Results The operation time, bleeding volume, eating time in defunctioning stoma groups and non-defunctioning stoma groups were no statistical significant.The time staying in hospital in defunctioning stoma groups was longer than that of non-defunctioning stoma groups(P<0.05). defunctioning stoma groups, anastomotic leakages happened in 2 case, anastomotic hemorrhage in 1 case, incision complications in 2 cases, anastomotic strictures in 8 cases, stoma complications in 1 case. The total morbidity was 28.5%.In non-defunctioning stoma group anastomotic leakages happened in 1 case, anastomotic hemorrhage happened in 1 case, incision complications happened in 1 case, internal complications happened in 1 case.The postoperative morbidity was 17.8%. The total complications had significant difference in the two groups(P<0.05). The anastomotic leakage and hemorrhage in two groups had no difference significantly. Conclusion Defunctioning stoma with no indication can not decrease the complication in laparoscopic low anterior resection for rectal cancer case. Key words: Rectal neoplasms; Laparoscopes; Ostomy; Postoperative complications; Low anterior resection

P-378 - Impact of diverting stoma in low anterior resection for rectal cancer on short-term surgical outcomes and reoperation

Introduction: The purpose of this study was to evaluate whether Protective diverting stoma after anterior resection of Dixon for rectal cancer has a significant impact on short-term surgical outcomes. Methods: All patients with rectal carcinoma referred to our surgical oncology department, south Egypt Cancer Institute for surgical management between July 2009, and July 2016, were involved in the study. 203 consecutive patients who underwent anterior resection for rectal cancer with or without diverting stoma were recruited from our retrospective database. The 61 patients who had diverting stoma were compared with the remaining 142 patients who did not have diverting stoma. Demographic, clinical, operative and short surgical outcomes were reviewed. Results: Sixty -one (32.3%) of 203 patients underwent temporary diverting stoma after anterior resection of Dixon for rectal cancer, the overall complications rate was 34.5%.The clinico -pathological features of patients who had a diverting stoma and those without stoma had no significant difference regarding similar as regard the age, gender, body mass index, medical co-morbidities, and tumor stage (P = >0.2). More patients in the stoma group have received a preoperative noeadjuvant therapy (P = >0.046).The operative critics between the 2 groups showed no significant difference in surgical approach, intraoperative contamination or way of anastomosis. Post-operatively, the overall complications rate was 34.5%. The stoma group had a statistically significant lower rate of complications compared to patients without stoma (21.3% vs 38.7,P=0.023).Significant differences were noted in postoperative ileus (P = 0.03), pneumonia (P = 0.03), surgical site infection (P = 0.05), reoperation (P = 0.04), and length of hospital stay, (P = 0.001). There was no significant statistical difference in incidence of thromboembolic disorders (P = 0.52), anastomotic leaks (P = 0.07) or hospital mortality (P = 0.07) but there is a significant difference in ICU admission (P = 0.05). Conclusion: The diverting stoma after anterior resection for rectal cancer significantly decreased postoperative complications and need for reoperation. So, its protective role was well established.

Costs and resource use following defunctioning stoma in low anterior resection for cancer – A long-term analysis of a randomized multicenter trial

BackgroundDefunctioning stoma in low anterior resection (LAR) for rectal cancer can prevent major complications, but overall cost-effectiveness for the healthcare provider is unknown. This study compared inpatient healthcare resources and costs within 5 years of LAR between two randomized groups of patients undergoing LAR with and without defunctioning stoma. MethodFive-year follow-up of a randomized, multicenter trial on LAR (NCT 00636948) with (stoma; n = 116) or without (no stoma; n = 118) defunctioning stoma comparing inpatient healthcare resources and costs. Unplanned stoma formation, days with stoma, length of hospital stay, reoperations, and total associated inpatient costs were analyzed. ResultsAverage costs were € 21.663 per patient with defunctioning stoma and € 15.922 per patient without defunctioning stoma within 5 years of LAR, resulting in an average cost-saving of € 5.741. There was no difference between groups regarding the total number of days with any stoma (stoma = 33 398 vs. no stoma = 34 068). The total number of unplanned reoperations were 70 (no stoma) and 32 (stoma); p < 0.001. In the group randomized to no stoma at LAR, 30.5% (36/118) required an unplanned stoma later. ConclusionRandomization to defunctioning stoma in LAR was more expensive than no stoma, despite the cost-savings associated with a reduced frequency of anastomotic leakage. Both groups required the same total number of days with a stoma within five years of LAR.

Low anterior resection combined with a covering stoma in the treatment of rectal cancer reduces the risk of permanent anastomotic failure.

The adoption of the total mesorectum excision technique and circular stapler devices has enabled the performance of ultralow colorectal anastomosis in rectal cancer surgery. However, rupture of the anastomosis still usually leads to a permanent stoma. The aim of this study was to analyze the cumulative failure rate and risk factors associated with reversal of colorectal or coloanal anastomosis after sphincter-saving surgery for rectal cancer, using standardized surgical regimen with the routine use of covering stoma. Our secondary interest was the feasibilities of redo surgery after failure. This was a retrospective study with 579 consecutive rectal cancer patients operated on at Helsinki University Hospital, Helsinki, Finland during 2005-2011. Data were collected from patient records. After exclusions, 273 consecutive patients treated with a low anterior resection with a protective stoma were included. In total, 23 out of 271 (8.5 %) of the colorectal/coloanal anastomoses were converted to a permanent stoma. In five patients (1.8 %), the covering stoma was not closed. The permanent stoma rate was thus 28 out of 271 (10.3 %). The risk factors associated with failure were the tumor distance from the anal verge (p = 0.03), coloanal anastomosis (p = 0.003), early anastomotic complication (p < 0.001), anastomotic fistula (p < 0.001), anal incontinence (p = 0.05), and local recurrence (p < 0.001). Our standardized surgical regimen with a covering stoma in low anterior resection for rectal cancer resulted in a minor anastomosis failure rate and a low risk of permanent stoma.

Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies.

BackgroundRecent studies have shown that a protective stoma can reduce morbidity in low anterior resection for rectal cancer; however, the necessity of it is still controversially discussed.MethodsWe performed this meta-analysis to provide a comprehensive evaluation of the role of defunctioning stoma in low anterior resection for rectal cancer on the rates of anastomotic leakage and reoperation related to leakage with or without defunctioning stoma by calculating the pooled risk ratio.ResultsStudies and relevant literature published between 2004 and 2014 regarding the construction of a protective stoma after low anterior resection were searched though PubMed and EMBASE databases. Finally, a total of 13 studies including 8,002 patients were included in this meta-analysis. The results indicated that protective stomas significantly reduced the rate of postoperative anastomotic leakage and reoperation after low anterior rectal resection. The pooled risk ratios were 0.47 (95% CI: 0.33–0.68, P <0.0001) and 0.36 (95% CI: 028–0.46, P <0.00001), respectively.ConclusionsThe findings from this present meta-analysis suggest that a defunctioning stoma could effectively reduce the clinical consequences of anastomotic leakage and reoperation, it is recommended in patients undergoing low rectal anterior resection for rectal cancer.

Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis.

To provide a comprehensive evaluation of the role of a protective stoma in low anterior resection (LAR) for rectal cancer. The PubMed, EMBASE, and MEDLINE databases were searched for studies and relevant literature published between 2007 and 2014 regarding the construction of a protective stoma during LAR. A pooled risk ratio (RR) with 95% confidence intervals (CIs) was used to assess the outcomes of the studies, including the rate of postoperative anastomotic leakage and reoperations related to leakage. Funnel plots and Egger's tests were used to evaluate the publication biases of the studies. P values < 0.05 were considered statistically significant. A total of 11 studies were included in the meta-analysis. In total, 5612 patients were examined, 2868 of whom had a protective stoma and 2744 of whom did not. The sample size of the studies varied from 34 to 1912 patients. All studies reported the number of patients who developed an anastomotic leakage and required a reoperation related to leakage. A random effects model was used to calculate the pooled RR with the corresponding 95%CI because obvious heterogeneity was observed among the 11 studies (I (2) = 77%). The results indicated that the creation of a protective stoma during LAR significantly reduces the rate of anastomotic leakage and the number of reoperations related to leakage, with pooled RRs of 0.38 (95%CI: 0.30-0.48, P < 0.00001) and 0.37 (95%CI: 0.29-0.48, P < 0.00001), respectively. The shape of the funnel plot did not reveal any evidence of obvious asymmetry. The presence of a protective stoma effectively decreased the incidences of anastomotic leakage and reoperation and is recommended in patients undergoing low rectal anterior resections for rectal cancer.

Necessity of defunctioning stoma in low anterior resection for rectal cancer: a meta-analysis

To evaluate the necessity of defunctioning stoma in low anterior resection for rectal cancer below peritoneal reflection. The databases of Medline, Embase, Cochrane Library, Wanfang and CNKI were searched. The eligible studies were identified for pooled analyses. Six randomized controlled trials with 648 cases(332 patients with defunctioning stoma and 316 without stoma) and 25 retrospective controlled trials with 10,722 cases(4,470 patients with defunctioning stoma and 6,252 without stoma) were included. Combined analyses showed that defunctioning stoma was effective for decreasing risk of postoperative anastomotic leakage (RR=0.33 and 95% CI:0.21-0.53 for RCTs, OR=0.60 and 95% CI:0.42-0.85 for retrospective studies), reoperation (RR=0.30, 95% CI:0.16-0.53 for RCTs, OR=0.26 and 95% CI:0.21-0.32 for retrospective studies) and mortality(OR=0.41, 95% CI:0.27-0.62 for retrospective studies). Defunctioning stoma should be routinely performed in low anterior resection for high-risk patients.

Defunctioning Stoma in Low Anterior Resection for Rectal Cancer: A Meta-Analysis of Five Recent Studies

The necessity of a defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer remains controversial. This meta-analysis evaluates the advantages of prophylactic stomas in patients undergoing low anterior resection and assesses postoperative outcomes of patients with or without a defunctioning stoma. Studies and relevant literatures regarding the formation of defunctioning stomas after low anterior resection were searched through PubMed and Embase. The rates of anastomotic leakage and re-operation related to leakage with or without defunctioning stoma were pooled and compared using a meta-analysis. The risk ratios were calculated with 95% confidence intervals to evaluate the influence of defunctioning stomas. Five recent studies including 878 patients in total were included in this meta-analysis. These studies demonstrated that defunctioning stomas significantly reduced the rate of postoperative anastomotic leakage and reoperation after low anterior resection, the pooled risk ratio was 0.34 (95% CI=0.22-0.53, p<0.00001) and 0.27 (95% CI=0.16-0.48, p<0.00001), respectively. Defunctioning stomas can be useful to minimize the rate of anastomotic leakage and re-operation related to leakage. Furthermore, anorectal function was not affected. However, the influence of a defunctioning stoma on long-term mortality and the quality of life in patients treated for rectal cancer is inconclusive.

The indications for a diverting stoma in low anterior resection for rectal cancer: a prospective multicentre study of 222 patients from Japanese cancer centers

The aim of the study was to determine the present state of diverting stoma construction in Japanese cancer centres and to investigate the relationship between symptomatic leakage and diverting stoma after low anterior resection for rectal cancer. Two hundred and twenty-two consecutive patients undergoing low anterior resection for rectal cancer located within 10 cm from the anal verge were investigated in a prospective, multicenter study. The overall leakage rate was 9.0% (20/222). Of 31 cases with an anastomosis within 2.0 cm from the anal verge, 22 (71%) had a diverting stoma. Of cases anastomosed within 5.0 cm, the absence of a diverting stoma and tumour size were significantly related to an increased rate of leakage [leakage in 13 (12.7%) of 102 cases without a diverting stoma; in three (3.8%) of 80 cases with a diverting stoma]. Among anastomoses within 2.0 cm from the anal verge, leakage occurred in four (44.4%) of nine cases without and in none (0%) of 22 cases with a diverting stoma. We recommend a diverting stoma for an anastomosis within 5.0 cm of the anal verge and strongly recommend it for a very low anastomosis within 2.0 cm.

Covering ileo- or colostomy in anterior resection for rectal carcinoma

Anastomotic leakage is one of the most important complications that occur after surgical low anterior resection for rectal cancer. There are indications that anastomotic leak is associated with increased morbidity, mortality, frequent re-operation or radiological drainage, and prolonged hospital stay. Defunctioning stoma can be useful for patients undergoing a rectal surgery. To determine the efficacy of protective defunctioning stoma in low anterior resection for rectal carcinoma. Searches were conducted November 2009. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1966) and EMBASE (from 1980). We included randomised clinical trials comparing the use of stoma versus "no stoma" in patients that received low anterior resection for rectal cancer. Six randomised controlled trials were identified and included in this review. Five trials were fully published in peer-reviewed journals. An attempt was made to obtain further information from the authors of the trial that was available only in an abstract form. The studies analysed the following outcomes: clinical anastomotic leakage, urgent reoperation, mortality and length of postoperative hospital stay. Review authors extracted the data independently, the risk ratios (RR) were estimated for the dichotomous outcomes and standardised mean difference were estimated for the continuous outcome All the trials reported results for clinical anastomotic leakage, urgent reoperation and mortality. Only two trials reported the results for length of postoperative hospital stay.With respect to controls, use of covering stoma was significantly associated with less anastomotic leakage (RR 0.33; 95%CI [0.21, 0.53]) and less urgent reoperation (RR 0.23; 95%CI [0.12, 0.42] ). There was no significant difference in terms of mortality (RR 0.58; 95%CI [0.14, 2.33]). There was no evidence of statistical heterogeneity in any of the comparisons. Covering stoma seems to be useful to prevent anastomotic leakage and urgent re-operations in patients receiving low anterior resection for rectal cancer. However, covering stoma does not seems to offer advantage in term of 30 days or long term mortality.

Meta-analysis of selective defunctioning stoma in low anterior resection

Whether selective defunctioning stoma could reduce the rate of anastomotic leak and lessen adverse effects in low anterior resection (LAR) remains controversial. This study was to evaluate the necessity of selective defunctioning stoma after LAR. Medline databases were searched and English-language articles regarding to selective defunctioning stoma in LAR published from January 1, 1990 to October 1, 2007 were acquired. Seven literatures from seven different studies were included in this study, with total enrollment of 5040 patient. The rate of anastomotic leakage and re-operation rate in different surgical procedures (with or without selective defunctioning stoma) were pooled to compare using meta-analysis. Selective defunctioning stoma did not significantly reduce the rate of anastomotic leakage after LAR. The pooled odds ratio (OR) was 0.68 (95%CI=0.45-1.02, P>0.05). Selective defunctioning stoma significantly reduced the rate of surgery-required anastomotic leakage following LAR. The pooled OR was 0.33(95% CI=0.25-0.44, P<0.01). Although selective defunctioning stoma does not reduce the rate of anastomotic leakage, it reduces the rate of surgery-required anastomotic leakage.