Department of General Surgery, The University of Texas Health Science Center, Houston, TX, USA.
Ann Surg Oncol. 2014 Feb;21(2):507-12. doi: 10.1245/s10434-013-3287-9. Epub 2013 Oct 2.
Radical resection is the primary treatment for rectal cancer. When anastomosis is possible, a temporary ileostomy is used to decrease morbidity from a poorly healed anastomosis. However, ileostomies are associated with complications, dehydration, and need for a second operation. We sought to evaluate the impact of ileostomy-related complications on the treatment of rectal cancer.
We conducted a retrospective study of patients who underwent sphincter-preserving surgery between January 2005 and December 2010 at a tertiary cancer center. The primary outcome was the overall rate of ileostomy-related complications. Secondary outcomes included complications related to ileostomy status, ileostomy closure, anastomotic complications at primary resection, rate of stoma closure, and completion of adjuvant chemotherapy assessed by multivariate logistic regression.
Of 294 patients analyzed, 32% (n = 95) were women. Two hundred seventy-one (92%) received neoadjuvant chemoradiation. The median tumor distance from the anal verge was 7 cm (interquartile range 5-10 cm). Two hundred eighty-one (96%) underwent stoma closure at a median of 7 months (interquartile range 5.4-8.3 months). The most common complication related to readmission was dehydration (n = 32-11%). Readmission within 60 days of primary resection was associated with delay in initiating adjuvant chemotherapy (odds ratio 3.01, 95% confidence interval 1.42-6.38, p = 0.004).
Diverting ileostomies created during surgical treatment of rectal cancers are associated with morbidity; however, this is balanced against the risk of anastomosis-related morbidity at rectal resection. Given the potential benefit of fecal diversion, patient-oriented interventions to improve ostomy management, particularly during adjuvant chemotherapy, can be expected to yield marked benefits.
根治性切除术是直肠癌的主要治疗方法。当吻合可行时，采用临时肠造口术来降低吻合口愈合不良的发病率。然而，肠造口术与并发症、脱水和需要二次手术有关。我们试图评估肠造口相关并发症对直肠癌治疗的影响。
我们对 2005 年 1 月至 2010 年 12 月在一家三级癌症中心接受保肛手术的患者进行了回顾性研究。主要结局是肠造口相关并发症的总体发生率。次要结局包括与肠造口状态相关的并发症、肠造口关闭、初次切除吻合口并发症、造口关闭率和通过多变量逻辑回归评估的辅助化疗完成率。
在分析的 294 例患者中，32%（n=95）为女性。271 例（92%）接受了新辅助放化疗。肿瘤距肛门缘的中位数为 7cm（四分位距 5-10cm）。281 例（96%）在中位数为 7 个月（四分位距 5.4-8.3 个月）时进行了造口关闭。与再次入院相关的最常见并发症是脱水（n=32-11%）。初次切除后 60 天内再次入院与辅助化疗启动延迟相关（比值比 3.01，95%置信区间 1.42-6.38，p=0.004）。
在直肠癌手术治疗过程中创建的转流性肠造口术与发病率相关；然而，这与直肠切除吻合口相关发病率的风险相平衡。鉴于粪便转流的潜在益处，可以预期以患者为导向的干预措施，特别是在辅助化疗期间，改善造口管理，将带来显著的益处。
