Haksal Mustafa, Okkabaz Nuri, Atici Ali Emre, Civil Osman, Ozdenkaya Yasar, Erdemir Ayhan, Aksakal Nihat, Oncel Mustafa
Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey.; Department of General Surgery, Medipol University Medical School, Istanbul, Turkey.
Department of General Surgery, Kartal Education and Research Hospital, Istanbul, Turkey.
Ann Surg Treat Res. 2017 Jan;92(1):35-41. doi: 10.4174/astr.2017.92.1.35. Epub 2016 Dec 30.
The current study aims to analyze the risk factors for the failure of ileostomy reversal after laparoscopic low anterior resection for rectal cancer.
All patients who underwent a laparoscopic low anterior resection for rectal cancer with a diverting ileostomy between 2007 and 2014 were abstracted. The patients who underwent and did not undergo a diverting ileostomy procedure were compared regarding patient, tumor, treatment related parameters, and survival.
Among 160 (103 males [64.4%], mean [± standard deviation] age was 58.1 ± 11.9 years) patients, stoma reversal was achieved in 136 cases (85%). Anastomotic stricture (n = 13, 52.4%) was the most common reason for stoma reversal. These were the risk factors for the failure of stoma reversal: Male sex (P = 0.035), having complications (P = 0.01), particularly an anastomotic leak (P < 0.001), or surgical site infection (P = 0.019) especially evisceration (P = 0.011), requirement for reoperation (P = 0.003) and longer hospital stay (P = 0.004). Multivariate analysis revealed that male sex (odds ratio [OR], 7.82; P = 0.022) and additional organ resection (OR, 6.71; P = 0.027) were the risk factors. Five-year survival rates were similar (P = 0.143).
Fifteen percent of patients cannot receive a stoma reversal after laparoscopic low anterior resection for rectal cancer. Anastomotic stricture is the most common reason for the failure of stoma takedown. Having complications, particularly an anastomotic leak and the necessity of reoperation, limits the stoma closure rate. Male sex and additional organ resection are the risk factors for the failure in multivariate analyses. These patients require a longer hospitalization period, but have similar survival rates as those who receive stoma closure procedure.
本研究旨在分析直肠癌腹腔镜低位前切除术后回肠造口还纳失败的危险因素。
选取2007年至2014年间接受直肠癌腹腔镜低位前切除并进行转流性回肠造口术的所有患者。比较接受和未接受转流性回肠造口术患者的患者、肿瘤、治疗相关参数及生存情况。
160例患者（103例男性[64.4%]，平均[±标准差]年龄为58.1±11.9岁）中，136例（85%）成功进行了造口还纳。吻合口狭窄（n = 13，52.4%）是造口还纳失败最常见的原因。以下是造口还纳失败的危险因素：男性（P = 0.035）、出现并发症（P = 0.01），尤其是吻合口漏（P < 0.001）或手术部位感染（P = 0.019），特别是脏器脱出（P = 0.011）、需要再次手术（P = 0.003）以及住院时间较长（P = 0.004）。多因素分析显示，男性（比值比[OR]，7.82；P = 0.022）和额外器官切除（OR，6.71；P = 0.027）是危险因素。5年生存率相似（P = 0.143）。
15%的患者在直肠癌腹腔镜低位前切除术后无法进行造口还纳。吻合口狭窄是造口拆除失败最常见的原因。出现并发症，尤其是吻合口漏和再次手术的必要性，限制了造口关闭率。在多因素分析中，男性和额外器官切除是失败的危险因素。这些患者需要更长的住院时间，但生存率与接受造口关闭手术的患者相似。
