Brown Shaun R, Khan Behram, Green Heather J, Beck David E
Department of Colon and Rectal Surgery, William Beaumont Medical Center, El Paso, TX.
Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA.
Ochsner J. 2017 Winter;17(4):328-330.
A diverting loop ileostomy is commonly constructed to protect a distal anastomosis after proctectomy for rectal cancer. Little data are available on whether closing the ileostomy before or after adjuvant chemotherapy affects survival.
We conducted a retrospective review of patients with rectal cancer who underwent a low anterior resection with diverting loop ileostomy followed by adjuvant chemotherapy at Ochsner Medical Center. The primary outcome was the long-term survival in patients who had their loop ileostomies closed before chemotherapy (BC) vs after chemotherapy (AC).
Seventy-two patients were identified (22 in the BC group vs 50 in the AC group). No difference in mean age (BC 59.5 ± 9.8 vs AC 59.2 ± 12.6, =0.9) or preoperative clinical stage was seen between study groups. The mean interval from ileostomy creation to closure was significantly shorter in the BC group vs AC group (16.9 ± 14.5 weeks vs 33.6 ± 18.1 weeks, =0.0001). Follow-up data revealed a similar mean duration from surgery to last contact (BC 50.6 ± 23.6 months vs AC 43.5 ± 22.1 months, =0.23) and similar overall survival (BC 86% vs AC 70%, =0.23) between groups.
Long-term survival was similar in patients who underwent ileostomy closure before and after adjuvant therapy following low anterior resection for rectal cancer. While this study was underpowered, it adds additional insight to an area of surgery lacking significant data. The timing of ileostomy closure should be individualized for each patient.
直肠癌直肠切除术后，通常会构建一个转流性回肠造口以保护远端吻合口。关于辅助化疗前或后关闭回肠造口是否会影响生存率，目前可用数据较少。
我们对在奥施纳医疗中心接受低位前切除术并伴有转流性回肠造口，随后接受辅助化疗的直肠癌患者进行了回顾性研究。主要结局是化疗前（BC）与化疗后（AC）关闭回肠造口的患者的长期生存率。
共纳入72例患者（BC组22例，AC组50例）。研究组之间的平均年龄（BC组59.5±9.8岁，AC组59.2±12.6岁，P = 0.9）或术前临床分期无差异。BC组回肠造口创建至关闭的平均间隔时间明显短于AC组（16.9±14.5周 vs 33.6±18.1周，P = 0.0001）。随访数据显示，两组从手术到最后一次接触的平均持续时间相似（BC组50.6±23.6个月，AC组43.5±22.1个月，P = 0.23），总体生存率也相似（BC组86%，AC组70%，P = 0.23）。
直肠癌低位前切除术后辅助治疗前和后接受回肠造口关闭的患者，长期生存率相似。虽然本研究的样本量不足，但它为这个缺乏大量数据的手术领域提供了更多见解。回肠造口关闭的时机应根据每位患者的情况个体化确定。
