澳大利亚和新西兰在直肠肿瘤手术后行预防性回肠造口术的现状：澳大利亚和新西兰结直肠肿瘤联合登记处分析。
Current practice in Australia and New Zealand for defunctioning ileostomy after rectal cancer surgery with anastomosis: Analysis of the Binational Colorectal Cancer Audit.
机构信息
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Faculty of Medical Sciences, Leiden University, Leiden, The Netherlands.
出版信息
Colorectal Dis. 2021 Jun;23(6):1421-1433. doi: 10.1111/codi.15607. Epub 2021 Mar 18.
AIM
This study aimed to investigate the use of defunctioning stomas after rectal cancer surgery in Australia and New Zealand, as current practice is unknown.
METHODS
From the Binational Colorectal Cancer Audit database, data on rectal cancer patients who underwent a resection between 2007 and 2019 with the formation of an anastomosis were extracted and analysed. The primary outcome was the rate of defunctioning stoma formation. Secondary outcomes were anastomotic leakage (AL) rates and other postoperative complications, length of hospital stay (LOS), readmissions and 30-day mortality rates between stoma and no-stoma groups. Propensity score matching was performed to correct for differences in baseline characteristics between stoma and no-stoma groups.
RESULTS
In total, 2581 (89%) received a defunctioning stoma and 319 (11%) did not. There were more male patients in the stoma group (65.5% vs. 57.7% for the no-stoma group; P = 0.006). The median age was 64 years in both groups. The stoma group underwent more ultra-low anterior resections (79.9% vs. 30.1%; P < 0.0001), included more American Joint Committee on Cancer Stage III patients (53.7% vs. 29.2%; P < 0.0001) and received more neoadjuvant therapy (66.9% vs. 16.3%; P < 0.0001). The AL rate was similar in both groups (5.1% vs. 6.0%; P = 0.52). LOS was longer in the stoma group (8 vs. 6 days; P < 0.0001) with higher 30-day readmission rates (14.9% vs. 8.3%; P = 0.003). After propensity score matching (n = 208 in both groups), AL rates remained similar (2.9% for stoma vs. 5.8% for no-stoma group; P = 0.15), but stoma patients required less reoperations (0% vs. 8%; P = 0.016). The stoma group had higher postoperative ileus rates and an increased LOS.
CONCLUSION
In Australia and New Zealand, most patients who underwent rectal cancer resections with the formation of an anastomosis received a defunctioning stoma. A defunctioning stoma does not prevent AL from occurring but is mostly associated with a lower reoperation rate. Patients with a defunctioning stoma experienced a higher postoperative ileus rate and had an increased LOS.
目的
本研究旨在调查澳大利亚和新西兰直肠癌手术后使用预防性造口术的情况，因为目前对此类手术的实际操作情况尚不清楚。
方法
从两国结直肠肿瘤登记处数据库中提取并分析了 2007 年至 2019 年间接受直肠切除术且吻合口形成的直肠癌患者的数据。主要结局为预防性造口术的形成率。次要结局为吻合口漏（AL）发生率和其他术后并发症、住院时间（LOS）、再入院率和 30 天死亡率。采用倾向评分匹配校正造口组和非造口组之间的基线特征差异。
结果
共有 2581 例（89%）患者接受了预防性造口术，319 例（11%）未接受。造口组中男性患者比例（65.5% vs. 57.7%）多于非造口组（P=0.006）。两组患者的中位年龄均为 64 岁。造口组接受超低位前切除术的比例（79.9% vs. 30.1%）更高（P<0.0001），美国癌症联合委员会（AJCC）分期为 III 期的患者比例（53.7% vs. 29.2%）更高（P<0.0001），接受新辅助治疗的比例（66.9% vs. 16.3%）更高（P<0.0001）。两组的 AL 发生率相似（5.1% vs. 6.0%；P=0.52）。造口组的 LOS 更长（8 天 vs. 6 天；P<0.0001），30 天再入院率更高（14.9% vs. 8.3%；P=0.003）。经倾向评分匹配（每组 n=208）后，AL 发生率仍相似（造口组为 2.9%，非造口组为 5.8%；P=0.15），但造口组需要再次手术的比例更低（0% vs. 8%；P=0.016）。造口组术后发生肠梗阻的比例更高，LOS 也更长。
结论
在澳大利亚和新西兰，大多数接受直肠吻合术的直肠癌患者都接受了预防性造口术。预防性造口术并不能预防 AL 的发生，但与较低的再次手术率有关。接受预防性造口术的患者术后肠梗阻发生率较高，LOS 也较长。
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