Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Int J Colorectal Dis. 2021 Jul;36(7):1433-1442. doi: 10.1007/s00384-021-03877-y. Epub 2021 Mar 17.
A defunctioning stoma reduces the risk of symptomatic anastomotic leakage after low anterior resection for rectal cancer and mitigates the consequences when a leakage occurs, but the impact on mortality and oncological outcomes is unclear. The aim was to investigate the associations of a defunctioning stoma with short- and long-term outcomes in patients undergoing low anterior resection for rectal cancer.
Data from all patients who underwent curative low anterior resection for rectal cancer between 1995 and 2010 were obtained from the Swedish Colorectal Cancer Register. A total of 4130 patients, including 2563 with and 1567 without a defunctioning stoma, were studied. Flexible parametric models were used to estimate hazard ratios for all-cause mortality, 5-year local recurrence, and distant metastatic disease in relation to the use of defunctioning stoma, adjusting for confounding factors and accounting for potential time-dependent effects.
During a median follow-up of 8.3 years, a total of 2169 patients died. In multivariable analysis, a relative reduction in mortality was observed up to 6 months after surgery (hazard ratio = 0.82: 95% CI 0.67-0.99), but not thereafter. After 5 years of follow-up, 4.2% (173/4130) of the patients had a local recurrence registered and 17.9% (741/4130) had developed distant metastatic disease, without difference between patients with and without defunctioning stoma.
A defunctioning stoma is associated with a short-term reduction in all-cause mortality in patients undergoing low anterior resection for rectal cancer without any difference in long-term mortality and oncological outcomes, and should be considered as standard of care.
预防性造口术可降低低位前切除术治疗直肠癌后吻合口症状性漏的风险，并减轻漏发生时的后果，但对死亡率和肿瘤学结果的影响尚不清楚。本研究旨在探讨预防性造口术与接受低位前切除术治疗直肠癌患者的短期和长期结局的相关性。
从瑞典结直肠癌登记处获得了 1995 年至 2010 年间所有接受根治性低位前切除术治疗的直肠癌患者的数据。共纳入 4130 例患者，其中 2563 例接受了预防性造口术，1567 例未接受预防性造口术。使用灵活参数模型来估计全因死亡率、5 年局部复发和远处转移疾病的风险比，与预防性造口术的使用相关，调整混杂因素，并考虑潜在的时间依赖性效应。
在中位随访 8.3 年期间，共有 2169 例患者死亡。多变量分析显示，手术后 6 个月内死亡率相对降低（风险比=0.82：95%置信区间 0.67-0.99），但此后无差异。在 5 年随访期间，4.2%（173/4130）的患者记录到局部复发，17.9%（741/4130）的患者发生远处转移疾病，预防性造口术组和未行预防性造口术组之间无差异。
预防性造口术与接受低位前切除术治疗直肠癌患者的全因死亡率短期降低相关，与长期死亡率和肿瘤学结局无差异，应被视为标准治疗方法。
