Department of Surgery, Gelderse Vallei Hospital, P.O. Box 9025, 6710 HN, Ede, The Netherlands.
Department of Finance, Gelderse Vallei Hospital, Ede, The Netherlands.
Tech Coloproctol. 2021 Oct;25(10):1133-1141. doi: 10.1007/s10151-021-02498-5. Epub 2021 Jul 22.
The role of diverting ileostomy is debated in rectal cancer surgery with primary anastomosis. The aim of this study was to evaluate the associated morbidity and hospital costs of diversion after sphincter saving TaTME surgery.
All patients undergoing TaTME with primary anastomosis for rectal cancer between January 2012 and December 2019 in a single centre in the Netherlands were included. Patients with diverting ileostomy creation during primary surgery were compared with those without ileostomy. Outcomes included length of hospital stay, anastomotic leakage rates and total hospital costs at 1 year.
One hundred and one patients were included in the ileostomy group, and 46 patients were in the non-ileostomy group. The number of female patients was 31 (30.7%) in the ileostomy group and 21 (45.7%) in the non-ileostomy group Mean age was 64.5 ± 11.1 years in the ileostomy group and 62.6 ± 10.7 years in the non-ileostomy group The anastomotic leakage rate was 21.7% in the non-ileostomy group and 15.8% in the ileostomy group (p = 0.385). The grade of leakage and number of anastomotic takedowns did not differ between groups. Mean costs at 1 year after surgery was €26,500.13 in the ileostomy group and €16,852.61 in the non-ileostomy group. The main cost driver was longer total length of hospital stay at 1 year (mean 12.4 ± 13.3 days vs 20.6 ± 12.6 days, p = 0.000).
Morbidity and associated costs after diverting ileostomy are high. The incidence and morbidity of anastomotic leakage was not reduced by creation of an ileostomy. Omission of a diverting ileostomy after TaTME could possibly result in a reduction in treatment associated morbidity and costs.
在直肠肿瘤手术中，保肛吻合术与预防性回肠造口术的作用存在争议。本研究旨在评估经肛门全直肠系膜切除术（TaTME）保肛吻合术后预防性回肠造口术相关的发病率和住院费用。
纳入 2012 年 1 月至 2019 年 12 月在荷兰某单一中心行 TaTME 术并进行一期吻合的直肠肿瘤患者。将术中行预防性回肠造口术的患者与未行造口术的患者进行比较。主要结局为 1 年的住院时间、吻合口漏发生率和总住院费用。
101 例患者纳入造口组，46 例患者纳入非造口组。造口组中女性患者 31 例（30.7%），非造口组中女性患者 21 例（45.7%）。造口组平均年龄为 64.5±11.1 岁，非造口组为 62.6±10.7 岁。非造口组吻合口漏发生率为 21.7%，造口组为 15.8%（p=0.385）。两组吻合口漏的严重程度和吻合口修复次数无差异。术后 1 年的平均费用在造口组为 26500.13 欧元，在非造口组为 16852.61 欧元。主要的费用驱动因素是 1 年时总住院时间较长（平均 12.4±13.3 天 vs 20.6±12.6 天，p=0.000）。
预防性回肠造口术后的发病率和相关费用较高。预防性回肠造口术并不能降低吻合口漏的发生率和发病率。TaTME 术后省略预防性回肠造口术可能会降低治疗相关的发病率和费用。
