Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, PO Box 7057, 1000 SN, Amsterdam, The Netherlands.
Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Tech Coloproctol. 2022 Feb;26(2):99-108. doi: 10.1007/s10151-021-02543-3. Epub 2021 Nov 26.
The aim of this study was to analyze the stoma-related reinterventions, complications and readmissions after an anterior resection for rectal cancer, based on a cross-sectional nationwide cohort study with 3-year follow-up.
Rectal cancer patients who underwent a resection with either a functional anastomosis, a defunctioned anastomosis, or Hartmann's procedure (HP) with an end colostomy in 2011 in 71 Dutch hospitals were included. The primary outcome was number of stoma-related reinterventions.
Of the 2095 patients with rectal cancer, 1400 patients received an anterior resection and were included in this study; 257 received an initially functional anastomosis, 741 a defunctioned anastomosis, and 402 patients a HP. Of the 1400 included patients, 62% were males, 38% were females and the mean age was 67 years (SD 11.1). Following a primary functional anastomosis, 48 (19%) patients received a secondary stoma. Stoma-related complications occurred in six (2%) patients, requiring reintervention in one (0.4%) case. In the defunctioned anastomosis group, stoma-related complications were present in 92 (12%) patients, and required reintervention in 23 (3%) patients, in 10 (1%) of these more than 1 year after initial resection. Stoma-related complications occurred in 92 (23%) patients after a HP, and required reintervention in 39 (10%) patients in 17 (4%) of cases more than 1 year after initial resection. The permanent stoma rate was 11% and 20%, in the functional anastomosis and the defuctioned anastomosis group, respectively. The end colostomy in the HP group was reversed in 4% of cases.
Construction of a stoma after resection for rectal cancer with preservation of the sphincter is accompanied with long-term stoma-related morbidity. Stoma complications are more frequent after a HP. Even after 1 year, a significant number of reinterventions are required.
本研究旨在基于一项为期 3 年的全国性队列研究，分析直肠癌前切除术后与造口相关的再干预、并发症和再入院情况。
纳入 2011 年在 71 家荷兰医院接受直肠切除术的患者，包括行功能吻合术、预防性造口术或Hartmann 术（HP）加末端结肠造口术的患者。主要结局是与造口相关的再干预数量。
2095 例直肠癌患者中，有 1400 例接受了前切除术并纳入本研究；257 例患者行初始功能吻合术，741 例行预防性造口术，402 例行 HP。在纳入的 1400 例患者中，62%为男性，38%为女性，平均年龄为 67 岁（SD 11.1）。行初始功能吻合术的患者中，有 48 例（19%）患者需要行二次造口术。6 例（2%）患者发生与造口相关的并发症，其中 1 例（0.4%）需要再次干预。在预防性造口术组，92 例（12%）患者发生与造口相关的并发症，23 例（3%）需要再次干预，其中 10 例（1%）在初次切除 1 年后以上需要再次干预。行 HP 的患者中，92 例（23%）患者发生与造口相关的并发症，39 例（10%）需要再次干预，其中 17 例（4%）在初次切除 1 年后以上需要再次干预。功能吻合术组和预防性造口术组的永久性造口率分别为 11%和 20%。HP 组的末端结肠造口有 4%被反转。
保留括约肌的直肠癌切除术后行造口术会导致长期造口相关发病率。HP 后造口并发症更为常见。即使在 1 年后，仍需要大量的再干预。
