Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China.
Langenbecks Arch Surg. 2022 Nov;407(7):2959-2967. doi: 10.1007/s00423-022-02589-3. Epub 2022 Jul 8.
Currently, the relationship between temporary stoma reversal and the severity of postoperative complications (POCs) after the index surgery based on the Clavien-Dindo classification has not yet been explored.
From July 2010 to June 2016, 380 patients undergoing sphincter-preserving surgery for rectal cancer with a temporary stoma in our hospital were included. Temporary stoma nonclosure rates, disease-free survival rates, and overall survival rates were estimated utilizing the Kaplan-Meier method.
Of all the 380 patients, primary stomas were created in 335 patients and secondary stomas in 45 patients. After the index surgery, 36.6% (139/380) of patients developed at least one postoperative complication. In the first analysis, which included all the patients, 24.7% of temporary stomas remained unclosed. In the second analysis for 335 patients with a primary stoma, 23.3% were left with unclosed stomas. After the COX regression analysis, both major POCs and minor POCs were found to be independent risk factors for the permanent stoma, and there was an increasing tendency toward the risk of permanent stoma with the increase in POC severity.
POCs are independent predictors of permanent stoma after rectal cancer surgery. Even minor POCs may affect the outcome, while there is a clear direct relationship between POC severity and permanent stoma rates.
目前，基于 Clavien-Dindo 分级的索引手术后临时造口还纳与术后并发症（POC）严重程度之间的关系尚未得到探索。
从 2010 年 7 月至 2016 年 6 月，我院收治了 380 例接受保肛手术治疗直肠癌且有临时造口的患者。利用 Kaplan-Meier 法估计临时造口未闭率、无病生存率和总生存率。
在所有 380 例患者中，335 例患者创建了原发造口，45 例患者创建了继发造口。索引手术后，36.6%（139/380）的患者至少发生了一种术后并发症。在第一项包括所有患者的分析中，24.7%的临时造口未闭合。在第二项针对 335 例原发造口患者的分析中，23.3%的造口未闭合。在 COX 回归分析后，主要 POC 和次要 POC 均被发现是永久性造口的独立危险因素，随着 POC 严重程度的增加，永久性造口的风险呈增加趋势。
POC 是直肠癌手术后永久性造口的独立预测因子。即使是轻微的 POC 也可能影响结局，而 POC 严重程度与永久性造口率之间存在明确的直接关系。
