University of Rochester Medical Center, Department of Surgery, New York, USA.
University of Rochester Medical Center, Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, New York, USA.
Colorectal Dis. 2023 Mar;25(3):404-412. doi: 10.1111/codi.16375. Epub 2022 Nov 13.
Patients with rectal cancer often undergo faecal diversion, yet the existing literature cursorily reports renal sequelae by the type of ostomy. We aimed to determine whether the presence of an ileostomy or colostomy was associated with postoperative renal morbidity.
We identified patients with rectal cancer undergoing elective resection with primary anastomosis without diversion, with an ileostomy and with a colostomy by 21 possible procedures in the colectomy- and proctectomy-specific National Surgical Quality Improvement Program files. The odds of major renal events (renal failure [dialysis initiated] or progressive renal insufficiency [>2 mg/dl increase in creatinine without dialysis]), progressive renal insufficiency alone and readmissions were assessed using propensity score weighting and logistic regression.
Of 15 075 patients (63.7% Stage II-III, 85.7% creatinine values obtained ≤30 days preoperatively), 37.7% were not diverted, 39.5% had an ileostomy and 22.9% a colostomy. Compared to non-diverted patients, diversion was associated with major renal events (ileostomy, odds ratio [OR] 2.1, 95% confidence interval [CI] 1.6-2.9; colostomy, OR 1.8, 95% CI 1.3-2.5), progressive renal insufficiency (ileostomy, OR 2.5, 95% CI 1.7-3.5; colostomy, OR 2.0, 95% CI 1.4-2.9), readmissions for renal failure (ileostomy, OR 3.2, 95% CI 2.1-5.0; colostomy, OR 2.5, 95% CI 1.6-4.1) and readmissions for fluid/electrolyte abnormalities (ileostomy, OR 2.3, 95% CI 1.6-3.3; colostomy, OR 1.8, 95% CI 1.2-2.6).
Diverting ostomies after elective rectal cancer resection are strongly associated with renal morbidity. The decision to divert is complex, and it is unclear whether select patients may benefit from a colostomy from a renal perspective.
接受直肠肿瘤切除术的患者常需进行粪便转流，但现有文献仅粗略报道了不同造口术式的肾后并发症。我们旨在确定行回肠造口术或结肠造口术是否与术后肾并发症相关。
我们通过 21 种结直肠切除术特有的方案，在全国外科质量改进计划的文件中确定了接受择期直肠肿瘤切除术且无转流、行回肠造口术和结肠造口术的患者。通过倾向评分加权和逻辑回归评估主要肾脏事件（肾衰竭[开始透析]或进行性肾功能不全[无透析时肌酐增加>2mg/dl]）、单纯进行性肾功能不全和再入院的发生概率。
在 15075 例患者中（63.7%为 II-III 期，85.7%的术前肌酐值在 30 天内获得），37.7%未行转流，39.5%行回肠造口术，22.9%行结肠造口术。与未行转流的患者相比，转流与主要肾脏事件（回肠造口术，比值比[OR] 2.1，95%置信区间[CI] 1.6-2.9；结肠造口术，OR 1.8，95% CI 1.3-2.5）、进行性肾功能不全（回肠造口术，OR 2.5，95% CI 1.7-3.5；结肠造口术，OR 2.0，95% CI 1.4-2.9）、肾衰竭相关再入院（回肠造口术，OR 3.2，95% CI 2.1-5.0；结肠造口术，OR 2.5，95% CI 1.6-4.1）和液体/电解质异常相关再入院（回肠造口术，OR 2.3，95% CI 1.6-3.3；结肠造口术，OR 1.8，95% CI 1.2-2.6）显著相关。
选择性直肠肿瘤切除术后行转流造口术与肾并发症密切相关。转流术的决策较为复杂，尚不清楚从肾脏角度来看，是否某些特定患者可从结肠造口术获益。
