Thomas Flavie, Menahem Benjamin, Lebreton Gil, Bouhier-Leporrier Karine, Dejardin Olivier, Alves Arnaud
Centre Hospitalier Universitaire de Caen, Caen, France.
Institut Nationale de la Recherche Medicale (INSERM) U1086 Unité de recherche Interdisciplinaire pour la Prévention et le Traitement des Cancers, Caen, France.
Front Oncol. 2023 Jan 26;12:1056314. doi: 10.3389/fonc.2022.1056314. eCollection 2022.
This study aimed: (i) to assess the cumulative incidence of permanent stoma (PS) after sphincter-preserving surgery (SPS) for rectal cancer (RC): (ii) to analyze associated risk factors for primary and secondary PS; and (iii) to compare the long-term survival of patients according to the stoma state.
We conducted a retrospective single-center cohort study based on a prospectively maintained database of SRC patients undergoing SPS from January 2007 to December 2017. Incidence of both primary (no reversal of defunctioning stoma) and secondary (created after closure of defunctioning stoma) PS were investigated. Associations between potential risk factors and PS were analyzed using a logistic regression model. Cumulative survival curve was drawn by Kaplan-Meier method.
Of the 257 eligible patients, 43 patients (16.7%) had a PS (16 primary PS and 27 secondary PS) after a median follow-up of 4.8 years. In multivariate analysis, the independent risk factors for primary PS were severe post-operative complications (OR 3.66; 95% CI, 1.19-11.20, p=0.022), and old age (OR 1.11; 95% CI 1.04-1.18, p=0.001) and those for secondary PS were local recurrence (OR 38.07; 95% CI 11.07-130.9, p<0.0001), anastomotic leakage (OR 7.01; 95% CI, 2.23-22.04, p=0.009), and severe post-operative complications (OR 3.67; 95% CI, 1.22-11.04, p=0.02), respectively. Both overall survival (OS) and disease-free survival (DFS) were significantly lower in patients with a PS compared with patients with SPS (p < 0.01).
This present study suggests that one out of 6 patients has a PS, 5 years after rectal resection with SPS for SRC.
本研究旨在：（i）评估直肠癌（RC）保肛手术（SPS）后永久性造口（PS）的累积发生率；（ii）分析原发性和继发性PS的相关危险因素；（iii）根据造口状态比较患者的长期生存率。
我们基于2007年1月至2017年12月接受SPS的SRC患者前瞻性维护的数据库进行了一项回顾性单中心队列研究。调查了原发性（未回纳功能性造口）和继发性（功能性造口关闭后造口）PS的发生率。使用逻辑回归模型分析潜在危险因素与PS之间的关联。采用Kaplan-Meier法绘制累积生存曲线。
在257例符合条件的患者中，中位随访4.8年后，43例患者（16.7%）有PS（16例原发性PS和27例继发性PS）。多因素分析显示，原发性PS的独立危险因素是术后严重并发症（OR 3.66；95%CI，1.19-11.20，p=0.022）和老年（OR 1.11；95%CI 1.04-1.18，p=0.001），继发性PS的独立危险因素分别是局部复发（OR 38.07；95%CI 11.07-130.9，p<0.0001）、吻合口漏（OR 7.01；95%CI，2.23-22.04，p=0.009）和术后严重并发症（OR 3.67；95%CI，1.22-11.04，p=0.02）。与接受SPS的患者相比，有PS的患者总生存期（OS）和无病生存期（DFS）均显著降低（p<0.01）。
本研究表明，SRC患者接受SPS直肠切除术后5年，每6例患者中有1例有PS。
