Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
Department of Surgery, University of Jeddah, Jeddah, Saudi Arabia.
BMC Surg. 2023 Jun 20;23(1):167. doi: 10.1186/s12893-023-01998-5.
Anterior resection (AR) is considered the gold standard for curative cancer treatment in the middle and upper rectum. The goal of the sphincter-preserving procedure, such as AR, is vulnerable to anastomotic leak (AL) complications. Defunctioning stoma (DS) became the protective measure against AL. Often a defunctioning loop-ileostomy is used, which is associated with substantial morbidity. However, not much is known if the routine use of DS reduces the overall incidence of AL.
Elective patients subjected to AR in 2007-2009 and 2016-18 were recruited from the Swedish colorectal cancer registry (SCRCR). Patient characteristics, including DS status and occurrence of AL, were analyzed. In addition, independent risk factors for AL were investigated by multivariable regression.
The statistical increase of DS from 71.6% in 2007-2009 to 76.7% in 2016-2018 did not impact the incidence of AL (9.2% and 8.2%), respectively. DLI was constructed in more than 35% of high-located tumors ≥ 11 cm from the anal verge. Multivariable analysis showed that male gender, ASA 3-4, BMI > 30 kg/m, and neoadjuvant therapy were independent risk factors for AL.
Routine DS did not decrease overall AL after AR. A selective decision algorithm for DS construction is needed to protect from AL and mitigate DS morbidities.
前切除术（AR）被认为是中高位直肠癌症治疗的金标准。保肛手术（如 AR）的目标易受吻合口漏（AL）并发症的影响。预防性造口术（DS）成为预防 AL 的措施。通常使用双腔回肠造口术，但该术式与大量并发症相关。然而，目前尚不清楚常规使用 DS 是否会降低 AL 的总体发生率。
从瑞典结直肠癌登记处（SCRCR）招募了 2007-2009 年和 2016-2018 年接受 AR 的选择性患者。分析了患者特征，包括 DS 状态和 AL 的发生情况。此外，还通过多变量回归分析了 AL 的独立危险因素。
DS 的使用率从 2007-2009 年的 71.6%增加到 2016-2018 年的 76.7%，但 AL 的发生率（分别为 9.2%和 8.2%）没有变化。DLI 构建超过 35%的高位肿瘤（距肛缘>11cm）。多变量分析显示，男性、ASA 3-4 级、BMI>30kg/m2和新辅助治疗是 AL 的独立危险因素。
AR 后常规使用 DS 并未降低总体 AL 发生率。需要制定选择性 DS 构建决策算法，以预防 AL 并减轻 DS 并发症。
