Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou, No.5, Fuxing St., Guishan Dist., Taoyuan City, 33305, Taiwan.
Division of Colon and Rectal Surgery, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan.
Langenbecks Arch Surg. 2023 Jul 12;408(1):274. doi: 10.1007/s00423-023-03014-z.
The optimal timing of stoma closure during or after adjuvant chemotherapy for rectal cancer patients undergoing sphincter-preserving surgery remains unknown. This study aimed to investigate the influence of clinical and oncological outcomes depending on the timing of stoma closure.
Between January 2006 and December 2015, we enrolled 244 consecutive rectal cancer patients who underwent curative-intent sphincter-preserving surgery with diverting transverse colostomy and adjuvant chemotherapy. Patients with stoma closure during (During group) adjuvant chemotherapy were compared to those who had stoma closure after adjuvant chemotherapy (After group).
Parastomal hernia occurred more frequently in the after group than in the during group. (10% vs. 2.9%, p = 0.028). Overall, no significant difference was observed in overall survival (OS) or disease-free survival (DFS) between the two groups (p = 0.911 for OS, p = 0.505 for DFS). However, an inferior OS occurred if reopen surgery was performed within 30 days of stoma closure in the during group, as compared with the after group (p = 0.004). In addition, a marginally poor DFS was observed in the group of patients who received further operations due to 30-day stoma closure complications compared to the other patients (p = 0.07).
For rectal cancer patients who underwent sphincter-preserving surgery, attention should be given to avoid 30-day major complications after stoma reversal because patients who require reoperation during adjuvant chemotherapy may have poor long-term survival.
接受保肛手术和辅助化疗的直肠癌患者，其造口关闭的最佳时机是在化疗期间还是化疗后仍不清楚。本研究旨在探讨造口关闭时机对临床和肿瘤学结局的影响。
2006 年 1 月至 2015 年 12 月，我们纳入了 244 例连续接受保肛手术和横结肠转流术以及辅助化疗的直肠癌患者。比较了辅助化疗期间行造口关闭术的患者（期间组）与辅助化疗后行造口关闭术的患者（之后组）。
之后组的造口旁疝发生率高于期间组（10%比 2.9%，p=0.028）。两组的总生存率（OS）或无病生存率（DFS）均无显著差异（OS：p=0.911，DFS：p=0.505）。然而，如果期间组在造口关闭后 30 天内行再手术，其 OS 明显劣于之后组（p=0.004）。此外，与其他患者相比，由于 30 天造口关闭并发症而接受进一步手术的患者的 DFS 略差（p=0.07）。
对于接受保肛手术的直肠癌患者，应注意避免在造口关闭后 30 天内发生严重并发症，因为在辅助化疗期间需要再次手术的患者可能生存预后较差。
