Duhoky Rauand, Piozzi Guglielmo Niccolò, Rutgers Marieke L W, Mykoniatis Ioannis, Siddiqi Najaf, Naqvi Syed, Khan Jim S
Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth PO6 3LY, UK.
School of Computing, Faculty of Technology, University of Portsmouth, Portsmouth PO1 2UP, UK.
J Pers Med. 2024 Jul 4;14(7):725. doi: 10.3390/jpm14070725.
(1) Background: In recent years, there has been a change in practice for diverting stomas in rectal cancer surgery, shifting from routine diverting stomas to a more selective approach. Studies suggest that the benefits of temporary ileostomies do not live up to their risks, such as high-output stomas, stoma dysfunction, and reoperation. (2) Methods: All rectal cancer patients treated with a robotic resection in a single tertiary colorectal centre in the UK from 2013 to 2021 were analysed. In 2015, our unit made a shift to a more selective approach to temporary diverting ileostomies. The cohort was divided into a routine diversion group treated before 2015 and a selective diversion group treated after 2015. Both groups were analysed and compared for short-term outcomes and morbidities. (3) Results: In group A, 63/70 patients (90%) had a diverting stoma compared to 98/135 patients (72.6%) in group B ( = 0.004). There were no significant differences between the groups in anastomotic leakages (11.8% vs. 17.8%, = 0.312) or other complications ( = 0.117). There were also no significant differences in readmission (3.8% vs. 2.6%, = 0.312) or reoperation (3.8% vs. 2.6%, = 1.000) after stoma closure. After 1 year, 71.6% and 71.9% ( = 1.000) of patients were stoma-free. One major reason for the delay in stoma reversal was the COVID-19 pandemic, which only occurred in group B (0% vs. 22%, = 0.054). (4) Conclusions: A more selective approach to diverting stomas for robotic rectal cancer patients does not lead to more complications or leaks and can be considered in the treatment of rectal cancer tumours.
（1）背景：近年来，直肠癌手术中造口改道的做法发生了变化，从常规造口改道转向更具选择性的方法。研究表明，临时回肠造口术的益处与其风险不相称，如高输出量造口、造口功能障碍和再次手术。（2）方法：对2013年至2021年在英国一家三级结直肠中心接受机器人切除术治疗的所有直肠癌患者进行分析。2015年，我们科室转向对临时改道回肠造口术采用更具选择性的方法。该队列分为2015年前接受治疗的常规改道组和2015年后接受治疗的选择性改道组。对两组的短期结局和发病率进行分析和比较。（3）结果：A组中，63/70例患者（90%）进行了造口改道，而B组为98/135例患者（72.6%）（P = 0.004）。两组在吻合口漏（11.8%对17.8%，P = 0.312）或其他并发症（P = 0.117）方面无显著差异。造口关闭后的再入院率（3.8%对2.6%，P = 0.312）或再次手术率（3.8%对2.6%，P = 1.000）也无显著差异。1年后，71.6%和71.9%（P = 1.000）的患者无造口。造口回纳延迟的一个主要原因是新冠疫情，这仅发生在B组（0%对22%，P = 0.054）。（4）结论：对机器人直肠癌患者采用更具选择性的造口改道方法不会导致更多并发症或渗漏，可在直肠癌肿瘤治疗中考虑。
