Momose Hirotaka, Takahashi Makoto, Kawai Masaya, Sugimoto Kiichi, Takahashi Hiromitsu, Motegi Shunsuke, Honjo Kumpei, Okazawa Yu, Takahashi Rina, Ishiyama Shun, Tomiki Yuichi, Sakamoto Kazuhiro
Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
J Anus Rectum Colon. 2025 Jan 25;9(1):88-94. doi: 10.23922/jarc.2024-047. eCollection 2025.
In rectal cancer surgery, a diverting stoma (DS) is used to prevent severe anastomotic leakage (AL), peritonitis, reoperation, and longer hospitalization. DS creation has increased in the last few decades, without establishment of clear criteria for construction of a DS. Therefore, the goal of the study was to investigate the validity of DS construction based on risk factors for AL, as an approach to reduce the number of stoma creations.
The subjects were 143 patients with rectal cancer who underwent laparoscopic or robot-assisted low anterior resection with DS creation from January 2010 to May 2021. Patients and operative characteristics were examined using univariate and multivariate analyses to identify risk factors for AL.
Of the 143 subjects, 30 (21%) had AL, including asymptomatic AL in 19 cases (13%) and AL requiring conservative therapy in 11 cases (8%). No case of AL required reoperation. In cases with asymptomatic AL, there was a defect in the anastomosis found by colonoscopy several days after the operation, before discharge. In univariate analysis, preoperative Glasgow prognostic score (GPS) ≥1 (=0.046) and number of stapler firings ≥3 (=0.002) were associated with AL. In multivariate analysis, only GPS ≥1 was significantly associated with increased AL (=0.033; OR=4.225; 95% CI 1.122 to 15.905).
DS creation is effective for avoiding reoperation for AL. Preoperative GPS ≥1 is a risk factor for AL in low anterior resection with a DS for rectal cancer. Thus, DS construction should be considered in a case with an elevated preoperative GPS.
在直肠癌手术中，转流造口（DS）用于预防严重吻合口漏（AL）、腹膜炎、再次手术和延长住院时间。在过去几十年中，DS的创建有所增加，但尚未建立明确的DS构建标准。因此，本研究的目的是基于AL的危险因素研究DS构建的有效性，作为减少造口创建数量的一种方法。
研究对象为2010年1月至2021年5月期间接受腹腔镜或机器人辅助低位前切除术并创建DS的143例直肠癌患者。使用单因素和多因素分析检查患者和手术特征，以确定AL的危险因素。
143例研究对象中，30例（21%）发生AL，其中19例（13%）为无症状AL，11例（8%）为需要保守治疗的AL。无AL病例需要再次手术。在无症状AL的病例中，术后出院前几天通过结肠镜检查发现吻合口有缺陷。单因素分析中，术前格拉斯哥预后评分（GPS）≥1（P=0.046）和吻合器击发次数≥3（P=0.002）与AL相关。多因素分析中，只有GPS≥1与AL增加显著相关（P=0.033；OR=
