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When are defunctioning stomas in rectal cancer surgery really reversed?: Results from a population-based single center experience
Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital, Örebro, Sweden.
2013 (English)In: Scandinavian Journal of Surgery, ISSN 1457-4969, E-ISSN 1799-7267, Vol. 102, no 4, 246-250 p.Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Background and Aims: This study assessed the timing of reversal of defunctioning stoma following low anterior resection of the rectum for cancer and risk factors for a defunctioning stoma becoming permanent in patients who were not reversed.

Material and Methods: Patients who underwent low anterior resection with defunctioning stoma during a 12-year period were assessed with regard to timing of stoma reversal. Delayed reversal was defined as > 4 months after low anterior resection. Patients with a defunctioning stoma that was never reversed were assessed regarding risk factors for permanent stoma.

Results: A total of 134 patients were analyzed. Of 106 stoma reversals, 19% were reversed within 4 months of low anterior resection, while 81% were reversed later than 4 months. In 58% of these patients, the delay was to due to low medical priority given to this procedure. The other main reasons for delayed stoma reversal were nonsurgical complications (20%), symptomatic anastomotic leakage following low anterior resection (12%), and postoperative adjuvant chemotherapy (10%). Of all patients, 21% (28/134) ended up with a permanent stoma. Risk factors for a defunctioning stoma becoming permanent were stage IV cancer (P < 0.001) and symptomatic anastomotic leakage following low anterior resection (P < 0.001).

Conclusion: Four in five patients experienced a delayed stoma reversal, in a majority because of the low priority given to this surgical procedure.

Place, publisher, year, edition, pages
Sage Publications, 2013. Vol. 102, no 4, 246-250 p.
Keyword [en]
Rectal cancer, low anterior resection of the rectum, defunctioning stoma, temporary stoma, stoma reversal, permanent stoma, risk factors
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-50041DOI: 10.1177/1457496913489086ISI: 000335584100006PubMedID: 24056133Scopus ID: 2-s2.0-84902682473OAI: oai:DiVA.org:oru-50041DiVA: diva2:924825
Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2017-10-17Bibliographically approved
In thesis
1. Defunctioning stoma in low anterior resection of the rectum for cancer: Aspects of stoma reversal, anastomotic leakage, anorectal function, and cost-effectiveness
Open this publication in new window or tab >>Defunctioning stoma in low anterior resection of the rectum for cancer: Aspects of stoma reversal, anastomotic leakage, anorectal function, and cost-effectiveness
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Rectal cancer is a common malignancy treated with surgical resection and curative intent in the majority of cases. One treatment option is low anterior resection (LAR) with preserved bowel continuity, often involving the formation of a temporary defunctioning stoma (DS).

The general aim of this thesis was to improve understanding of the role of DS in rectal cancer surgery with regard to timing of stoma reversal and development of anastomotic leakage (AL), impact on long-term anorectal function (AF), as well as aspects of cost-effectiveness.

Study I addressed the timing of stoma reversal following LAR. We found that 19% of reversed patients were reversed within 4 months of LAR, while 81% of reversals were delayed. In 58% of delayed reversals the delay was due to low priority on surgical waiting lists.

Studies II-IV were based on 234 patients randomized to receive a DS or no DS following LAR. Study II compared patients with AL following LAR diagnosed during the initial hospital stay (early leakage, EL) with patients diagnosed after hospital discharge (late leakage, LL). LL was more common in females, and originated more frequently from the transverse stapler line. EL was more common in males, and originated more frequently from the circular stapler line. Study III assessed AF 5 years after LAR with regard to whether patients initially had a DS or no DS. We found no difference in AF between the two randomized groups. When comparing with a 1-year follow-up in the same patient cohort, there were no further changes in AF over time. Study III assessed necessary healthcare resources and cost within 5 years of LAR, depending on whether patients initially had a DS or no DS. The overall cost analysis revealed a higher cost for patients randomized to DS, regardless of the cost-savings associated with a reduced frequency of anastomotic leakage.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. 56 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 143
Keyword
rectal cancer, low anterior resection, defunctioning stoma, stoma reversal, anastomotic leakage, anorectal function, costs, resources
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-49021 (URN)978-91-7529-139-0 (ISBN)
Public defence
2016-05-27, Universitetssjukhuset, Bomanssonsalen, Södra Grev Rosengatan, Örebro, 09:15 (English)
Opponent
Supervisors
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2017-10-17Bibliographically approved

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