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Kawai M, Sakamoto K, Honjo K, Okazawa Y, Takahashi R, Kawano S, Munakata S, Sugimoto K, Ishiyama S, Takahashi M, Kojima Y, Tomiki Y. Benefits and risks of diverting stoma creation during rectal cancer surgery. Ann Coloproctol 2022:ac.2022.00353.0050. [PMID: 36472048 DOI: 10.3393/ac.2022.00353.0050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/09/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer. Methods We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (-) groups, and the outcomes, including postoperative complications, were compared. Results The incidence of ileus was higher in the DS (+) group than in the DS (-) group (P<0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (-) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group. Conclusion Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.
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Affiliation(s)
- Masaya Kawai
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kumpei Honjo
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yu Okazawa
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Rina Takahashi
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shingo Kawano
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shinya Munakata
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shun Ishiyama
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Makoto Takahashi
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yutaka Kojima
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yuichi Tomiki
- Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
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Alekseev MV, Shelygin YA, Rybakov EG. [Risk factors associated with non-closure of defunctioning stoma in patients with rectal cancer: univariate and multivariate analysis]. Khirurgiia (Mosk) 2021:40-47. [PMID: 33570353 DOI: 10.17116/hirurgia202102140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the risk factors associated with non-closure of defunctioning stoma in patients with rectal cancer. MATERIAL AND METHODS A retrospective analysis included patients who underwent surgical treatment at the Ryzhikh National Medical Research Centre of Coloproctology for the period from March 2017 to August 2019. Inclusion criterion was anterior or low anterior resection followed by anastomosis and preventive stoma. Univariate and multivariate analysis enrolled 28 factors for identifying the risk factors of non-closure of defunctioning stoma. RESULTS There were 246 patients with rectal cancer. Intraoperative fluorescence angiography was applied in 145 cases to assess blood supply within the anastomosis and reduce the risk of anastomotic leakage. According to multivariate analysis, only two factors had significant influence on non-closure of preventive stoma - any grade of anastomotic leakage (OR 6.5; 95% CI 2.2-18.8, p=0.001) and rectal cancer stage IV (OR 7.2; 95% CI 1.9-27.6, p=0.004). CONCLUSION According to our data, permanent stoma is observed in 15% of patients.
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Affiliation(s)
- M V Alekseev
- Ryzhikh National Medical Research Centre of Coloproctology, Moscow, Russia.,Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - Yu A Shelygin
- Ryzhikh National Medical Research Centre of Coloproctology, Moscow, Russia.,Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - E G Rybakov
- Ryzhikh National Medical Research Centre of Coloproctology, Moscow, Russia
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Rosendorf J, Klicova M, Cervenkova L, Horakova J, Klapstova A, Hosek P, Palek R, Sevcik J, Polak R, Treska V, Chvojka J, Liska V. Reinforcement of Colonic Anastomosis with Improved Ultrafine Nanofibrous Patch: Experiment on Pig. Biomedicines 2021; 9:102. [PMID: 33494257 PMCID: PMC7909771 DOI: 10.3390/biomedicines9020102] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 01/12/2023] Open
Abstract
Anastomotic leakage is a dreadful complication in colorectal surgery. It has a negative impact on postoperative mortality, long term life quality and oncological results. Nanofibrous polycaprolactone materials have shown pro-healing properties in various applications before. Our team developed several versions of these for healing support of colorectal anastomoses with promising results in previous years. In this study, we developed highly porous biocompatible polycaprolactone nanofibrous patches. We constructed a defective anastomosis on the large intestine of 16 pigs, covered the anastomoses with the patch in 8 animals (Experimental group) and left the rest uncovered (Control group). After 21 days of observation we evaluated postoperative changes, signs of leakage and other complications. The samples were assessed histologically according to standardized protocols. The material was easy to work with. All animals survived with no major complication. There were no differences in intestinal wall integrity between the groups and there were no signs of anastomotic leakage in any animal. The levels of collagen were significantly higher in the Experimental group, which we consider to be an indirect sign of higher mechanical strength. The material shall be further perfected in the future and possibly combined with active molecules to specifically influence the healing process.
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Affiliation(s)
- Jachym Rosendorf
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic;
| | - Marketa Klicova
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, 460 01 Liberec, Czech Republic; (M.K.); (J.H.); (A.K.); (J.C.)
| | - Lenka Cervenkova
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
| | - Jana Horakova
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, 460 01 Liberec, Czech Republic; (M.K.); (J.H.); (A.K.); (J.C.)
| | - Andrea Klapstova
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, 460 01 Liberec, Czech Republic; (M.K.); (J.H.); (A.K.); (J.C.)
| | - Petr Hosek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
| | - Richard Palek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic;
| | - Jan Sevcik
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
| | - Robert Polak
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic;
| | - Vladislav Treska
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic;
| | - Jiri Chvojka
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, 460 01 Liberec, Czech Republic; (M.K.); (J.H.); (A.K.); (J.C.)
| | - Vaclav Liska
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic;
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Kim JC, Lee JL, Bong JW, Seo JH, Kim CW, Park SH, Kim J. Oncological and anorectal functional outcomes of robot-assisted intersphincteric resection in lower rectal cancer, particularly the extent of sphincter resection and sphincter saving. Surg Endosc 2019; 34:2082-2094. [DOI: 10.1007/s00464-019-06989-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/15/2019] [Indexed: 01/06/2023]
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Use of a nomogram to predict the closure rate of diverting ileostomy after low anterior resection: A retrospective cohort study. Int J Surg 2017; 47:83-88. [PMID: 28951289 DOI: 10.1016/j.ijsu.2017.09.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Although temporary ileostomy is widely used to prevent complications due to anastomotic leakage after middle and low rectal cancer surgery, some patients fail to achieve stoma closure after primary surgery. The aim of this study was to identify the risk factors for permanent stoma following low anterior resection (LAR) or intersphincteric resection (ISR) with a temporary ileostomy for rectal cancer, while focusing on the time course, to develop a nomogram that can predict the rate of unreversed ileostomy 1 year after initial surgery. METHOD A total of 212 consecutive rectal cancer patients who underwent LAR or ISR with or without a temporary stoma between 2012 and 2015 at the University of Tokyo Hospital were retrospectively reviewed. Data analyses were performed using JMP Pro 11.0 and R 3.0.1 with rms and Hmisc packages to identify the risk factors for diverting ileostomy resulting in un-reversed stoma, and to develop a nomogram using these factors. RESULTS Among 212 patients, diverting ileostomy and colostomy were performed in 116 and 11 patients, respectively, and a stoma was not created in 85 patients. Among the ileostomy cases, 94 underwent stoma reversal, and the median interval from initial surgery to stoma closure was 6.9 months. Three patients eventually underwent stoma re-creation, and hence, 25 patients had permanent stoma. The following variables were correlated with the stoma non-reversal rate and were included in the nomogram: depth of invasion (p = 0.02), presence of metastatic organs (p = 0.07), and preoperative chemoradiotherapy (p = 0.03). The nomogram C-index was 0.612, indicating moderate predictive ability. CONCLUSIONS The most common factors preventing stoma closure included distant metastasis or rectal cancer recurrence. The nomogram developed in the present study can help identify rectal cancer patients with high risk of stoma non-reversal.
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Stergios K, Kontzoglou K, Pergialiotis V, Korou LM, Frountzas M, Lalude O, Nikiteas N, Perrea DN. The potential effect of biological sealants on colorectal anastomosis healing in experimental research involving severe diabetes. Ann R Coll Surg Engl 2017; 99:189-192. [PMID: 27917665 PMCID: PMC5450286 DOI: 10.1308/rcsann.2016.0357] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 12/25/2022] Open
Abstract
Colorectal anastomoses continuous to pose a significant challenge in current surgical practice. Anastomotic leakage remains one of the most frequent and dramatic complications of colorectal surgery, even in centres of high specialisation. Diabetes is a well-established independent factor which results in higher anastomotic leakage rates. Fibrin sealants have been applied in experimental and clinical studies for the prevention of anastomotic dehiscence. However, little is known regarding their impact on diabetic patients. Several fibrin sealants have been proposed as adjunct to standard surgical techniques to prevent leakage from colonic anastomoses following the reversal of temporary colostomies, approved for general haemostasis. This review summarises current advances in colorectal anastomoses and provides evidence that may strengthen the need for tissue sealants in colorectal anastomoses of diabetic patients. We searched Medline (1966-2016) and Scopus (2004-2016) for current evidence in the field. To date, there is no evidence to support the use of fibrin sealants as an adjunct in diabetic patients who undergo colorectal surgery. Experimental animal models with extreme diabetes could be of significant use in the present field and further research is needed prior to application of fibrin sealants in a clinical setting.
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Affiliation(s)
- K Stergios
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
- Colorectal Department, General Surgery, Princess Alexandra Hospital NHS Trust , Harlow , UK
| | - K Kontzoglou
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| | - V Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| | - L M Korou
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| | - M Frountzas
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| | - O Lalude
- Colorectal Department, General Surgery, Princess Alexandra Hospital NHS Trust , Harlow , UK
| | - N Nikiteas
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| | - D N Perrea
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
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