Tailored Management with Highly-Selective Diversion for Low Colorectal Anastomosis : Biochemical Postoperative Follow-Up and Long-Term Results from a Single-Institution Cohort
© 2021. Society of Surgical Oncology..
BACKGROUND: Defunctioning stoma (DS) can decrease the rate of symptomatic anastomotic leakage (AL). Since 2010, we have used tailored, highly selective DS management for low colorectal anastomosis (LCRA).
METHODS: In total, 433 rectal cancer patients underwent the same standardized procedure. Non-stoma (NS) management was used in patients with no surgical difficulties as well as good colonic preparation and quality of anastomoses. In all other cases, DS was used. C-reactive protein was measured during postoperative follow-up. Imbalance in the initial population was adjusted using propensity-score matching according to sex, age, body mass index, tumor location, and American Society of Anesthesiologists score. Rate of AL within 30 days, 5-year overall survival, local relapse-free survival, and disease-free survival were recorded.
RESULTS: Anastomosis was mostly ultra-low and was performed equally by laparoscopy or robotic surgery. The overall rate of AL was 13.4%, with no significant differences between groups (DS, 12.2%; NS, 14.6%; p = 0.575). Operative time, blood loss, and hospital stay were significantly lower for NS patients. The rate of secondary stoma was 11.4% overall. Pathological results were similar, with a 98% R0 resection rate. With a median follow-up of 5.5 years for the NS and DS groups, the overall survival was 84.9% and 73.4%, respectively (p = 0.064), disease-free survival was 67.0% and 55.8%, respectively (p = 0.095), and local relapse-free survival was 95.2% and 88.7%, respectively (p = 0.084). The long-term, stoma-free rate was 89.1% overall.
CONCLUSIONS: Tailoring DS for LCRA seems safe and could provide potential benefits in postoperative morbidity with the same long-term oncological results in NS patients. Prospective, multicentric studies should validate this approach.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29 |
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| Enthalten in: |
Annals of surgical oncology - 29(2022), 4 vom: 07. Apr., Seite 2514-2524 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rouanet, Philippe [VerfasserIn] |
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| Anmerkungen: |
Date Completed 23.03.2022 Date Revised 04.04.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1245/s10434-021-11197-2 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM335301983 |
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| 500 | |a Date Revised 04.04.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. Society of Surgical Oncology. | ||
| 520 | |a BACKGROUND: Defunctioning stoma (DS) can decrease the rate of symptomatic anastomotic leakage (AL). Since 2010, we have used tailored, highly selective DS management for low colorectal anastomosis (LCRA) | ||
| 520 | |a METHODS: In total, 433 rectal cancer patients underwent the same standardized procedure. Non-stoma (NS) management was used in patients with no surgical difficulties as well as good colonic preparation and quality of anastomoses. In all other cases, DS was used. C-reactive protein was measured during postoperative follow-up. Imbalance in the initial population was adjusted using propensity-score matching according to sex, age, body mass index, tumor location, and American Society of Anesthesiologists score. Rate of AL within 30 days, 5-year overall survival, local relapse-free survival, and disease-free survival were recorded | ||
| 520 | |a RESULTS: Anastomosis was mostly ultra-low and was performed equally by laparoscopy or robotic surgery. The overall rate of AL was 13.4%, with no significant differences between groups (DS, 12.2%; NS, 14.6%; p = 0.575). Operative time, blood loss, and hospital stay were significantly lower for NS patients. The rate of secondary stoma was 11.4% overall. Pathological results were similar, with a 98% R0 resection rate. With a median follow-up of 5.5 years for the NS and DS groups, the overall survival was 84.9% and 73.4%, respectively (p = 0.064), disease-free survival was 67.0% and 55.8%, respectively (p = 0.095), and local relapse-free survival was 95.2% and 88.7%, respectively (p = 0.084). The long-term, stoma-free rate was 89.1% overall | ||
| 520 | |a CONCLUSIONS: Tailoring DS for LCRA seems safe and could provide potential benefits in postoperative morbidity with the same long-term oncological results in NS patients. Prospective, multicentric studies should validate this approach | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Selvy, Marie |e verfasserin |4 aut | |
| 700 | 1 | |a Jarlier, Marta |e verfasserin |4 aut | |
| 700 | 1 | |a Bugnon, Caroline |e verfasserin |4 aut | |
| 700 | 1 | |a Carrier, Guillaume |e verfasserin |4 aut | |
| 700 | 1 | |a Mourregot, Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Colombo, Pierre-Emmanuel |e verfasserin |4 aut | |
| 700 | 1 | |a Taoum, Christophe |e verfasserin |4 aut | |
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