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Open Access 06-11-2023 | Enterostomy

Permanent stoma rate and long-term stoma complications in laparoscopic, robot-assisted, and transanal total mesorectal excisions: a retrospective cohort study

Authors: T. A. Burghgraef, R. T. J. Geitenbeek, M. Broekman, J. C. Hol, R. Hompes, E. C. J. Consten, The MIRECA Study Group

Published in: Surgical Endoscopy | Issue 1/2024

Abstract

Background

The surgical resection of rectal carcinoma is associated with a high risk of permanent stoma rate. Primary anastomosis rate is suggested to be higher in robot-assisted and transanal total mesorectal excision, but permanent stoma rate is unknown.

Methods

Patients undergoing total mesorectal excision for MRI-defined rectal cancer between 2015 and 2017 in 11 centers highly experienced in laparoscopic, robot-assisted or transanal total mesorectal excision were included in this retrospective study. Permanent stoma rate, stoma-related complications, readmissions, and reoperations were registered. A multivariable regression analysis was performed for permanent stoma rate, stoma-related complications, and stoma-related reoperations.

Results

In total, 1198 patients were included. Permanent stoma rate after low anterior resection (with anastomosis or with an end colostomy) was 40.1% in patients undergoing laparoscopic surgery, 21.3% in patients undergoing robot-assisted surgery, and 25.6% in patients undergoing transanal surgery (P < 0.001). Permanent stoma rate after low anterior resection with an anastomosis was 17.3%, 11.8%, and 15.1%, respectively. The robot-assisted and transanal techniques were independently associated with a reduction in permanent stoma rate in patients who underwent a low anterior resection (with anastomosis or with an end colostomy) (OR 0.39 [95% CI 0.25, 0.59] and OR 0.35 [95% CI 0.22, 0.55]), while this was not seen in patients who underwent a restorative low anterior resection. 45.4% of the patients who had a stoma experienced stoma-related complications, 4.0% were at least once readmitted, and 8.9% underwent at least one reoperation.

Conclusions

The robot-assisted and transanal techniques are associated with a lower permanent stoma rate in patients who underwent a low anterior resection.

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Simillis C, Lal N, Thoukididou SN et al (2019) Open versus laparoscopic versus robotic versus transanal mesorectal excision for rectal cancer: a systematic review and network meta-analysis. Ann Surg 270(1):59–68. https://doi.org/10.1097/SLA.0000000000003227CrossRefPubMed

Heald RJ, Ryall RDH (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 327(8496):1479–1482. https://doi.org/10.1016/S0140-6736(86)91510-2CrossRef

Heald RJ, Husband EM, Ryall RDH (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69(10):613–616. https://doi.org/10.1002/bjs.1800691019CrossRefPubMed

Matthiesen P, Hallböök O, Rutegard J, Simert G, Sjödahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer. A randomized multicenter trial. Ann Surg 246(2):207–214. https://doi.org/10.1097/SLA.0b013e3180603024CrossRef

Hüser N, Michalski CW, Erkan M et al (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248(1):52–60. https://doi.org/10.1097/SLA.0b013e318176bf65CrossRefPubMed

Pisarska M, Gajewska N, Małczak P et al (2018) Defunctioning ileostomy reduces leakage rate in rectal cancer surgery—systematic review and meta-analysis. Oncotarget 9(29):20816–20825. https://doi.org/10.18632/oncotarget.25015CrossRefPubMedPubMedCentral

Kim S, Kim MH, Oh JH et al (2020) Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function. Color Dis 22(4):399–407. https://doi.org/10.1111/codi.14898CrossRef

den Dulk M, Smit M, Peeters KC et al (2007) A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol 8(4):297–303. https://doi.org/10.1016/S1470-2045(07)70047-5CrossRef

Näsvall P, Dahlstrand U, Löwenmark T, Rutegård J, Gunnarsson U, Strigård K (2017) Quality of life in patients with a permanent stoma after rectal cancer surgery. Qual Life Res 26(1):55–64. https://doi.org/10.1007/s11136-016-1367-6CrossRefPubMed

10.

Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG (2000) Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum 43(5):650–655. https://doi.org/10.1007/BF02235581CrossRefPubMed

11.

Tseng HC, Wang HH, Hsu YY, Weng WC (2004) Factors related to stress in outpatients with permanent colostomies. Kaohsiung J Med Sci 20(2):70–76. https://doi.org/10.1016/s1607-551x(09)70087-7CrossRefPubMed

12.

Shabbir J, Britton DC (2010) Stoma complications: a literature overview. Color Dis 12(10):958–964. https://doi.org/10.1111/j.1463-1318.2009.02006.xCrossRef

13.

Kwiatt M, Kawata M (2013) Avoidance and management of stomal complications. Clin Colon Rectal Surg 26(2):112–121. https://doi.org/10.1055/s-0033-1348050CrossRefPubMedPubMedCentral

14.

Hol JC, Burghgraef TA, Rutgers MLW et al (2021) Comparison of laparoscopic versus robot-assisted versus transanal total mesorectal excision surgery for rectal cancer: a retrospective propensity score-matched cohort study of short-term outcomes. Br J Surg. https://doi.org/10.1093/bjs/znab233CrossRefPubMedPubMedCentral

15.

Olthof PB, Giesen LJX, Vijfvinkel TS, Roos D, Dekker JWT (2020) Transition from laparoscopic to robotic rectal resection: outcomes and learning curve of the initial 100 cases. Surg Endosc 1:3. https://doi.org/10.1007/s00464-020-07731-0CrossRef

16.

Burghgraef TA, Crolla RM, Verheijen PM, Fahim M, van Geloven A, Leijtens JW, Pronk A, Smits AB, Verdaasdonk EG, Consten EC (2022) Robot-assisted total mesorectal excision versus laparoscopic total mesorectal excision: a retrospective propensity score-matched cohort analysis in experienced centers. Dis Colon Rectum 65(2):218–27CrossRefPubMed

17.

Feng Q, Yuan W, Li T et al (2022) Robotic versus laparoscopic surgery for middle and low rectal cancer (REAL): short-term outcomes of a multicentre randomised controlled trial. Lancet Gastroenterol Hepatol 7(11):991–1004. https://doi.org/10.1016/S2468-1253(22)00248-5CrossRefPubMed

18.

Souza N, Tot Babberich MP, Hoore A, Tiret E, Xynos E, Beets-Tan RG, Nagtegaal ID, Blomqvist L, Holm T, Glimelius B, Lacy A (2019) Definition of the rectum: an international, expert-based Delphi Consensus. Ann Surg 270(6):955–959CrossRef

19.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008CrossRef

20.

Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum : a proposal by the International Study Group of Rectal Cancer. Surgery 147:339–351. https://doi.org/10.1016/j.surg.2009.10.012CrossRefPubMed

21.

Landelijke werkgroep Gastro Intestinale Tumoren (2019) Richtlijn colorectaal carcinoom 4.0. https://www.oncoline.nl/colorectaalcarcinoom. Accessed 13 Jan 2020

22.

Seo SI, Yu CS, Kim GS et al (2013) Characteristics and risk factors associated with permanent stomas after sphincter-saving resection for rectal cancer. World J Surg 37(10):2490–2496. https://doi.org/10.1007/s00268-013-2145-zCrossRefPubMed

23.

Lee CM, Huh JW, Park YA et al (2015) Risk factors of permanent stomas in patients with rectal cancer after low anterior resection with temporary stomas. Yonsei Med J 56(2):447–453. https://doi.org/10.3349/ymj.2015.56.2.447CrossRefPubMedPubMedCentral

24.

Miura T, Sakamoto Y, Morohashi H, Yoshida T, Sato K, Hakamada K (2018) Risk factor for permanent stoma and incontinence quality of life after sphincter-preserving surgery for low rectal cancer without a diverting stoma. Ann Gastroenterol Surg 2(1):79–86. https://doi.org/10.1002/ags3.12033CrossRefPubMed

25.

Kim MJ, Kim YS, Park SC et al (2016) Risk factors for permanent stoma after rectal cancer surgery with temporary ileostomy. Surgery 159(3):721–727. https://doi.org/10.1016/j.surg.2015.09.011CrossRefPubMed

26.

Gadan S, Floodeen H, Lindgren R, Rutegård M, Matthiessen P (2020) What is the risk of permanent stoma beyond 5 years after low anterior resection for rectal cancer? A 15-year follow-up of a randomized trial. Color Dis 22(12):2098–2104. https://doi.org/10.1111/codi.15364CrossRef

27.

Shiraishi T, Nishizawa Y, Ikeda K, Tsukada Y, Sasaki T, Ito M (2020) Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery era. BMC Surg. https://doi.org/10.1186/s12893-020-00802-yCrossRefPubMedPubMedCentral

28.

Krishnamurty DM, Blatnik J, Mutch M (2017) Stoma complications. Clin Colon Rectal Surg 30(3):193–200. https://doi.org/10.1055/s-0037-1598160CrossRefPubMedPubMedCentral

29.

Koc U, Karaman K, Gomceli I et al (2017) A retrospective analysis of factors affecting early stoma complications. Ostomy Wound Manag 63(1):28–32

30.

Back E, Häggström J, Holmgren K et al (2021) Permanent stoma rates after anterior resection for rectal cancer: risk prediction scoring using preoperative variables. Br J Surg 108(11):1388–1395. https://doi.org/10.1093/bjs/znab260CrossRefPubMedPubMedCentral

31.

Greijdanus NG, Wienholts K, Ubels S et al (2023) Stoma-free survival after rectal cancer resection with anastomotic leakage. Ann Surg. https://doi.org/10.1097/SLA.0000000000006043CrossRefPubMed

32.

Malik TAM, Lee MJ, Harikrishnan AB (2018) The incidence of stoma related morbidity—a systematic review of randomised controlled trials. Ann R Coll Surg Engl 100(7):501–508. https://doi.org/10.1308/rcsann.2018.0126CrossRefPubMedPubMedCentral

33.

Nastro P, Knowles CH, McGrath A, Heyman B, Porrett TRC, Lunniss PJ (2010) Complications of intestinal stomas. Br J Surg 97(12):1885–1889. https://doi.org/10.1002/bjs.7259CrossRefPubMed

34.

Hazen SJA, Vogel I, Borstlap WAA et al (2021) Long-term stoma-related reinterventions after anterior resection for rectal cancer with or without anastomosis: population data from the Dutch snapshot study. Tech Coloproctol. https://doi.org/10.1007/s10151-021-02543-3CrossRefPubMed

35.

Lawday S, Flamey N, Fowler GE et al (2021) Quality of life in restorative versus non-restorative resections for rectal cancer: systematic review. BJS Open. https://doi.org/10.1093/bjsopen/zrab101CrossRefPubMedPubMedCentral

36.

Pachler J, Wille-Jørgensen P (2012) Quality of life after rectal resection for cancer, with or without permanent colostomy. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd004323.pub4CrossRefPubMedPubMedCentral

37.

Orsini RG, Thong MSY, Van De Poll-Franse LV et al (2013) Quality of life of older rectal cancer patients is not impaired by a permanent stoma. Eur J Surg Oncol 39(2):164–170. https://doi.org/10.1016/j.ejso.2012.10.005CrossRefPubMed

38.

Feddern ML, Emmertsen KJ, Laurberg S (2019) Quality of life with or without sphincter preservation for rectal cancer. Colorectal Dis 21(9):1051–1057. https://doi.org/10.1111/CODI.14684CrossRefPubMed

Title: Permanent stoma rate and long-term stoma complications in laparoscopic, robot-assisted, and transanal total mesorectal excisions: a retrospective cohort study
Authors: T. A. Burghgraef
R. T. J. Geitenbeek
M. Broekman
J. C. Hol
R. Hompes
E. C. J. Consten
The MIRECA Study Group
Publication date: 06-11-2023
Publisher: Springer US
Keywords: Enterostomy
Enterostomy
Colostomy
Rectal Cancer
Rectal Cancer
Ileostomy
Published in: Surgical Endoscopy / Issue 1/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-023-10517-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Permanent stoma rate and long-term stoma complications in laparoscopic, robot-assisted, and transanal total mesorectal excisions: a retrospective cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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