Top

Langenbeck's Archives of Surgery

Published in:

01-12-2023 | Enterostomy | Research

Defunctioning stoma and anastomotic stricture in rectal cancer surgery: a propensity score matching study

Authors: Haoran Wang, Xiao Wang, Peng Wang, Kai Lv, Haoqing He, Wenguang Yuan, Mofan Fu, Jingbo Chen, Hui Yang

Published in: Langenbeck's Archives of Surgery | Issue 1/2023

Abstract

Background

In cases of rectal cancer surgery, patients at high risk of anastomotic leakage often receive a defunctioning stoma (DS). However, its role in postoperative anastomotic strictures (AS) remains unclear. This study aimed to investigate the correlation between DS and AS and outcomes of transanal endoscopic microsurgery (TEM) in treating rectal AS.

Methods

This retrospective study was conducted from January 2019 to September 2021 and included patients who underwent rectal cancer surgery. A 1:1 ratio was used for propensity score matching (PSM). Univariate analyses were performed to identify statistically significant variables, and multivariate analyses were conducted to determine the factors affecting AS.

Results

This study included 383 patients. The results of the univariate analysis suggested that surgery time (HR 4.597, 95% CI 1.563–13.525, P=0.006), postoperative anastomotic leakage (HR 11.830, 95% CI 3.773–37.094, P<0.001), and DS (HR 15.475, 95% CI 6.042–39.641, P<0.001) were significantly associated with AS. In the multivariate analysis, postoperative anastomotic leakage (HR 7.596, 95% CI 1.987–29.044, P= 0.003) and DS (HR 11.252, 95% CI 4.113–30.779, P<0.001) were identified as significant risk factors for AS. After matching, the univariate analysis revealed that postoperative anastomotic leakage (HR 8.333, 95% CI 1.541–45.052, P= 0.014) and DS (HR 9.965, 95% CI 2.200–45.142, P= 0.003) were associated with AS. The multivariate analysis indicated that postoperative anastomotic leakage (HR 14.549, 95% CI 1.765–119.913, P= 0.013) and DS (HR 12.450, 95% CI 2.418–64.108, P= 0.003) were significant risk factors for AS.

Conclusions

This study provides evidence that DS is independently associated with AS, and postoperative anastomotic leakage increases the risk of AS. Furthermore, this study suggests that TEM could be a valuable treatment option for AS.

Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6(6):462–469PubMedCrossRef

Osera S, Ikematsu H, Odagaki T, Oono Y, Yano T, Kobayashi A et al (2015) Efficacy and safety of endoscopic radial incision and cutting for benign severe anastomotic stricture after surgery for lower rectal cancer (with video). Gastrointest Endosc 81(3):770–773PubMedCrossRef

Polese L, Vecchiato M, Frigo AC, Sarzo G, Cadrobbi R, Rizzato R et al (2012) Risk factors for colorectal anastomotic stenoses and their impact on quality of life: what are the lessons to learn? Colorectal Dis 14(3):e124–e128PubMedCrossRef

Schlegel RD, Dehni N, Parc R, Caplin S, Tiret E (2001) Results of reoperations in colorectal anastomotic strictures. Dis Colon Rectum 44(10):1464–1468PubMedCrossRef

Lee SY, Kim CH, Kim YJ, Kim HR (2018) Anastomotic stricture after ultralow anterior resection or intersphincteric resection for very low-lying rectal cancer. Surg Endosc 32(2):660–666PubMedCrossRef

Hu X, Guo P, Zhang N, Guo G, Li B, Liu Y et al (2023) Nomogram for benign anastomotic stricture after surgery for rectal cancer. Asian J Surg 46(1):111–119PubMedCrossRef

Kumar A, Daga R, Vijayaragavan P, Prakash A, Singh RK, Behari A et al (2011) Anterior resection for rectal carcinoma - risk factors for anastomotic leaks and strictures. World J Gastroenterol 17(11):1475–1479PubMedPubMedCentralCrossRef

Mathew J, Kazi M, Sukumar V, Thakur S, Desouza A, Saklani A (2023) Factors predicting successful resolution and long-term outcomes of benign anastomotic strictures following rectal cancer surgery. Eur J Surg Oncol 49(7):1307–1313. https://doi.org/10.1016/j.ejso.2023.02.012PubMedCrossRef

Lim M, Akhtar S, Sasapu K, Harris K, Burke D, Sagar P et al (2006) Clinical and subclinical leaks after low colorectal anastomosis: a clinical and radiologic study. Dis Colon Rectum 49(10):1611–1619PubMedCrossRef

10.

Clifford RE, Fowler H, Manu N, Vimalachandran D (2021) Management of benign anastomotic strictures following rectal resection: a systematic review. Colorectal Dis 23(12):3090–3100PubMedCrossRef

11.

Chan RH, Lin SC, Chen PC, Lin WT, Wu CH, Lee JC et al (2020) Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results. Tech Coloproctol 24(12):1271–1276PubMedPubMedCentralCrossRef

12.

Ran L, Chuanwang Y, Wei S, Wenguang Y, Liang H, Jiancheng Z et al (2022) Risk factors and treatment of rectal stenosis after transanal endoscopic microsurgery. Colorectal Dis 24(1):85–92PubMedCrossRef

13.

Bannura GC, Cumsille MA, Barrera AE, Contreras JP, Melo CL, Soto DC (2004) Predictive factors of stenosis after stapled colorectal anastomosis: prospective analysis of 179 consecutive patients. World J Surg 28(9):921–925PubMedCrossRef

14.

Seethapathy R, Zhao S, Long JD, Strohbehn IA, Sise ME (2022) A propensity score-matched observational study of remdesivir in patients with COVID-19 and severe kidney disease. Kidney360 3(2):269–278PubMedCrossRef

15.

Kraenzler A, Maggiori L, Pittet O, Alyami MS, AlDJ P, Panis Y (2017) Anastomotic stenosis after coloanal, colorectal and ileoanal anastomosis: what is the best management? Colorectal Dis 19(2):O90–OO6PubMedCrossRef

16.

Back E, Haggstrom J, Holmgren K, Haapamaki MM, Matthiessen P, Rutegard J et al (2021) Permanent stoma rates after anterior resection for rectal cancer: risk prediction scoring using preoperative variables. Br J Surg 108(11):1388–1395PubMedPubMedCentralCrossRef

17.

Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H et al (2005) Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92(9):1137–1142PubMedCrossRef

18.

Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl 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):207–214PubMedPubMedCentralCrossRef

19.

Hedrick TL, Sawyer RG, Foley EF, Friel CM (2006) Anastomotic leak and the loop ileostomy: friend or foe? Dis Colon Rectum 49(8):1167–1176PubMedCrossRef

20.

Sparreboom CL, van Groningen JT, Lingsma HF, Wouters M, Menon AG, Kleinrensink GJ et al (2018) Different risk factors for early and late colorectal anastomotic leakage in a nationwide audit. Dis Colon Rectum 61(11):1258–1266PubMedCrossRef

21.

Holmgren K, Haggstrom J, Haapamaki MM, Matthiessen P, Rutegard J, Rutegard M (2021) Defunctioning stomas may reduce chances of a stoma-free outcome after anterior resection for rectal cancer. Colorectal Dis 23(11):2859–2869PubMedCrossRef

22.

Hanna MH, Vinci A, Pigazzi A (2015) Diverting ileostomy in colorectal surgery: when is it necessary? Langenbecks Arch Surg 400(2):145–152PubMedCrossRef

23.

Pieniowski EHA, Nordenvall C, Johar A, Palmer G, Tumlin Ekelund S, Lagergren P et al (2022) Defunctioning stoma in rectal cancer surgery - a risk factor for low anterior resection syndrome? Eur J Surg Oncol 48(12):2518–2524PubMedCrossRef

24.

Bertocchi E, Barugola G, Benini M, Bocus P, Rossini R, Ceccaroni M et al (2019) Colorectal anastomotic stenosis: lessons learned after 1643 colorectal resections for deep infiltrating endometriosis. J Minim Invasive Gynecol 26(1):100–104PubMedCrossRef

25.

Davis B, Rivadeneira DE (2013) Complications of colorectal anastomoses: leaks, strictures, and bleeding. Surg Clin North Am 93(1):61–87PubMedCrossRef

26.

Biraima M, Adamina M, Jost R, Breitenstein S, Soll C (2016) Long-term results of endoscopic balloon dilation for treatment of colorectal anastomotic stenosis. Surg Endosc 30(10):4432–4437PubMedCrossRef

Title: Defunctioning stoma and anastomotic stricture in rectal cancer surgery: a propensity score matching study
Authors: Haoran Wang
Xiao Wang
Peng Wang
Kai Lv
Haoqing He
Wenguang Yuan
Mofan Fu
Jingbo Chen
Hui Yang
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Enterostomy
Enterostomy
Rectal Cancer
Rectal Cancer
Published in: Langenbeck's Archives of Surgery / Issue 1/2023
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-023-03118-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Defunctioning stoma and anastomotic stricture in rectal cancer surgery: a propensity score matching study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2023

Risk factors for recurrent disease in small papillary thyroid cancers – a Swedish register-based study

Textbook outcome contributes to long-term prognosis in older adults with gastric cancer

Prevalence of elevated alkaline phosphatase levels among post-bariatric surgery patients

Valvulotomy of the great saphenous vein in ex situ non-reversed and in situ setting: a multicenter post-market study to assess the safety and efficacy of the AndraValvulotome™”

Value of palliative surgery in perihilar cholangiocarcinoma

Prevalence of urinary dysfunction after minimally invasive surgery for deep rectosigmoid endometriosis