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24-05-2023 | Rectal Cancer | Original Article

High-output stoma is a risk factor for stoma outlet obstruction in defunctioning loop ileostomies after rectal cancer surgery

Authors: Yuta Imaizumi, Yasuhiro Takano, Atsuko Okamoto, Takafumi Nakano, Naoki Takada, Hiroshi Sugano, Yasuhiro Takeda, Masahisa Ohkuma, Makoto Kosuge, Ken Eto

Published in: Surgery Today | Issue 2/2024

Abstract

Purpose

Defunctioning loop ileostomy has been reported to reduce symptomatic anastomotic leakage after rectal cancer surgery; however, stoma outlet obstruction (SOO) is a serious postileostomy complication. We, therefore, explored novel risk factors for SOO in defunctioning loop ileostomy after rectal cancer surgery.

Methods

This is a retrospective study that included 92 patients who underwent defunctioning loop ileostomy with rectal cancer surgery at our institution. Among them, 77 and 15 ileostomies were created at the right lower abdominal and umbilical sites, respectively. We defined the output volume_MAX as the maximum output volume the day before the onset of SOO or—for those without SOO—that was observed during hospitalization. Univariate and multivariate analyses were performed to evaluate risk factors for SOO.

Results

SOO was observed in 24 cases, and the median onset was 6 days postoperatively. The stoma output volume in the SOO group was consistently higher than that in the non-SOO group. In the multivariate analysis, the rectus abdominis thickness (p < 0.01) and output volume_MAX (p < 0.01) were independent risk factors for SOO.

Conclusion

A high-output stoma may predict SOO in patients with defunctioning loop ileostomy for rectal cancer. Considering that SOO occurs even at umbilical sites with no rectus abdominis, a high-output stoma may trigger SOO primarily.

Yeh CY, Changchien CR, Wang JY, Chen JS, Chen HH, Chiang JM, et al. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg. 2005;241:9–13.CrossRefPubMedPubMedCentral

Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1014 patients. J Am Coll Surg. 1997;185:105–13.CrossRefPubMed

Eckmann C, Kujath P, Schiedeck TH, Shekarriz H, Bruch HP. Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis. 2004;19:128–33.CrossRefPubMed

Detry RJ, Kartheuser A, Delriviere L, Saba J, Kestens PJ. Use of the circular stapler in 1000 consecutive colorectal anastomoses: experience of one surgical team. Surgery. 1995;117:140–5.CrossRefPubMed

Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg. 2005;81:1224–6.CrossRef

Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2005;92:211–6.CrossRefPubMed

Branagan G, Finnis D. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum. 2005;48:1021–6.CrossRefPubMed

Biondo S, Parés D, Kreisler E, Ragué JM, Fraccalvieri D, Ruiz AG, et al. Anastomotic dehiscence after resection and primary anastomosis in left-sided colonic emergencies. Dis Colon Rectum. 2005;48:2272–80.CrossRefPubMed

Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg. 2002;26:499–502.CrossRefPubMed

10.

Caulfield H, Hyman NH. Anastomotic leak after low anterior resection: a spectrum of clinical entities. JAMA Surg. 2013;148:177–82.CrossRefPubMed

11.

Ptok H, Marusch F, Meyer F, Schubert D, Gastinger I, Lippert H, et al. Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg. 2007;94:1548–54.CrossRefPubMed

12.

Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis. 2005;7:51–7.CrossRefPubMed

13.

Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, et al. Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg. 2003;90:1261–6.CrossRefPubMed

14.

Bertelsen CA, Andreasen AH, Jorgensen T, Harling H, Danish Colorectal Cancer G. Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis. 2010;12:37–43.CrossRefPubMed

15.

Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.CrossRefPubMedPubMedCentral

16.

Chude GG, Rayate NV, Patris V, Koshariya M, Jagad R, Kawamoto J, et al. Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospect Randomiz Study Hepatogastroenterology. 2008;55:1562–7.

17.

Okada S, Hata K, Emoto S, Murono K, Kaneko M, Sasaki K, et al. Elevated risk of stoma outlet obstruction following colorectal surgery in patients undergoing ileal pouch-anal anastomosis: a retrospective cohort study. Surg Today. 2018;48:1060–7.CrossRefPubMed

18.

Tamura K, Matsuda K, Yokoyama S, Iwamoto H, Mizumoto Y, Murakami D, et al. Defunctioning loop ileostomy for rectal anastomoses: predictors of stoma outlet obstruction. Int J Colorectal Dis. 2019;34:1141–5.CrossRefPubMed

19.

Ohira G, Miyauchi H, Hayano K, Kagaya A, Imanishi S, Tochigi T, et al. Incidence and risk factor of outlet obstruction after construction of ileostomy. J Anus Rectum Colon. 2018;2:25–30.CrossRefPubMedPubMedCentral

20.

Sasaki S, Nagasaki T, Oba K, Akiyoshi T, Mukai T, Yamaguchi T, et al. Risk factors for outlet obstruction after laparoscopic surgery and diverting ileostomy for rectal cancer. Surg Today. 2021;51:366–73.CrossRefPubMed

21.

Enomoto H, Suwa K, Takeuchi N, Hannya Y, Tsukazaki Y, Ushigome T, et al. Risk of outlet obstruction associated with defunctioning loop ileostomy in rectal cancer surgery. Cancer Diagn Progn. 2021;1:465–70.CrossRefPubMedPubMedCentral

22.

Abe T, Nishimura J, Yasui M, Matsuda C, Haraguchi N, Nakai N, et al. Risk factors for outlet obstruction in patients with diverting ileostomy following rectal surgery. J Anus Rectum Colon. 2021;5:254–60.CrossRefPubMedPubMedCentral

23.

Kuwahara K, Mokuno Y, Matsubara H, Uji M, Kobayashi I, Iyomasa S. Risk factors for stoma outlet obstruction: preventing this complication after construction of diverting ileostomy during laparoscopic colorectal surgery. JMA J. 2022;5:207–15.PubMedPubMedCentral

24.

Eto K, Omura N, Haruki K, Uno Y, Ohkuma M, Nakajima S, et al. Transumbilical defunctioning ileostomy: a new approach for patients at risks of anastomotic leakage after laparoscopic low anterior resection. Anticancer Res. 2013;33:5011–6.PubMed

25.

Eto KEN, Kosuge M, Ohkuma M, Haruki K, Neki KAI, Mitsumori N, et al. Comparison of transumbilical and conventional defunctioning ileostomy in laparoscopic anterior resections for rectal cancer. Anticancer Res. 2016;36:4139.PubMed

26.

Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, et al. Preoperative chemoradiotherapy might improve the prognosis of patients with locally advanced low rectal cancer and lateral pelvic lymph node metastases. World J Surg. 2017;41:876–83.CrossRefPubMed

27.

Kitahara T, Sato Y, Oshiro T, Matsunaga R, Nagashima M, Okazumi S. Risk factors for postoperative stoma outlet obstruction in ulcerative colitis. World J Gastrointest Surg. 2020;12:507–19.CrossRefPubMedPubMedCentral

28.

Arenas Villafranca JJ, Lopez-Rodriguez C, Abiles J, Rivera R, Gandara Adan N, Utrilla NP. Protocol for the detection and nutritional management of high-output stomas. Nutr J. 2015;14:45.CrossRefPubMedPubMedCentral

29.

Hara Y, Miura T, Sakamoto Y, Morohashi H, Nagase H, Hakamada K. Organ/space infection is a common cause of high output stoma and outlet obstruction in diverting ileostomy. BMC Surg. 2020;20:83.CrossRefPubMedPubMedCentral

Title: High-output stoma is a risk factor for stoma outlet obstruction in defunctioning loop ileostomies after rectal cancer surgery
Authors: Yuta Imaizumi
Yasuhiro Takano
Atsuko Okamoto
Takafumi Nakano
Naoki Takada
Hiroshi Sugano
Yasuhiro Takeda
Masahisa Ohkuma
Makoto Kosuge
Ken Eto
Publication date: 24-05-2023
Publisher: Springer Nature Singapore
Keywords: Rectal Cancer
Rectal Cancer
Enterostomy
Ileostomy
Enterostomy
Published in: Surgery Today / Issue 2/2024
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-023-02704-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

High-output stoma is a risk factor for stoma outlet obstruction in defunctioning loop ileostomies after rectal cancer surgery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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