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Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients
BACKGROUND: One of the most severe complications of low anterior rectal resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the prevalence of AL requiring surgical intervention. However, up to one-third of temporary stomas may never be closed. The first aim of the st...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427951/ https://www.ncbi.nlm.nih.gov/pubmed/32795302 http://dx.doi.org/10.1186/s12957-020-01979-5 |
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author | Zeman, Marcin Czarnecki, Marek Chmielarz, Andrzej Idasiak, Adam Grajek, Maciej Czarniecka, Agnieszka |
author_facet | Zeman, Marcin Czarnecki, Marek Chmielarz, Andrzej Idasiak, Adam Grajek, Maciej Czarniecka, Agnieszka |
author_sort | Zeman, Marcin |
collection | PubMed |
description | BACKGROUND: One of the most severe complications of low anterior rectal resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the prevalence of AL requiring surgical intervention. However, up to one-third of temporary stomas may never be closed. The first aim of the study was to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study was to assess preoperative PS risk factors in patients with LI. METHODS: A total of 286 consecutive patients who underwent low anterior rectal resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and the values of selected peripheral blood parameters were analysed. RESULTS: PS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p < 0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p < 0.001). In the LI group, the only significant risk factor for PS in the multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.007, 97.5% CI 1.002–1.013, p = 0.013). CONCLUSIONS: Although protective LI may reduce the incidence of symptomatic AL, it can be related to a higher risk of PS in this group of patients. The preoperative plasma fibrinogen concentration can be a risk factor for PS in LI patients and may be a useful variable in decision-making models. |
format | Online Article Text |
id | pubmed-7427951 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-74279512020-08-17 Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients Zeman, Marcin Czarnecki, Marek Chmielarz, Andrzej Idasiak, Adam Grajek, Maciej Czarniecka, Agnieszka World J Surg Oncol Research BACKGROUND: One of the most severe complications of low anterior rectal resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the prevalence of AL requiring surgical intervention. However, up to one-third of temporary stomas may never be closed. The first aim of the study was to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study was to assess preoperative PS risk factors in patients with LI. METHODS: A total of 286 consecutive patients who underwent low anterior rectal resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and the values of selected peripheral blood parameters were analysed. RESULTS: PS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p < 0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p < 0.001). In the LI group, the only significant risk factor for PS in the multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.007, 97.5% CI 1.002–1.013, p = 0.013). CONCLUSIONS: Although protective LI may reduce the incidence of symptomatic AL, it can be related to a higher risk of PS in this group of patients. The preoperative plasma fibrinogen concentration can be a risk factor for PS in LI patients and may be a useful variable in decision-making models. BioMed Central 2020-08-14 /pmc/articles/PMC7427951/ /pubmed/32795302 http://dx.doi.org/10.1186/s12957-020-01979-5 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Zeman, Marcin Czarnecki, Marek Chmielarz, Andrzej Idasiak, Adam Grajek, Maciej Czarniecka, Agnieszka Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients |
title | Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients |
title_full | Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients |
title_fullStr | Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients |
title_full_unstemmed | Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients |
title_short | Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients |
title_sort | assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427951/ https://www.ncbi.nlm.nih.gov/pubmed/32795302 http://dx.doi.org/10.1186/s12957-020-01979-5 |
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