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Risk Factors in Anastomotic Leaks After Low Anterior Resection for Rectal Cancer and the Effects of Diverting Stoma on Clinical Results

Turkish journal of colorectal disease, 2018-10, Vol.28 (3), p.114-120 [Peer Reviewed Journal]

2018. This work is published under https://creativecommons.org/licenses/by-nc/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;ISSN: 2536-4898 ;EISSN: 2536-4901 ;DOI: 10.4274/tjcd.57704

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  • Title:
    Risk Factors in Anastomotic Leaks After Low Anterior Resection for Rectal Cancer and the Effects of Diverting Stoma on Clinical Results
  • Author: Gündeş, Ebubekir ; Çetin, Durmuş Ali ; Aday, Ulaş ; Çiyiltepe, Hüseyin ; Bozdağ, Emre ; Uzun, Orhan ; Değer, Kamuran Cumhur ; Duman, Mustafa
  • Çolak,Tahsin
  • Subjects: Cancer surgery ; Colorectal cancer ; Health risk assessment ; Ostomy ; Tıp
  • Is Part Of: Turkish journal of colorectal disease, 2018-10, Vol.28 (3), p.114-120
  • Description: Aim: The aim of this study was to determine the risk factors which might render patients who underwent rectal cancer surgery prone to anastomotic leaks (AL) and to investigate whether diverting stoma (DS) alleviated the severity of AL. Method: Patients who underwent elective curative surgery because of rectal cancer in our clinic between January 2010 and December 2016 were included in the study. The definition and grading of AL were determined using the criteria put forward by the International Study Group of Rectal Cancer. Relationships among variables related to the clinical, surgical, and pathological results of patients with AL were investigated through univariate and multivariate analyses. Patients observed to have AL were classified as those with and without DS for subgroup analysis. Results: Of 110 patients who underwent low anterior resection, AL was detected in 19 patients (17.2%). Sixty-three patients (57.3%) had DS during the first surgery [DS (+)], while 47 patients (42.7%) did not [DS (-)]. The results of the univariate analysis revealed significant associations between AL and male sex, chronic artery disease (CAD), preoperative chemoradiation (CRT), preoperative hemoglobin <10 g/dL, and operation time >300 (minute). There was no significant relationship between AL and DS [p=0.653; odds ratio (OR)=0.797; 95% confidence interval (CI)=0.295-2.149]. The results of the multivariate analysis, however, showed CAD (p=0.024; OR=4.201; 95% CI=0.069-0.824) and preoperative CRT (p=0.030; OR=3.66; 95% CI=0.017-1.804) as independent prognostic factors. In subgroup analysis of patients with AL, the DS (-) group had significantly longer mean hospital stay (p=0.049), higher Clavien-Dindo morbidity score (p=0.028), and more severe AL (p=0.002). Relaparotomy was performed in 7 patients (77.7%) in the DS (-) group but none of the patients in the DS (+) group (p=0.001). Conclusion: CAD and preoperative CRT were associated with increased risk of AL after rectal cancer surgery. Although diversion ostomy procedures do not decrease AL and postoperative mortality rates, we believe that DS alleviates the severity of AL. Therefore, they enable leaks to be treated palliatively and reduce the need for emergency reoperations.
  • Publisher: Mersin: Türk Kolon Ve Rektum Cerrahisi Derneği
  • Language: English;Turkish
  • Identifier: ISSN: 2536-4898
    EISSN: 2536-4901
    DOI: 10.4274/tjcd.57704
  • Source: AUTh Library subscriptions: ProQuest Central
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