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Evaluation of selective defunctioning stoma after low anterior resection for rectal cancer.

Abstract：

BACKGROUND:Anastomotic leakage is a major concern after resection for low rectal cancer. Therefore, the use of a defunctioning stoma (DS) has been suggested, but limited data exist to clearly determine the necessity of a routine diversion. In our department, the indication of DS was evaluated subjectively by the operating surgeon. The aim of this study was to evaluate the selective use of fecal diversion. MATERIALS AND METHODS:Retrospective chart review of patients who underwent low anterior resection for carcinoma was performed. The incidence and consequences of clinical leaks were determined in these patients who were considered in two groups: defunctioning stoma and no defunctioning stoma. RESULTS:From 1995 to 2005, 132 consecutive patients underwent low anterior resection; a DS was performed in 42 patients (31.8%). Median level of anastomosis was 4 cm in both groups. Overall clinical leakage rate was 9.8%: 7.1% (n = 3) with a DS and 11% (n = 10) without a stoma. Mortality rate was 1.5% (n = 2), both in the unprotected group. No patient in the diversion group required a permanent stoma, contrasting with four unprotected patients in which continuity could not be restored after break down of the anastomosis. CONCLUSION:Finding lower clinical leakage rate in a probable higher risk group and better outcome when a leak occurs in our study constituted strong evidence of the effectiveness of a DS. Selective use of a DS based on subjective assessment at the time of surgery could not allow experienced surgeons to perform single-stage procedure safely. Construction of a DS seems useful for patients with distal rectal cancer.

journal_name

Int J Colorectal Dis

journal_title

International journal of colorectal disease

authors

Lefebure B,Tuech JJ,Bridoux V,Costaglioli B,Scotte M,Teniere P,Michot F

doi

10.1007/s00384-007-0380-1

subject

Has Abstract

pub_date

2008-03-01 00:00:00

pages

283-8

issue

3

eissn

0179-1958

issn

1432-1262

journal_volume

23

pub_type

杂志文章

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