Low preoperative maximum squeezing pressure evaluated by anorectal manometry is a risk factor for non-reversal of divert
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ORIGINAL ARTICLE
Low preoperative maximum squeezing pressure evaluated by anorectal manometry is a risk factor for non-reversal of diverting stoma Risa Fukui 1 & Hiroaki Nozawa 1 & Yugo Hirata 1 & Kazushige Kawai 1 & Keisuke Hata 1 & Toshiaki Tanaka 1 & Takeshi Nishikawa 1 & Yasutaka Shuno 1 & Kazuhito Sasaki 1 & Manabu Kaneko 1 & Koji Murono 1 & Shigenobu Emoto 1 & Hirofumi Sonoda 1 & Hiroaki Ishii 1 & Soichiro Ishihara 1 Received: 30 July 2020 / Accepted: 7 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose A diverting stoma is created to prevent anastomotic leakage and related complications impairing sphincteric function in rectal surgery. However, diverting stoma may be left unclosed. This study is aimed to analyze preoperative factors including anorectal manometric data associated with diverting stoma non-reversal before rectal surgery. We also addressed complications related to diverting stoma in patients undergoing surgery for rectal malignant tumor. Methods A total of 203 patients with rectal malignant tumor who underwent sphincter-preserving surgery with diverting stoma were retrospectively evaluated. The risk factors for non-reversal of diverting stoma were identified by univariate and multivariate analyses. For these analyses, anorectal manometric data were measured before rectal surgery. The association between stomarelated complications and other clinicopathological features was also analyzed. Results During the median follow-up of 46.4 months, 24% (49 patients) did not undergo stoma reversal. Among parameters that were available before rectal surgery, age ≥ 75 years, albumin < 3.5 g/dl, tumor size ≥ 30 mm, tumor distance from the anal verge < 4 cm, and maximum squeezing pressure (MSP) < 130 mmHg measured by anorectal manometry (ARM) were independent factors associated with stoma non-reversal. The most common stoma-related complication was peristomal skin irritation (25%). Ileostomy was the only factor associated with peristomal skin irritation. Conclusion The current study demonstrated that low preoperative MSP evaluated by ARM, old age, hypoalbuminemia, and a large tumor close to the anus were predictive of diverting stoma non-reversal. Stoma site should be well deliberated when patients have the aforementioned risk factors for diverting stoma non-reversal. Keywords Diverting stoma . Stoma non-reversal . Rectal tumor . Anorectal manometry
Introduction An increasing number of patients with rectal malignant tumor undergo sphincter-preserving surgery [1–6]. A diverting stoma is often created to prevent anastomotic leakage and related complications [7–10]. However, 14–35% of patients with diverting stoma did not receive stoma reversal afterwards
* Risa Fukui [email protected] 1
Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
[11–17]. Reported risk factors for stoma non-reversal include older age [18], higher body mass index [14], a lower hemoglobin level [17], a more impaired re
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