The effect of a diverting stoma on morbidity and risk of permanent stoma following anastomotic leakage after low anterio
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ORIGINAL ARTICLE
The effect of a diverting stoma on morbidity and risk of permanent stoma following anastomotic leakage after low anterior resection for rectal cancer: a nationwide cohort study Nis Hallundbæk Schlesinger 1
&
Henry Smith 1
Accepted: 14 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Diverting stomata (DS) have been shown to mitigate the clinical impact of anastomotic leakage (AL) but not without complications, and their routine use remains a matter of international debate. The objective of this study was to examine the association between stomata and the clinical consequences of AL. Methods This was a nationwide retrospective cohort study including all patients suffering from AL after low anterior resection from 2001 to 2010. Results Four thousand sixty-three patients were treated in the period of whom 581 (11.9%) developed AL. In case of AL, patients without a diverting stoma had a slightly higher 90-day mortality rate (13.5% versus 8.7%, p = 0.089). Patients suffered more complications due to AL, both surgical (52% versus 28%, p < 0.001) and non-surgical (48% versus 35%, p = 0.004) with a higher Clavien-Dindo score. Twenty percent of patients developed stoma-related complications prior to stoma reversal. Mortality related to stoma reversal was 2.4%. Factors associated with a risk of a permanent stoma were age (HR 1.04, 95% CI 1.01–1.08), blood transfusion during primary surgery (HR 2.35, 95% CI 1.16–4–78), conserved anastomosis after AL (HR 0.019, 95% CI 0.009– 0.04), and a diverting stoma fashioned at the index operation (HR 0.50, 95% CI 0.26–0.97). Conclusion The use of diverting stomata during low anterior resection mitigates the clinical impact of AL. However, this benefit needs to be balanced against the risk of stoma-related complications, seen in 20%, and mortality with stoma reversal (2.4%). Where practical, the decision to divert should be made pre-operatively in a multidisciplinary setting. Keywords Colorectal cancer . Anastomotic leakage . Diverting stoma
Introduction Colorectal cancer (CRC) accounts for a substantial proportion of the global cancer burden, affecting approximately 1.8 million people and resulting in approximately 900,000 cancerrelated deaths each year [1]. Surgery remains the primary treatment modality for the majority of patients with CRC, but despite recent achievements in minimally invasive cancer surgery, morbidity and mortality due to post-operative complications remains an immense challenge. Anastomotic leakage (AL) continues to be one of the most common and feared
* Nis Hallundbæk Schlesinger [email protected] 1
Department of Surgery, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, DK-2400 Copenhagen, NV, Denmark
complications, with an incidence of 5 to 20% after low anterior resection for rectal cancer [2–9]. The consequences of AL can be severe, with subsequent mortality rates ranging from 6 to 22% [2–9]. Other potential sequelae include the need for reoperation, persistent
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