TY - JOUR
T1 - Prophylactic defunctioning stomas improve clinical outcomes of anastomotic leak following rectal cancer resections
T2 - An analysis of the US Rectal Cancer Consortium
AU - Hrebinko, Katherine
AU - Anto, Vincent P.
AU - Reitz, Katherine M.
AU - Gamboa, Adriana C.
AU - Regenbogen, Scott E.
AU - Hawkins, Alexander T.
AU - Hopkins, M. Benjamin
AU - Ejaz, Aslam
AU - Bauer, Philip S.
AU - Wise, Paul E.
AU - Balch, Glen C.
AU - Holder-Murray, Jennifer
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/12
Y1 - 2024/12
N2 - Purpose: Anastomotic leak (AL) is a complication of low anterior resection (LAR) that results in substantial morbidity. There is immense interest in evaluating immediate postoperative and long-term oncologic outcomes in patients who undergo diverting loop ileostomies (DLI). The purpose of this study is to understand the relationship between fecal diversion, AL, and oncologic outcomes. Methods: This is a retrospective multicenter cohort study using patient data obtained from the US Rectal Cancer Consortium database compiled from six academic institutions. The study population included patients with rectal adenocarcinoma undergoing LAR. The primary outcome was the incidence of AL among patients who did or did not receive DLI during LAR. Secondary outcomes included risk factors for AL, receipt of adjuvant therapy, 3-year overall survival, and 3-year recurrence. Results: Of 815 patients, 38 (4.7%) suffered AL after LAR. Patients with AL were more likely to be male, have unintentional preoperative weight loss, and are less likely to undergo DLI. On multivariable analysis, DLI remained protective against AL (p < 0.001). Diverted patients were less likely to undergo future surgical procedures including additional ostomy creation, completion proctectomy, or pelvic washout for AL. Subgroup analysis of 456 patients with locally advanced disease showed that DLI was correlated with increased receipt of adjuvant therapy for patients with and without AL on univariate analysis (SHR:1.59; [95% CI 1.19–2.14]; p = 0.002), but significance was not met in multivariate models. Conclusion: Lack of DLI and preoperative weight loss was associated with anastomotic leak. Fecal diversion may improve the timely initiation of adjuvant oncologic therapy. The long-term outcomes following routine diverting stomas warrant further study.
AB - Purpose: Anastomotic leak (AL) is a complication of low anterior resection (LAR) that results in substantial morbidity. There is immense interest in evaluating immediate postoperative and long-term oncologic outcomes in patients who undergo diverting loop ileostomies (DLI). The purpose of this study is to understand the relationship between fecal diversion, AL, and oncologic outcomes. Methods: This is a retrospective multicenter cohort study using patient data obtained from the US Rectal Cancer Consortium database compiled from six academic institutions. The study population included patients with rectal adenocarcinoma undergoing LAR. The primary outcome was the incidence of AL among patients who did or did not receive DLI during LAR. Secondary outcomes included risk factors for AL, receipt of adjuvant therapy, 3-year overall survival, and 3-year recurrence. Results: Of 815 patients, 38 (4.7%) suffered AL after LAR. Patients with AL were more likely to be male, have unintentional preoperative weight loss, and are less likely to undergo DLI. On multivariable analysis, DLI remained protective against AL (p < 0.001). Diverted patients were less likely to undergo future surgical procedures including additional ostomy creation, completion proctectomy, or pelvic washout for AL. Subgroup analysis of 456 patients with locally advanced disease showed that DLI was correlated with increased receipt of adjuvant therapy for patients with and without AL on univariate analysis (SHR:1.59; [95% CI 1.19–2.14]; p = 0.002), but significance was not met in multivariate models. Conclusion: Lack of DLI and preoperative weight loss was associated with anastomotic leak. Fecal diversion may improve the timely initiation of adjuvant oncologic therapy. The long-term outcomes following routine diverting stomas warrant further study.
KW - Anastomotic leak
KW - Clinical outcomes
KW - Fecal diversion
KW - Rectal cancer
UR - http://www.scopus.com/inward/record.url?scp=85188092618&partnerID=8YFLogxK
U2 - 10.1007/s00384-024-04600-3
DO - 10.1007/s00384-024-04600-3
M3 - Article
C2 - 38498217
AN - SCOPUS:85188092618
SN - 0179-1958
VL - 39
JO - International Journal of Colorectal Disease
JF - International Journal of Colorectal Disease
IS - 1
M1 - 39
ER -