Colorectal Dis. 2021 Nov;23(11):2937-2947. doi: 10.1111/codi.15878. Epub 2021 Sep 07.
Time interval between rectal cancer resection and reintervention for anastomotic leakage and the impact of a defunctioning stoma: A Dutch population-based study.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
Anne-Loes K Warps, Rob A E M Tollenaar, Pieter J Tanis, Jan Willem T Dekker,
Affiliations
Affiliations
- Department of Surgery, Leiden University Medical Centre, Leiden University, Leiden, The Netherlands.
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
- Department of Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.
- Department of surgery, Reinier de Graaf Groep, Delft, The Netherlands.
PMID: 34407272
DOI: 10.1111/codi.15878
Abstract
AIM: In the Netherlands, a selective policy of faecal diversion after rectal cancer surgery is generally applied. This study aimed to evaluate the timing, type, and short-term outcomes of reoperation for anastomotic leakage after primary rectal cancer resection stratified for a defunctioning stoma.
METHOD: Data of all patients who underwent primary rectal cancer surgery with primary anastomosis from 2013-2019 were extracted from the Dutch ColoRectal Audit. Primary outcomes were new stoma construction, mortality, ICU admission, prolonged hospital stay, and readmission.
RESULTS: In total, 10,772 rectal cancer patients who underwent surgery with primary anastomosis were included, of whom 46.6% received a primary defunctioning stoma. The reintervention rate for anastomotic leakage was 8.2% and 11.6% for patients with and without a defunctioning stoma (p < 0.001). Reintervention consisted of reoperation in 44.0% and 85.3% (p < 0.001), with a median time interval from primary resection to reoperation of seven days (IQR 4-14) vs. five days (IQR 3-13), respectively. In the presence of a defunctioning stoma, early reoperation (<5 days; n = 47) was associated with significantly more end-colostomy construction (51% vs. 33%) and ICU admission (66% vs. 38%) than late reoperation (≥5 days; n = 127). Without defunctioning stoma, early reoperation (n = 252) was associated with significantly higher mortality (4% vs. 1%), and more ICU admissions (52% vs.34%) than late reoperation (n = 302).
CONCLUSIONS: Early reoperations after rectal cancer resection are associated with worse outcomes reflected by a more frequent ICU admission in general, more colostomy construction, and higher mortality in patients with primary defunctioned and nondefunctioned anastomosis.
© 2021 The Association of Coloproctology of Great Britain and Ireland.
Keywords: anastomotic leakage; rectal cancer; reoperation; stoma; surgery; time interval
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