Defunctioning stoma and anastomotic leak rate after total mesorectal excision with coloanal anastomosis in the context of PROCARE.
Details
Serval ID
serval:BIB_77729CED2F68
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Defunctioning stoma and anastomotic leak rate after total mesorectal excision with coloanal anastomosis in the context of PROCARE.
Journal
Acta Chirurgica Belgica
Contributor(s)
PROCARE , Bertrand C., De Coninck D., Duinslaeger M., Kartheuser A., Penninckx F., Van de Stadt J., Vaneerdeweg W., Claeys D., Burnon D., Haustermans K., Scalliet P., Spaas P., Demetter P., Jouret-Mourin A., Sempoux C., Demey W., Humblet Y., Van Cutsem E., Laurent S., Van Cutsem E., Van Laethem JL. , Danse E., Op de Beeck B., Smeets P., Melange M., Rahier J., Cabooter M., Pattyn P., Peeters M., Buset M., Haeck L., Mansvelt B., Van Eycken E., Dercq JP., Thijs A.
ISSN
0001-5458 (Print)
ISSN-L
0001-5458
Publication state
Published
Issued date
2012
Peer-reviewed
Oui
Volume
112
Number
1
Pages
10-14
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Abstract
BACKGROUND: Anastomotic leakage (AL) after total mesorectal excision is a major adverse event. Construction of a defunctioning stoma (DS) reduces the morbidity of AL. This study aims to illustrate the AL rate and its related morbidity with and without primary stoma formation in the context of a Belgian project, PROCARE.
METHODS: Between January 2006 and March 2011, 1912 patients who underwent elective TME with colo-anal anastomosis for invasive rectal adenocarcinoma up to 15 cm above the anal verge were registered. A primary DS was constructed in 1183 patients (62%). Early clinical AL rate, AL-related re-operation rate, length of stay (LoS), in-hospital mortality were analysed.
RESULTS: In patients without leak, mortality was 1.1% and the mean LoS was 14.7 days. AL occurred in 6.5%, varying from 0%-25% between participating centres. In patients with AL, mortality was 4.8% (p < 0.001). In the presence of a primary DS, AL rate was 4.3%, requiring re-operation under narcosis in 78% with no mortality, resulting in a mean LoS of 30.4 days. In the absence of a primary DS, AL rate was 10.2%, requiring re-operation under narcosis in 93% with a mortality of 8.1% and a mean LoS of 33.4 days. Analysis per centre showed a weak relation between percentage of DS construction and AL rate.
CONCLUSION: Construction of a primary DS significantly reduced the incidence of early AL, re-operation rate, and mortality. Although technical aspects of colo-anal anastomosis are of paramount importance, construction of a DS at primary surgery has to be considered by those teams with high early AL rate and/or high AL related mortality.
METHODS: Between January 2006 and March 2011, 1912 patients who underwent elective TME with colo-anal anastomosis for invasive rectal adenocarcinoma up to 15 cm above the anal verge were registered. A primary DS was constructed in 1183 patients (62%). Early clinical AL rate, AL-related re-operation rate, length of stay (LoS), in-hospital mortality were analysed.
RESULTS: In patients without leak, mortality was 1.1% and the mean LoS was 14.7 days. AL occurred in 6.5%, varying from 0%-25% between participating centres. In patients with AL, mortality was 4.8% (p < 0.001). In the presence of a primary DS, AL rate was 4.3%, requiring re-operation under narcosis in 78% with no mortality, resulting in a mean LoS of 30.4 days. In the absence of a primary DS, AL rate was 10.2%, requiring re-operation under narcosis in 93% with a mortality of 8.1% and a mean LoS of 33.4 days. Analysis per centre showed a weak relation between percentage of DS construction and AL rate.
CONCLUSION: Construction of a primary DS significantly reduced the incidence of early AL, re-operation rate, and mortality. Although technical aspects of colo-anal anastomosis are of paramount importance, construction of a DS at primary surgery has to be considered by those teams with high early AL rate and/or high AL related mortality.
Keywords
Adenocarcinoma/surgery, Adult, Aged, Aged, 80 and over, Anal Canal/surgery, Anastomotic Leak/epidemiology, Anastomotic Leak/prevention & control, Colon/surgery, Colostomy, Digestive System Surgical Procedures, Female, Humans, Incidence, Length of Stay, Male, Middle Aged, Quality Improvement, Rectal Neoplasms/surgery, Reoperation/statistics & numerical data
Pubmed
Web of science
Create date
20/10/2016 15:45
Last modification date
20/08/2019 14:34
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