Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer
Objectives: In rectal cancer surgery, a diverting stoma (DS) is used to prevent severe anastomotic leakage (AL), peritonitis, reoperation, and longer hospitalization. DS creation has increased in the last few decades, without establishment of clear criteria for construction of a DS. Therefore, the g...
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| Format: | Article |
| Language: | English |
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The Japan Society of Coloproctology
2025-01-01
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| Series: | Journal of the Anus, Rectum and Colon |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/jarc/9/1/9_2024-047/_pdf/-char/en |
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| _version_ | 1832584906191929344 |
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| author | Hirotaka Momose Makoto Takahashi Masaya Kawai Kiichi Sugimoto Hiromitsu Takahashi Shunsuke Motegi Kumpei Honjo Yu Okazawa Rina Takahashi Shun Ishiyama Yuichi Tomiki Kazuhiro Sakamoto |
| author_facet | Hirotaka Momose Makoto Takahashi Masaya Kawai Kiichi Sugimoto Hiromitsu Takahashi Shunsuke Motegi Kumpei Honjo Yu Okazawa Rina Takahashi Shun Ishiyama Yuichi Tomiki Kazuhiro Sakamoto |
| author_sort | Hirotaka Momose |
| collection | DOAJ |
| description | Objectives: In rectal cancer surgery, a diverting stoma (DS) is used to prevent severe anastomotic leakage (AL), peritonitis, reoperation, and longer hospitalization. DS creation has increased in the last few decades, without establishment of clear criteria for construction of a DS. Therefore, the goal of the study was to investigate the validity of DS construction based on risk factors for AL, as an approach to reduce the number of stoma creations.
Methods: The subjects were 143 patients with rectal cancer who underwent laparoscopic or robot-assisted low anterior resection with DS creation from January 2010 to May 2021. Patients and operative characteristics were examined using univariate and multivariate analyses to identify risk factors for AL.
Results: Of the 143 subjects, 30 (21%) had AL, including asymptomatic AL in 19 cases (13%) and AL requiring conservative therapy in 11 cases (8%). No case of AL required reoperation. In cases with asymptomatic AL, there was a defect in the anastomosis found by colonoscopy several days after the operation, before discharge. In univariate analysis, preoperative Glasgow prognostic score (GPS) 1 (p=0.046) and number of stapler firings 3 (p=0.002) were associated with AL. In multivariate analysis, only GPS 1 was significantly associated with increased AL (p=0.033; OR=4.225; 95% CI 1.122 to 15.905).
Conclusions: DS creation is effective for avoiding reoperation for AL. Preoperative GPS 1 is a risk factor for AL in low anterior resection with a DS for rectal cancer. Thus, DS construction should be considered in a case with an elevated preoperative GPS. |
| format | Article |
| id | doaj-art-055ba2d2611048fba4369bd6e16cd6c7 |
| institution | Kabale University |
| issn | 2432-3853 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | The Japan Society of Coloproctology |
| record_format | Article |
| series | Journal of the Anus, Rectum and Colon |
| spelling | doaj-art-055ba2d2611048fba4369bd6e16cd6c72025-01-27T10:02:40ZengThe Japan Society of ColoproctologyJournal of the Anus, Rectum and Colon2432-38532025-01-0191889410.23922/jarc.2024-0472024-047Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal CancerHirotaka Momose0Makoto Takahashi1Masaya Kawai2Kiichi Sugimoto3Hiromitsu Takahashi4Shunsuke Motegi5Kumpei Honjo6Yu Okazawa7Rina Takahashi8Shun Ishiyama9Yuichi Tomiki10Kazuhiro Sakamoto11Department of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineDepartment of Coloproctological Surgery, Juntendo University Faculty of MedicineObjectives: In rectal cancer surgery, a diverting stoma (DS) is used to prevent severe anastomotic leakage (AL), peritonitis, reoperation, and longer hospitalization. DS creation has increased in the last few decades, without establishment of clear criteria for construction of a DS. Therefore, the goal of the study was to investigate the validity of DS construction based on risk factors for AL, as an approach to reduce the number of stoma creations. Methods: The subjects were 143 patients with rectal cancer who underwent laparoscopic or robot-assisted low anterior resection with DS creation from January 2010 to May 2021. Patients and operative characteristics were examined using univariate and multivariate analyses to identify risk factors for AL. Results: Of the 143 subjects, 30 (21%) had AL, including asymptomatic AL in 19 cases (13%) and AL requiring conservative therapy in 11 cases (8%). No case of AL required reoperation. In cases with asymptomatic AL, there was a defect in the anastomosis found by colonoscopy several days after the operation, before discharge. In univariate analysis, preoperative Glasgow prognostic score (GPS) 1 (p=0.046) and number of stapler firings 3 (p=0.002) were associated with AL. In multivariate analysis, only GPS 1 was significantly associated with increased AL (p=0.033; OR=4.225; 95% CI 1.122 to 15.905). Conclusions: DS creation is effective for avoiding reoperation for AL. Preoperative GPS 1 is a risk factor for AL in low anterior resection with a DS for rectal cancer. Thus, DS construction should be considered in a case with an elevated preoperative GPS.https://www.jstage.jst.go.jp/article/jarc/9/1/9_2024-047/_pdf/-char/endiverting stomaglasgow prognostic scoreminimally invasive surgeryrectal cancer |
| spellingShingle | Hirotaka Momose Makoto Takahashi Masaya Kawai Kiichi Sugimoto Hiromitsu Takahashi Shunsuke Motegi Kumpei Honjo Yu Okazawa Rina Takahashi Shun Ishiyama Yuichi Tomiki Kazuhiro Sakamoto Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer Journal of the Anus, Rectum and Colon diverting stoma glasgow prognostic score minimally invasive surgery rectal cancer |
| title | Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer |
| title_full | Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer |
| title_fullStr | Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer |
| title_full_unstemmed | Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer |
| title_short | Effects of Diverting Stoma Creation in Minimally Invasive Surgery for Rectal Cancer |
| title_sort | effects of diverting stoma creation in minimally invasive surgery for rectal cancer |
| topic | diverting stoma glasgow prognostic score minimally invasive surgery rectal cancer |
| url | https://www.jstage.jst.go.jp/article/jarc/9/1/9_2024-047/_pdf/-char/en |
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