Long-term restoration of bowel continuity after rectal cancer resection and the influence of surgical technique: A nationwide cross-sectional study.
permanent stoma
rectal cancer
robot‐assisted laparoscopy
total mesorectal excision
transanal total mesorectal excision
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
05 May 2024
05 May 2024
Historique:
revised:
10
01
2024
received:
02
10
2023
accepted:
02
04
2024
medline:
6
5
2024
pubmed:
6
5
2024
entrez:
6
5
2024
Statut:
aheadofprint
Résumé
Literature on nationwide long-term permanent stoma rates after rectal cancer resection in the minimally invasive era is scarce. The aim of this population-based study was to provide more insight into the permanent stoma rate with interhospital variability (IHV) depending on surgical technique, with pelvic sepsis, unplanned reinterventions and readmissions as secondary outcomes. Patients who underwent open or minimally invasive resection of rectal cancer (lower border below the sigmoid take-off) in 67 Dutch centres in 2016 were included in this cross-sectional cohort study. Among 2530 patients, 1470 underwent a restorative resection (58%), 356 a Hartmann's procedure (14%, IHV 0%-42%) and 704 an abdominoperineal resection (28%, IHV 3%-60%). Median follow-up was 51 months. The overall permanent stoma rate at last follow-up was 50% (IHV 13%-79%) and the unintentional permanent stoma rate, permanent stoma after a restorative procedure or an unplanned Hartmann's procedure, was 11% (IHV 0%-29%). A total of 2165 patients (86%) underwent a minimally invasive resection: 1760 conventional (81%), 170 transanal (8%) and 235 robot-assisted (11%). An anastomosis was created in 59%, 80% and 66%, with corresponding unintentional permanent stoma rates of 12%, 24% and 14% (p = 0.001), respectively. When corrected for age, American Society of Anesthesiologists classification, cTNM, distance to the anorectal junction and neoadjuvant (chemo)radiotherapy, the minimally invasive technique was not associated with an unintended permanent stoma (p = 0.071) after a restorative procedure. A remarkable IHV in the permanent stoma rate after rectal cancer resection was found. No beneficial influence of transanal or robot-assisted laparoscopy on the unintentional permanent stoma rate was found, although this might be caused by the surgical learning curve. A reduction in IHV and improving preoperative counselling for decision-making for restorative procedures are required.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : KWF Kankerbestrijding
ID : 12768
Investigateurs
Arend G J Aalbers
(AGJ)
Susanna M van Aalten
(SM)
Femke J Amelung
(FJ)
Marjolein Ankersmit
(M)
Imogeen E Antonisse
(IE)
Jesse F Ashruf
(JF)
Tjeerd S Aukema
(TS)
Henk Avenarius
(H)
Renu R Bahadoer
(RR)
Frans C H Bakers
(FCH)
Ilsalien S Bakker
(IS)
Fleur Bangert
(F)
Renée M Barendse
(RM)
Heleen M D Beekhuis
(HMD)
Willem A Bemelman
(WA)
Maaike Berbée
(M)
Shira H de Bie
(SH)
Robert H C Bisschops
(RHC)
Liselotte W van Bockel
(LW)
Anniek H Boer
(AH)
Frank C den Boer
(FC)
Evert-Jan G Boerma
(EG)
Leonora S F Boogerd
(LSF)
Jaap Borstlap
(J)
Robin D Blok
(RD)
Johanna E Bouwman
(JE)
Sicco J Braak
(SJ)
Manon N G J A Braat
(MNGJA)
Jennifer Bradshaw
(J)
Amarins T A Brandsma
(ATA)
Vivian van Breest Smallenburg
(V)
Wim T van den Broek
(WT)
Sjirk W van der Burg
(SW)
Jacobus W A Burger
(JWA)
Thijs A Burghgraef
(TA)
David W G Ten Cate
(DWG)
Heleen M Ceha
(HM)
Jeltsje S Cnossen
(JS)
J Robert
(J)
Coebergh van den Braak
(C)
Maaike Corver
(M)
Rogier M P H Crolla
(RMPH)
Sam Curutchet
(S)
Alette W Daniëls-Gooszen
(AW)
Paul H P Davids
(PHP)
Emmelie N Dekker
(EN)
Jan Willem T Dekker
(JWT)
Ahmet Demirkiran
(A)
Tyche Derksen
(T)
Arjen L Diederik
(AL)
Anne M Dinaux
(AM)
Kemal Dogan
(K)
Ilse M van Dop
(IM)
Kitty E Droogh-de Greve
(KE)
Hanneke Duijsens
(H)
Michalda S Dunker
(MS)
Johan Duyck
(J)
Eino B van Duyn
(EB)
Laurentine S E van Egdom
(LSE)
Bram Eijlers
(B)
Youssef El-Massoudi
(Y)
Saskia van Elderen
(S)
Anouk M L H Emmen
(AMLH)
Marc Engelbrecht
(M)
Anne C van Erp
(AC)
Jeroen A van Essen
(JA)
Hans F J Fabry
(HFJ)
Thomas Fassaert
(T)
Eline A Feitsma
(EA)
Shirin S Feshtali
(SS)
Bas Frietman
(B)
Edgar J B Furnée
(EJB)
Anne van Geel
(A)
Elisabeth D Geijsen
(ED)
Nanette van Geloven
(N)
Michael F Gerhards
(MF)
Hugo Gielkens
(H)
Renza van Gils
(R)
Lucas Goense
(L)
Marc J P M Govaert
(MJPM)
Wilhelmina M U van Grevenstein
(WMU)
Elisabeth J de Groof
(EJ)
Irene de Groot
(I)
Robbert J de Haas
(RJ)
Nadia A G Hakkenbrak
(NAG)
Mariska D den Hartogh
(MD)
Vera Heesink
(V)
Joost T Heikens
(JT)
Ellen M Hendriksen
(EM)
Sjoerd van den Hoek
(S)
Erik J R J van der Hoeven
(EJRJ)
Christiaan Hoff
(C)
Anna Hogewoning
(A)
Cornelis R C Hogewoning
(CRC)
Stefan Hoogendoorn
(S)
Francois van Hoorn
(F)
René L van der Hul
(RL)
Rieke van Hulst
(R)
Farshad Imani
(F)
Bas Inberg
(B)
Martijn P W Intven
(MPW)
Pedro Janssen
(P)
Chris E J de Jong
(CEJ)
Jacoline Jonkers
(J)
Daniela Jou-Valencia
(D)
Bas Keizers
(B)
Stijn H J Ketelaers
(SHJ)
Eva Knöps
(E)
Sebastiaan van Koeverden
(S)
Sylvia Kok
(S)
Stephanie E M Kolderman
(SEM)
Fleur I de Korte
(FI)
Robert T J Kortekaas
(RTJ)
Julie C Korving
(JC)
Ingrid M Koster
(IM)
Jasenko Krdzalic
(J)
Pepijn Krielen
(P)
Leonard F Kroese
(LF)
Eveline Krul
(E)
Derk Lahuis
(D)
Bas Lamme
(B)
An A G van Landeghem
(AAG)
Jeroen W A Leijtens
(JWA)
Mathilde M Leseman-Hoogenboom
(MM)
Manou de Lijster
(M)
Martijn S Marsman
(MS)
Milou H Martens
(MH)
Ilse Masselink
(I)
Wout van der Meij
(W)
Philip Meijnen
(P)
Jarno Melenhorst
(J)
Dietrich J L de Mey
(DJL)
Julia Moelker-Galuzina
(J)
Linda Morsink
(L)
Erik J Mulder
(EJ)
Karin Muller
(K)
Gijsbert D Musters
(GD)
Joost Nederend
(J)
Peter A Neijenhuis
(PA)
Lindsey C F de Nes
(LCF)
M Nielen
(M)
Jan B J van den Nieuwboer
(JBJ)
Jonanne F Nieuwenhuis
(JF)
Joost Nonner
(J)
Bo J Noordman
(BJ)
Stefi Nordkamp
(S)
Pim B Olthof
(PB)
Steven J Oosterling
(SJ)
Daan Ootes
(D)
Vera Oppedijk
(V)
Pieter Ott
(P)
Ida Paulusma
(I)
Koen C M J Peeters
(KCMJ)
Ilona T A Pereboom
(ITA)
Jan Peringa
(J)
Zoë Pironet
(Z)
Joost D J Plate
(JDJ)
Fatih Polat
(F)
Ingrid G M Poodt
(IGM)
Lisanne A E Posma
(LAE)
Jeroen F Prette
(JF)
Bareld B Pultrum
(BB)
Seyed M Qaderi
(SM)
Jan M van Rees
(JM)
Rutger-Jan Renger
(RJ)
Anouk J M Rombouts
(AJM)
Lodewijk Roosen
(L)
Ellen A Roskott-Ten Brinke
(EA)
Joost Rothbarth
(J)
Dennis B Rouw
(DB)
Tom Rozema
(T)
Heidi Rutten
(H)
Harm J T Rutten
(HJT)
Marit E van der Sande
(ME)
Boudewijn E Schaafsma
(BE)
Renske A Schasfoort
(RA)
Merel M Scheurkogel
(MM)
P Arjan
(P)
Schouten van der Velden
(S)
Wilhelmina H Schreurs
(WH)
Puck M E Schuivens
(PME)
Colin Sietses
(C)
Petra C G Simons
(PCG)
Marjan J Slob
(MJ)
Gerrit D Slooter
(GD)
Martsje van der Sluis
(M)
Bo P Smalbroek
(BP)
Anke B Smits
(AB)
Ernst J Spillenaar-Bilgen
(EJ)
Patty H Spruit
(PH)
Tanja C Stam
(TC)
Jaap Stoker
(J)
K Aaldert
(K)
Sofieke Talsma
(S)
G Y Mireille The
(GYM)
Jeroen A W Tielbeek
(JAW)
Aukje A J M van Tilborg
(AAJM)
Fiek van Tilborg
(F)
Dorothée van Trier
(D)
Maxime J M van der Valk
(MJM)
Inge J S Vanhooymissen
(IJS)
G Boudewijn C Vasbinder
(GBC)
Cornelis J Veeken
(CJ)
Laura A Velema
(LA)
Anthony W H van de Ven
(AWH)
Emiel G G Verdaasdonk
(EGG)
Wouter M Verduin
(WM)
Tim Verhagen
(T)
Paul M Verheijen
(PM)
Maarten Vermaas
(M)
An-Sofie E Verrijssen
(AE)
Anna Vera D Verschuur
(AVD)
Harmke Verwoerd-van Schaik
(H)
Roy F A Vliegen
(RFA)
Sophie Voets
(S)
F Jeroen Vogelaar
(FJ)
Clementine L A Vogelij
(CLA)
Hanneke A Vos-Westerman
(HA)
Marianne de Vries
(M)
Joy C Vroemen
(JC)
Bas S T van Vugt
(BST)
Johannes A Wegdam
(JA)
Bob J van Wely
(BJ)
Marinke Westerterp
(M)
Paul P van Westerveld
(PP)
Allard G Wijma
(AG)
Bart W K de Wit
(BWK)
Fennie Wit
(F)
Karlijn Woensdregt
(K)
Victor van Woerden
(V)
Floor S W van der Wolf
(FSW)
Sander van der Wolk
(S)
Johannes M Wybenga
(JM)
Edwin S van der Zaag
(ES)
Bobby Zamaray
(B)
Herman J A Zandvoort
(HJA)
Dennis van der Zee
(D)
Annette Zeilstra
(A)
Kang J Zheng
(KJ)
David D E Zimmerman
(DDE)
Marcel Zorgdrager
(M)
Informations de copyright
© 2024 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.
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