High complication rate after low anterior resection for mid and high rectal cancer; results of a population-based study
Abstract Background Surgical resection is the cornerstone of treatment for rectal cancer patients. Treatment options consist of a primary anastomosis, anastomosis with defunctioning stoma or end-colostomy with closure of the distal rectal stump. This study aimed to compare postoperative outcome of t...
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| Veröffentlicht in: | European journal of surgical oncology 2014-06, Vol.40 (6), p.692-698 |
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| container_title | European journal of surgical oncology |
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| creator | Bakker, I.S Snijders, H.S Wouters, M.W Havenga, K Tollenaar, R.A.E.M Wiggers, T Dekker, J.W.T |
| description | Abstract Background Surgical resection is the cornerstone of treatment for rectal cancer patients. Treatment options consist of a primary anastomosis, anastomosis with defunctioning stoma or end-colostomy with closure of the distal rectal stump. This study aimed to compare postoperative outcome of these three surgical options. Methods Data was derived from the national database of the Dutch Surgical Colorectal Audit. Mid and high rectal cancer patients who underwent rectal cancer resection between January 2011 and December 2012 were included. Endpoints were postoperative complications including anastomotic leakage, reinterventions, hospital stay and mortality within 30 days postoperative. Results In total, 2585 patients were included. Twenty-five per cent of all patients received a primary anastomosis; 51% an anastomosis with defunctioning stoma, and 24% an end-colostomy. More than one third of patients developed postoperative complications, the lowest rate being in the primary anastomosis group. Anastomotic leakage rates were 12% in patients with a primary anastomosis, and 9% in patients with an anastomosis with defunctioning stoma ( p |
| doi_str_mv | 10.1016/j.ejso.2014.02.234 |
| format | Article |
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Treatment options consist of a primary anastomosis, anastomosis with defunctioning stoma or end-colostomy with closure of the distal rectal stump. This study aimed to compare postoperative outcome of these three surgical options. Methods Data was derived from the national database of the Dutch Surgical Colorectal Audit. Mid and high rectal cancer patients who underwent rectal cancer resection between January 2011 and December 2012 were included. Endpoints were postoperative complications including anastomotic leakage, reinterventions, hospital stay and mortality within 30 days postoperative. Results In total, 2585 patients were included. Twenty-five per cent of all patients received a primary anastomosis; 51% an anastomosis with defunctioning stoma, and 24% an end-colostomy. More than one third of patients developed postoperative complications, the lowest rate being in the primary anastomosis group. Anastomotic leakage rates were 12% in patients with a primary anastomosis, and 9% in patients with an anastomosis with defunctioning stoma ( p < 0.05). Multivariate analysis showed more postoperative complications, prolonged hospital stay, and increased mortality rates in patients with a defunctioning stoma or end-colostomy. The latter had proportionally less invasive reinterventions when compared to the other two groups. Conclusions Patients with a primary anastomosis had the best postoperative outcome. A defunctioning stoma leads to a lower anastomotic leakage rate, though is associated with higher rates of complications, prolonged hospital stay and mortality. The decision to create a defunctioning stoma should be focus of future studies.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2014.02.234</identifier><identifier>PMID: 24655803</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Anastomosis, Surgical ; Colostomy ; Digestive System Surgical Procedures - methods ; Female ; Hematology, Oncology and Palliative Medicine ; Hospital Mortality ; Humans ; Length of Stay - statistics & numerical data ; Low anterior resection ; Male ; Malignancy ; National audit ; Postoperative complications ; Postoperative Complications - epidemiology ; Postoperative Complications - mortality ; Rectal cancer ; Rectal Neoplasms - mortality ; Rectal Neoplasms - pathology ; Rectal Neoplasms - surgery ; Surgery ; Surgical outcome ; Treatment Outcome</subject><ispartof>European journal of surgical oncology, 2014-06, Vol.40 (6), p.692-698</ispartof><rights>Elsevier Ltd</rights><rights>2014 Elsevier Ltd</rights><rights>Copyright © 2014 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-e4cbd4c0b53fa7ac1916ea8c4486061c3c81a38485425e0c97ba0401236693df3</citedby><cites>FETCH-LOGICAL-c411t-e4cbd4c0b53fa7ac1916ea8c4486061c3c81a38485425e0c97ba0401236693df3</cites><orcidid>0000-0002-0189-4929</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ejso.2014.02.234$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24655803$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bakker, I.S</creatorcontrib><creatorcontrib>Snijders, H.S</creatorcontrib><creatorcontrib>Wouters, M.W</creatorcontrib><creatorcontrib>Havenga, K</creatorcontrib><creatorcontrib>Tollenaar, R.A.E.M</creatorcontrib><creatorcontrib>Wiggers, T</creatorcontrib><creatorcontrib>Dekker, J.W.T</creatorcontrib><title>High complication rate after low anterior resection for mid and high rectal cancer; results of a population-based study</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>Abstract Background Surgical resection is the cornerstone of treatment for rectal cancer patients. Treatment options consist of a primary anastomosis, anastomosis with defunctioning stoma or end-colostomy with closure of the distal rectal stump. This study aimed to compare postoperative outcome of these three surgical options. Methods Data was derived from the national database of the Dutch Surgical Colorectal Audit. Mid and high rectal cancer patients who underwent rectal cancer resection between January 2011 and December 2012 were included. Endpoints were postoperative complications including anastomotic leakage, reinterventions, hospital stay and mortality within 30 days postoperative. Results In total, 2585 patients were included. Twenty-five per cent of all patients received a primary anastomosis; 51% an anastomosis with defunctioning stoma, and 24% an end-colostomy. More than one third of patients developed postoperative complications, the lowest rate being in the primary anastomosis group. Anastomotic leakage rates were 12% in patients with a primary anastomosis, and 9% in patients with an anastomosis with defunctioning stoma ( p < 0.05). Multivariate analysis showed more postoperative complications, prolonged hospital stay, and increased mortality rates in patients with a defunctioning stoma or end-colostomy. The latter had proportionally less invasive reinterventions when compared to the other two groups. Conclusions Patients with a primary anastomosis had the best postoperative outcome. A defunctioning stoma leads to a lower anastomotic leakage rate, though is associated with higher rates of complications, prolonged hospital stay and mortality. The decision to create a defunctioning stoma should be focus of future studies.</description><subject>Aged</subject><subject>Anastomosis, Surgical</subject><subject>Colostomy</subject><subject>Digestive System Surgical Procedures - methods</subject><subject>Female</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Low anterior resection</subject><subject>Male</subject><subject>Malignancy</subject><subject>National audit</subject><subject>Postoperative complications</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - mortality</subject><subject>Rectal cancer</subject><subject>Rectal Neoplasms - mortality</subject><subject>Rectal Neoplasms - pathology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Surgery</subject><subject>Surgical outcome</subject><subject>Treatment Outcome</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU-L1TAUxYMozvPpF3AhWbppvfnTNkURZFBHGHChrkOa3jqpaVOT1uF9e9N5owsXrm4u95wD-R1CnjMoGbD61VjimELJgckSeMmFfEAOrBK84KxqHpIDNFIVTavEBXmS0ggArWjax-SCy7qqFIgDub1y32-oDdPinTWrCzONZkVqhhUj9eGWmjm_XIg0YkJ7pxjyNrk-n3p6s_tjPhhPrZktxte7cvNromGghi5h2fxdctGZhD1N69afnpJHg_EJn93PI_n24f3Xy6vi-vPHT5fvrgsrGVsLlLbrpYWuEoNpjGUtq9EoK6WqoWZWWMWMUFJVklcItm06AxIYF3Xdin4QR_LynLvE8HPDtOrJJYvemxnDljSrOAgJVcZ2JPwstTGkFHHQS3STiSfNQO_A9ah34HoHroHrDDybXtznb92E_V_LH8JZ8OYswPzLXw6jTtZh5tS7nZrug_t__tt_7Na7OVflf-AJ0xi2OGd-munENegve-V740wCCCaU-A0nJqd7</recordid><startdate>20140601</startdate><enddate>20140601</enddate><creator>Bakker, I.S</creator><creator>Snijders, H.S</creator><creator>Wouters, M.W</creator><creator>Havenga, K</creator><creator>Tollenaar, R.A.E.M</creator><creator>Wiggers, T</creator><creator>Dekker, J.W.T</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0189-4929</orcidid></search><sort><creationdate>20140601</creationdate><title>High complication rate after low anterior resection for mid and high rectal cancer; results of a population-based study</title><author>Bakker, I.S ; Snijders, H.S ; Wouters, M.W ; Havenga, K ; Tollenaar, R.A.E.M ; Wiggers, T ; Dekker, J.W.T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-e4cbd4c0b53fa7ac1916ea8c4486061c3c81a38485425e0c97ba0401236693df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Anastomosis, Surgical</topic><topic>Colostomy</topic><topic>Digestive System Surgical Procedures - methods</topic><topic>Female</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Low anterior resection</topic><topic>Male</topic><topic>Malignancy</topic><topic>National audit</topic><topic>Postoperative complications</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - mortality</topic><topic>Rectal cancer</topic><topic>Rectal Neoplasms - mortality</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Surgery</topic><topic>Surgical outcome</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bakker, I.S</creatorcontrib><creatorcontrib>Snijders, H.S</creatorcontrib><creatorcontrib>Wouters, M.W</creatorcontrib><creatorcontrib>Havenga, K</creatorcontrib><creatorcontrib>Tollenaar, R.A.E.M</creatorcontrib><creatorcontrib>Wiggers, T</creatorcontrib><creatorcontrib>Dekker, J.W.T</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bakker, I.S</au><au>Snijders, H.S</au><au>Wouters, M.W</au><au>Havenga, K</au><au>Tollenaar, R.A.E.M</au><au>Wiggers, T</au><au>Dekker, J.W.T</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High complication rate after low anterior resection for mid and high rectal cancer; results of a population-based study</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2014-06-01</date><risdate>2014</risdate><volume>40</volume><issue>6</issue><spage>692</spage><epage>698</epage><pages>692-698</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>Abstract Background Surgical resection is the cornerstone of treatment for rectal cancer patients. Treatment options consist of a primary anastomosis, anastomosis with defunctioning stoma or end-colostomy with closure of the distal rectal stump. This study aimed to compare postoperative outcome of these three surgical options. Methods Data was derived from the national database of the Dutch Surgical Colorectal Audit. Mid and high rectal cancer patients who underwent rectal cancer resection between January 2011 and December 2012 were included. Endpoints were postoperative complications including anastomotic leakage, reinterventions, hospital stay and mortality within 30 days postoperative. Results In total, 2585 patients were included. Twenty-five per cent of all patients received a primary anastomosis; 51% an anastomosis with defunctioning stoma, and 24% an end-colostomy. More than one third of patients developed postoperative complications, the lowest rate being in the primary anastomosis group. Anastomotic leakage rates were 12% in patients with a primary anastomosis, and 9% in patients with an anastomosis with defunctioning stoma ( p < 0.05). Multivariate analysis showed more postoperative complications, prolonged hospital stay, and increased mortality rates in patients with a defunctioning stoma or end-colostomy. The latter had proportionally less invasive reinterventions when compared to the other two groups. Conclusions Patients with a primary anastomosis had the best postoperative outcome. A defunctioning stoma leads to a lower anastomotic leakage rate, though is associated with higher rates of complications, prolonged hospital stay and mortality. The decision to create a defunctioning stoma should be focus of future studies.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>24655803</pmid><doi>10.1016/j.ejso.2014.02.234</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-0189-4929</orcidid></addata></record> |
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| subjects | Aged Anastomosis, Surgical Colostomy Digestive System Surgical Procedures - methods Female Hematology, Oncology and Palliative Medicine Hospital Mortality Humans Length of Stay - statistics & numerical data Low anterior resection Male Malignancy National audit Postoperative complications Postoperative Complications - epidemiology Postoperative Complications - mortality Rectal cancer Rectal Neoplasms - mortality Rectal Neoplasms - pathology Rectal Neoplasms - surgery Surgery Surgical outcome Treatment Outcome |
| title | High complication rate after low anterior resection for mid and high rectal cancer; results of a population-based study |
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