[High one-year morbidity rate after anterior resection for rectal cancer]

Heleen S Snijders, Ilsalien S Bakker, Jan Willem T Dekker, Thomas A Vermeer, Esther C J Consten, Christiaan Hoff, Joost M Klaase, Klaas Havenga, Rob A E M Tollenaar, Theo Wiggers
Nederlands Tijdschrift Voor Geneeskunde 2014, 158: A7515

OBJECTIVE: To describe the short-term and one-year outcomes after anterior resection for rectal cancer; surgical options included: primary anastomosis, anastomosis with a defunctioning stoma and an end-colostomy.

DESIGN: Observational study.

METHOD: Patients undergoing surgical resection for primary mid- and high rectal cancer in seven Dutch hospitals were retrospectively studied with one-year follow up. Short-term endpoints were postoperative complications, re-interventions, prolonged hospital stay and mortality. One-year end-points were unplanned re-admissions and re-interventions, presence of stoma, morbidity after stoma removal and mortality.

RESULTS: Nineteen percent of 388 included patients received a primary anastomosis only, 55% an anastomosis with defunctioning stoma, and 26% an end-colostomy. Short-term anastomotic leakage was 10% in patients with a primary anastomosis vs. 7% with a defunctioning stoma (P = 0.46). An end-colostomy was associated with less -invasive re-interventions. One-year outcomes showed low morbidity in patients with an anastomosis. Patients with a defunctioning stoma had a high percentage of re-admissions (18%) and re-intervention (12%) rates, mostly due to anastomotic leakage. An end-colostomy was associated with unplanned re-interventions due to stoma or abscess problems. During follow-up, there was a 25% increase in patients with an end-colostomy.

CONCLUSION: This study showed a high one-year morbidity rate after anterior resection for rectal cancer. A defunctioning stoma was associated with a high risk for late complications including anastomotic leakage. These results can be used for giving information to patients. Also, the profession can review the current consensus and not create, in principle, a stoma in all patients.


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