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High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
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2017 (Engelska)Ingår i: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 19, nr 12, s. 1067-1075Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

AIM: Fashioning a defunctioning stoma is common when performing an anterior resection for rectal cancer in order to avoid and mitigate the consequences of an anastomotic leakage. We investigated the permanent stoma prevalence, factors influencing stoma outcome and complication rates following stoma reversal surgery.

METHOD: Patients who had undergone an anterior resection for rectal cancer between 2007 and 2013 in the northern healthcare region were identified using the Swedish Colorectal Cancer Registry and were followed until the end of 2014 regarding stoma outcome. Data were retrieved by a review of medical records. Multiple logistic regression was used to evaluate predefined risk factors for stoma permanence. Risk factors for non-reversal of a defunctioning stoma were also analysed, using Cox proportional-hazards regression.

RESULTS: A total of 316 patients who underwent anterior resection were included, of whom 274 (87%) were defunctioned primarily. At the end of the follow-up period 24% had a permanent stoma, and 9% of patients who underwent reversal of a stoma experienced major complications requiring a return to theatre, need for intensive care or mortality. Anastomotic leakage and tumour Stage IV were significant risk factors for stoma permanence. In this series, partial mesorectal excision correlated with a stoma-free outcome. Non-reversal was considerably more prevalent among patients with leakage and Stage IV; Stage III patients at first had a decreased reversal rate, which increased after the initial year of surgery.

CONCLUSION: Stoma permanence is common after anterior resection, while anastomotic leakage and advanced tumour stage decrease the chances of a stoma-free outcome. Stoma reversal surgery entails a significant risk of major complications.

Ort, förlag, år, upplaga, sidor
2017. Vol. 19, nr 12, s. 1067-1075
Nyckelord [en]
Defunctioning stoma, diverting stoma, faecal diversion, permanent stoma
Nationell ämneskategori
Kirurgi
Identifikatorer
URN: urn:nbn:se:umu:diva-142563DOI: 10.1111/codi.13771ISI: 000416856200006PubMedID: 28612478OAI: oai:DiVA.org:umu-142563DiVA, id: diva2:1162432
Tillgänglig från: 2017-12-04 Skapad: 2017-12-04 Senast uppdaterad: 2018-06-09Bibliografiskt granskad

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Holmgren, KlasKverneng Hultberg, DanielHaapamäki, Markku M.Rutegård, JörgenRutegård, Martin

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Holmgren, KlasKverneng Hultberg, DanielHaapamäki, Markku M.Rutegård, JörgenRutegård, Martin
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