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Defunctioning stoma before neoadjuvant treatment or resection of endoscopically obstructing rectal cancer
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0002-8601-0159
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.ORCID iD: 0000-0002-5046-1820
Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM). Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.ORCID iD: 0000-0002-0974-6373
2023 (English)In: International Journal of Colorectal Disease, ISSN 0179-1958, E-ISSN 1432-1262, Vol. 38, no 1, article id 24Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate whether patients with endoscopically untraversable rectal cancer may benefit from a defunctioning stoma created before neoadjuvant therapy or resectional surgery.

Methods: This retrospective study comprise patients diagnosed with rectal cancer during 2007–2020 in Region Västerbotten, Sweden. The primary outcome was time between diagnosis and any treatment, while survival and the incidence of complications were secondary outcomes. Excluded were patients without endoscopic obstruction, patients already having a stoma, patients with recurrent disease, palliative patients, and patients receiving a stoma shortly after diagnosis due to any urgent bowel-related complication. Data were obtained from the Swedish Colorectal Cancer Registry and medical records. Kaplan–Meier failure curves were drawn, and a multivariable Cox regression model was employed for confounding adjustment.

Results: Out of 843 patients, 57 remained after applying exclusion criteria. Some 12/57 (21%) patients received a planned stoma before treatment, and the remainder received upfront neoadjuvant therapy or surgery. Median time to any treatment was 51 days for the planned stoma group and 36 days for the control group, with an adjusted hazard ratio of 0.28 (95% confidence interval: 0.12–0.64). Complications occurred at a rate of 5/12 (42%) and 7/45 (16%) in the planned stoma group and control group, respectively. Survival was similar between groups.

Conclusion: A planned stoma results in treatment delay, but it remains unclear whether this is clinically relevant. Complications were more common in the planned stoma group, although the data are limited. While larger studies are needed, it seems feasible to avoid defunctioning stomas even in endoscopically obstructing rectal cancers.

Place, publisher, year, edition, pages
Springer Nature, 2023. Vol. 38, no 1, article id 24
Keywords [en]
Bowel Obstruction, Endoscopy, Rectal Cancer, Stoma
National Category
Gastroenterology and Hepatology Surgery
Identifiers
URN: urn:nbn:se:umu:diva-204495DOI: 10.1007/s00384-023-04318-8ISI: 000918433400001PubMedID: 36698033Scopus ID: 2-s2.0-85146873003OAI: oai:DiVA.org:umu-204495DiVA, id: diva2:1735180
Funder
Knut and Alice Wallenberg FoundationSwedish Society of MedicineAvailable from: 2023-02-08 Created: 2023-02-08 Last updated: 2024-02-01Bibliographically approved

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Sandén, GustavSvensson, JohanLjuslinder, IngridRutegård, Martin

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SurgeryStatisticsOncologyWallenberg Centre for Molecular Medicine at Umeå University (WCMM)Department of Surgical and Perioperative Sciences
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International Journal of Colorectal Disease
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