Abstract
Aim
To introduce a novel endo-luminal balloon-assisted drainage (EBAD) and compare postoperative complication rates between EBAD and diverting stoma (DS) groups.
Methods
The single center prospective non-random cohort study included a total of 163 patients in convenience patients with rectal cancer between January 2019 and January 2021. Out of 163 patients, 83 underwent DS and 80 EBAD. Primary endpoints were postoperative complication rate.
Results
The total number of complications was 28 in the DS group vs. 22 in the EBAD group (P = 0.388). 18 patients (21.7%) in the DS group and 14 patients (17.5%) in the EBAD group developed postoperative complication (P = 0.501). There were no differences identified for anastomotic leak rates between the two groups (P = 0.677). The rate of the pelvic abscess was lower in the EBAD group (1/80, 1.3%) than in the DS group (4/83, 4.8%) but with no statistical significance (P = 0.386). Compared with the DS group, the median operative time was shorter in the EBAD group (225 vs. 173.5 min, P < 0.001). Regarding incomplete small bowel obstruction, a higher prevalence was observed in the DS group compared to the EBAD group (7.2% vs 2.5%, P = 0.301). 7 patients (11.3%) in the DS group developed a para-stomal hernia, while no patient suffered a catheter-related complication. The median postoperative hospital stay was shorter in the DS groups than in the EBAD group (7 vs 8 days, P = 0.009). The median residence time of endo-luminal balloon-assisted drainage was 5.41 days. The median average and total volume of drainage were 51.57 ml/day and 255 ml, respectively.
Conclusion
EBAD is feasible and safe with similar postoperative complications when compared with a DS. EBAD may replace DS after rectum resection.
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References
Rullier E, et al. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85(3):355–8. https://doi.org/10.1046/j.1365-2168.1998.00615.x.
Law WI, Chu KW, Ho JW, Chan CW. Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg. 2000;179(2):92–6. https://doi.org/10.1016/s0002-9610(00)00252-x.
Peeters KC, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2005;92(2):211–6. https://doi.org/10.1002/bjs.4806.
Tortorelli AP, et al. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management. Am Surg. 2015;81(1):41–7.
Katayama H, et al. Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46(6):668–85. https://doi.org/10.1007/s00595-015-1236-x.
2017 HQIP (National Bowel Cancer Audit: Annual Report 2017.
Snijders HS, et al. An increasing use of defunctioning stomas after low anterior resection for rectal cancer. Is this the way to go? Eur J Surg Oncol. 2013;39(7):715–20. https://doi.org/10.1016/j.ejso.2013.03.025.
Rutegard M, Bostrom P, Haapamaki M, Matthiessen P, Rutegard J. Current use of diverting stoma in anterior resection for cancer: population-based cohort study of total and partial mesorectal excision. Int J Colorectal Dis. 2016;31(3):579–85. https://doi.org/10.1007/s00384-015-2465-6.
Lewis P, Bartolo DC. Closure of loop ileostomy after restorative proctocolectomy. Ann R Coll Surg Engl. 1990;72(4):263–5.
Khoo RE, Cohen MM, Chapman GM, Jenken DA, Langevin JM. Loop ileostomy for temporary fecal diversion. Am J Surg. 1994;167(5):519–22. https://doi.org/10.1016/0002-9610(94)90249-6.
Alves A, et al. Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy. Br J Surg. 2008;95(6):693–8. https://doi.org/10.1002/bjs.6212.
Perez RO, et al. Loop ileostomy morbidity: timing of closure matters. Dis Colon Rectum. 2006;49(10):1539–45. https://doi.org/10.1007/s10350-006-0645-8.
Chow A, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis. 2009;24(6):711–23. https://doi.org/10.1007/s00384-009-0660-z.
Akesson O, Syk I, Lindmark G, Buchwald P. Morbidity related to defunctioning loop ileostomy in low anterior resection. Int J Colorectal Dis. 2012;27(12):1619–23. https://doi.org/10.1007/s00384-012-1490-y.
Tsunoda A, et al. Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum. 2008;51(2):218–22. https://doi.org/10.1007/s10350-007-9101-7.
Mala T, Nesbakken A. Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis. 2008;10(8):785–8. https://doi.org/10.1111/j.1463-1318.2007.01456.x.
Giannakopoulos GF, et al. Morbidity and complications of protective loop ileostomy. Colorectal Dis. 2009;11(6):609–12. https://doi.org/10.1111/j.1463-1318.2008.01690.x.
Mansfield SD, Jensen C, Phair AS, Kelly OT, Kelly SB. Complications of loop ileostomy closure: a retrospective cohort analysis of 123 patients. World J Surg. 2008;32(9):2101–6. https://doi.org/10.1007/s00268-008-9669-7.
Veenhof AA, van der Peet DL, Meijerink WJ, Cuesta MA. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2008;247(4):718–9. https://doi.org/10.1097/SLA.0b013e31816a7493.
David GG, et al. Loop ileostomy following anterior resection: is it really temporary? Colorectal Dis. 2010;12(5):428–32. https://doi.org/10.1111/j.1463-1318.2009.01815.x.
Holmgren K, et al. High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study. Colorectal Dis. 2017;19(12):1067–75. https://doi.org/10.1111/codi.13771.
Montedori A, Cirocchi R, Farinella E, Sciannameo F, Abraha I. Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev. 2010. https://doi.org/10.1002/14651858.CD006878.pub2.
Huser N, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg. 2008;248(1):52–60. https://doi.org/10.1097/SLA.0b013e318176bf65.
Machado M, et al. Defunctioning stoma in low anterior resection with colonic pouch for rectal cancer: a comparison between two hospitals with a different policy. Dis Colon Rectum. 2002;45(7):940–5. https://doi.org/10.1007/s10350-004-6333-7.
Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6(6):462–9. https://doi.org/10.1111/j.1463-1318.2004.00657.x.
Denost Q, et al. To drain or not to drain infraperitoneal anastomosis after rectal excision for cancer: The GRECCAR 5 randomized trial. Ann Surg. 2017;265(3):474–80. https://doi.org/10.1097/SLA.0000000000001991.
Penna M, et al. Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the international TaTME registry. Ann Surg. 2019;269(4):700–11. https://doi.org/10.1097/SLA.0000000000002653.
Phatak UR, et al. Impact of ileostomy-related complications on the multidisciplinary treatment of rectal cancer. Ann Surg Oncol. 2014;21(2):507–12. https://doi.org/10.1245/s10434-013-3287-9.
Ihnat P, et al. Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc. 2016;30(11):4809–16. https://doi.org/10.1007/s00464-016-4811-3.
Gastinger I, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005;92(9):1137–42. https://doi.org/10.1002/bjs.5045.
Thalheimer A, Bueter M, Kortuem M, Thiede A, Meyer D. Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum. 2006;49(7):1011–7. https://doi.org/10.1007/s10350-006-0541-2.
Bonin E, et al. Diverting stoma-related complications following colorectal endometriosis surgery: a 163-patient cohort. Eur J Obstet Gynecol Reprod Biol. 2019;232:46–53. https://doi.org/10.1016/j.ejogrb.2018.11.008.
Funding
This project was supported by the grant from the Sun Yat-sen University Clinical Research 5010 Program (Grant No. 2016005).
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Drs. Wenfeng Liang, Haiqing Jie, Shuangling Luo, Ziwei Zeng, Zhihang Liu, Liang Huang and Liang Kang have no conflicts of interest or financial ties to disclose. All authors are aware of and agree to the content of the paper and their being listed as an author on the paper.
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Liang, W., Jie, H., Zeng, Z. et al. Comparison of postoperative complication rates between a novel endoluminal balloon-assisted drainage and diverting stoma after low rectal cancer. Clin Transl Oncol 24, 1347–1353 (2022). https://doi.org/10.1007/s12094-021-02775-7
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DOI: https://doi.org/10.1007/s12094-021-02775-7