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Aspects of anastomotic leakage, anorectal function and defunctioning stoma in Low Anterior Resection of the rectum for cancer
Örebro University, School of Health and Medical Sciences.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2011. , 62 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 60
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-18840ISBN: 978-91-7668-828-1 (print)OAI: oai:DiVA.org:oru-18840DiVA: diva2:444664
Public defence
2011-11-18, Wilandersalen, Universitetssjukhuset i Örebro, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-09-29 Created: 2011-09-29 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection for rectal cancer
Open this publication in new window or tab >>Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection for rectal cancer
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2010 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 12, no 7 Online, e82-e87 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to investigate patients with symptomatic anastomotic leakage diagnosed after hospital discharge.METHOD: Patients (n = 234) undergoing low anterior resection of the rectum for cancer who were included in a prospective multicentre trial (NCT 00636948) and who developed symptomatic anastomotic leakage diagnosed after hospital discharge (late leakage, LL; n = 18) were identified. Patient characteristics, operative details, recovery on postoperative day 5, length of hospital stay, and how the leakage was diagnosed were recorded. A comparison with those who did not develop symptomatic leakage (no leakage, NL; n = 189) was made. The minimum follow up was 24 months.RESULTS: In the LL patients the median age was 69 years, 61% were female patients, and 6% had stage IV cancer disease. On postoperative day 5, the LL group had a postoperative course similar to the NL group regarding temperature, oral intake and bowel function. The proportion of patients on antibiotic treatment on postoperative day 5, regardless of indication, was 28% in the LL compared with 4% in the NL group (P < 0.001). The median initial hospital stay was 10 days for both groups. When readmission for any reason was added, the hospital stay rose to a median of 21.5 and 13 days in the LL and the NL groups respectively (P < 0.001).CONCLUSION: Symptomatic anastomotic leakage diagnosed after hospital discharge following low anterior resection of the rectum for cancer is not uncommon and has an immediate clinical postoperative course which may appear uneventful.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-20482 (URN)10.1111/j.1463-1318.2009.01938.x (DOI)19594606 (PubMedID)
Available from: 2011-12-05 Created: 2011-12-05 Last updated: 2017-12-08Bibliographically approved
2. Does a defunctioning stoma affect anorectal function after low rectal resection?: Results of a randomized multicenter trial
Open this publication in new window or tab >>Does a defunctioning stoma affect anorectal function after low rectal resection?: Results of a randomized multicenter trial
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2011 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 54, no 6, 747-752 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Anorectal function is often impaired after low anterior resection of the rectum. Many factors affect the functional outcome and not all are known. OBJECTIVE: This trial aimed to assess whether a temporary defunctioning stoma affected anorectal function after the patients had been stoma-free for a year. DESIGN: Multicenter randomized controlled trial. SETTING: Twenty-one Swedish hospitals performing surgery for rectal cancer participated. PATIENTS: Patients who had undergone low anterior resection for adenocarcinoma of the rectum were eligible. INTERVENTIONS: Patients were randomly assigned to receive a defunctioning stoma or no stoma. MAIN OUTCOME MEASURES: Anorectal function was evaluated with a questionnaire after patients had been without a stoma for 12 months. Questions pertained to stool frequency, urgency, fragmentation of bowel movements, evacuation difficulties, incontinence, lifestyle alterations, and whether patients would prefer a permanent stoma. RESULTS: After exclusion of patients in whom stomas became permanent, a total of 181 (90%) of 201 patients answered the questionnaire (90 in the stoma group and 91 in the no-stoma group). The median number of stools was 3 during the day and 0 at night in both groups. Inability to defer defecation for 15 minutes was reported in 35% of patients in the stoma group and 25% in the no stoma group (P = .15). Median scores were the same in each group regarding need for medication, evacuation difficulties, fragmentation of bowel movements, incontinence, and effects on well-being. Two patients (2.2%) in the stoma group and 3 patients (3.3%) in the no-stoma group would have preferred a permanent stoma. LIMITATIONS: Because this study was an analysis of secondary end points of a randomized trial, no prestudy power calculation was performed. CONCLUSIONS: A defunctioning stoma after low anterior resection did not affect anorectal function evaluated after 1 year. Many patients experienced impaired anorectal function, but nearly all preferred having impaired anorectal function to a permanent stoma.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-20480 (URN)10.1007/DCR.0b013e3182138e79 (DOI)000290309500018 ()
Available from: 2011-12-05 Created: 2011-12-05 Last updated: 2017-12-08Bibliographically approved
3. What is the risk for a permanent stoma after low anterior resection of the rectum for cancer?: a six-year follow-up of a multicenter trial
Open this publication in new window or tab >>What is the risk for a permanent stoma after low anterior resection of the rectum for cancer?: a six-year follow-up of a multicenter trial
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2011 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 54, no 1, 41-47 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The aim of this study was to assess the risk for permanent stoma after low anterior resection of the rectum for cancer. METHODS: In a nationwide multicenter trial 234 patients undergoing low anterior resection of the rectum were randomly assigned to a group with defunctioning stomas (n = 116) or a group with no defunctioning stomas (n = 118). The median age was 68 years, 45% of the patients were women, 79% had preoperative radiotherapy, and 4% had International Union Against Cancer cancer stage IV. The patients were analyzed with regard to the presence of a permanent stoma, the type of stoma, the time point at which the stoma was constructed or considered as permanent, and the reasons for obtaining a permanent stoma. Median follow-up was 72 months (42-108). One patient with a defunctioning stoma who died within 30 days after the rectal resection was excluded from the analysis. RESULTS: During the study period 19% (45/233) of the patients obtained a permanent stoma: 25 received an end sigmoid stoma and 20 received a loop ileostomy. The end sigmoid stomas were constructed at a median of 22 months (1-71) after the low anterior resection of the rectum, and the loop ileostomies were considered as permanent at a median of 12.5 months (1-47) after the initial rectal resection. The reasons for loop ileostomy were metastatic disease (n = 6), unsatisfactory anorectal function (n = 6), deteriorated general medical condition (n = 3), new noncolorectal cancer (n = 2), patient refusal of further surgery (n = 2), and chronic constipation (n = 1). Reasons for end sigmoid stoma were unsatisfactory anorectal function (n = 22) and urgent surgery owing to anastomotic leakage (n = 3). The risk for permanent stomas in patients with symptomatic anastomotic leakage was 56% (25/45) compared with 11% (20/188) in those without symptomatic anastomotic leakage (P < .001). CONCLUSION: One patient of 5 ended up with a permanent stoma after low anterior resection of the rectum for cancer, and half of the patients with a permanent stoma had previous symptomatic anastomotic leakage.

National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-20481 (URN)10.1007/DCR.0b013e3181fd2948 (DOI)000285377500008 ()
Available from: 2011-12-05 Created: 2011-12-05 Last updated: 2017-12-08Bibliographically approved
4. Feasibility of early closure of defunctioning stoma and postoperative monitoring in low anterior resection of the rectum for cancer
Open this publication in new window or tab >>Feasibility of early closure of defunctioning stoma and postoperative monitoring in low anterior resection of the rectum for cancer
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(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-20483 (URN)
Available from: 2011-12-05 Created: 2011-12-05 Last updated: 2017-10-17Bibliographically approved

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