Predictive factors for temporary defunctioning stoma
					permanence in the treatment of rectal adenocarcinoma

Formiga, Fernanda Bellotti; Miotto, Sabrina; Formiga, Galdino José Sitônio; Denardin, Odilon Victor Porto

doi:10.1016/j.jcol.2013.09.003

Acessibilidade / Reportar erro

Brasil

Journal of Coloproctology (Rio de Janeiro)

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • J. Coloproctol. (Rio J.) 33 (4) • Nov-Dec 2013 • https://doi.org/10.1016/j.jcol.2013.09.003 copy

Predictive factors for temporary defunctioning stoma permanence in the treatment of rectal adenocarcinoma^* * Study carried out at: Service of Coloproctology of Hospital Heliópolis, São Paulo, SP, Brazil

Fatores preditivos da permanência do estoma derivativo temporário no tratamento do adenocarcinoma de reto

Authorship SCIMAGO INSTITUTIONS RANKINGS

PURPOSE:

determine the predictive factors for non-closure of defunctioning stoma in the low anterior resection for the treatment of rectal adenocarcinoma.

METHODS:

a retrospective cohort study of patients undergoing low anterior resection with defunctioning stoma for a period of nine years was performed. We compared, using univariate and multivariate analysis, the group that closed the defunctioning stoma (Group A) with the group that did not (Group B).

RESULTS:

eighty-one patients were analyzed; mean age was 61 ± 11 years, with a predominance of women (55.6%). Middle rectal tumors (66.6%), pT3 (59.2%) and pN0 (71.6%) were the most frequent. Stapled anastomosis (65.4%), and loop colostomy (80.2%) were the procedures most frequently performed. Sixty-five patients (80.2%) underwent stoma closure. The mean time for closure was 8.7 ± 4.4 months. The independent risk factors for non-closure of defunctioning stoma were complications of the anastomosis (p = 0.008) and follow-up complications (p = 0.007).

CONCLUSION:

complications with anastomosis and during the follow-up are factors that may justify a permanent stoma after low anterior resection for treatment of rectal adenocarcinoma.

Rectal neoplasms; Surgery; Complications; Surgical stomas; Surgical anastomosis

Variable	Category	n^a a n, number of patients. (%) / Measure
Gender	Male	36 (44.4)
Gender	Female	45 (55.6)
Age (years)	Mean ± SD	61.05 ± 11.89
	Median	62
	Minimum (Min) -	28 - 84
	Maximum (Max)
Comorbidities		43 (53.0)
Smoking status		16 (19.7)6 (7.4)
Alcohol consumption
Location	Lower rectum	6 (7.4)
	Middle rectum	54 (66.6)
	Upper rectum	18 (22.2)
	Rectosigmoidjunction	3 (3.7)
CEA (ng/mL)	Mean ± SD	17.3 ± 54.2
	Median	3.4
	Min - Max	0.5 - 393.2
Histologicaldifferentiation ^b b G0, indeterminate; G1, well-differentiated; G2; moderately differentiated; G3, little differentiated.	G0	5 (6.2)
	G1	20 (24.7)
	G2	50 (61.7)
	G3	6 (7.4)
pT^c c TNM by AJCC sixth edition.	pT0	5 (6.2)
	pT1	7 (8.6)
	pT2	21 (25.9)
	pT3	48 (59.3)
pN^c c TNM by AJCC sixth edition.	pN0	58 (71.6)
	pN1	16 (19.7)
	pN2	7 (8.6)
Metastasis		1 (1.2)
Staging^c c TNM by AJCC sixth edition.	0	2 (2.5)
	I	19 (23.5)
	II	32 (39.5)
	III	27 (33.3)
	IV	1 (1.2)
Perineural invasion		7 (8.6)
Lymphatic invasion		24 (29.6)
Venous invasion		3 (3.7)

Complications	Number of patients (%)
Postoperative	17 (20.9)
Anastomotic dehiscence	9 (52.9)
Surgical wound infection	6 (35.2)
Prolonged ileus	6 (35.2)
Reoperation	5 (29.4)
Decompensation of comorbidities	4 (23.5)
Anastomosis	11 (13.5)
Stenosis	6 (54.5)
Anastomosis recurrence	4 (36.3)
Fistula 2	(18.1)
Follow-up	10 (12.3)
Local recurrence	7 (70)
Metastasis	8 (80)
Another surgery	10 (100)
Comorbidity complication	2 (20)
Death	1 (10)

Variable	Category	Number of patients (%)		Univariate	Multivariate
		Group A	Group B	^p	^p
Gender	Male	27 (75)	9 (25)	0.401	_
	Female	38 (84.4)	7 (15.6)
Age (years)	Mean ± SD	62.0 ± 10.5	60.8 ± 12.1		_
	Median	62.5	62	0.708
	Min - Max	48-80	28-84
Comorbidities	Present	32 (74.4)	11 (25.6)	0.263	_
	Absent	33 (86.8)	5 (13.2)
Smoking	Present	11 (68.8)	5 (31.3)	0.290	_
	Absent	54 (83.1)	11 (16.9)
Alcohol consumption	Present	5 (83.3)	1 (16.7)	0.844	_
	Absent	60 (80)	15 (20)
Location	Lower rectum	3 (50)	3 (50)
	Middle rectum	44 (81.5)	10 (18.5)
	Upper rectum	15 (83.3)	3 (16.7)	0.225	_
	Rectosigmoid junction	3 (100)	0 (0)
CEA (ng/mL)	Mean ± SD	16.7 ± 56.1	19.5 ± 48.5
	Median	3.7	1.955	0.863	_
	Min - Max	0.5 - 393.2	O.8 - 184.3
^a a G0, indeterminate; G1, well-differentiated; G2; moderately differentiated; G3, little differentiated. Histological	G0	3 (60)	2 (40)
differentiation	G1	19 (95)	1 (5)	0.20	_
	G2	38 (76)	12 (24)
	G3	5 (83.3)	1 (16.7)
^b b TNM by AJCC sixth edition. pT	pT0	4 (80)	1 (20)
	pT1	6 (85.7)	1 (14.3)	0.694	_
	pT2	15 (71.4)	6 (28.6)
	pT3	40 (83.3)	8 (16.7)
^b b TNM by AJCC sixth edition. pN	pN0	49 (84.5)	9 (15.5)
	pN1	11 (68.8)	5 (31.3)	0.311	_
	pN2	5 (71.4)	2 (28.6)
Metastases	Present	1 (100)	0 (0)	0.618	_
	Absent	64 (80)	16 (20)
^b b TNM by AJCC sixth edition. Staging	0-II	44 (83)	9 (17)	0.396	_
	III-IV	21 (75)	7 (25)
Perineural invasion	Present	4 (57.1)	3 (42.9)	0.135	_
	Absent	61 (82.4)	13 (17.6)
Lymphatic invasion	Present	17 (70.8)	7 (29.2)	0.222	_
	Absent	48 (84.2)	9 (15.8)
Venous invasion	Present	2 (66.7)	1 (33.3)	0.488	_
	Absent	63 (80.2)	15 (19.8)

Variable	Category	Number of patients (%)		Univariate	Multivariate
		Group A	Group B	^p	^p
Neoadjuvant chemotherapy	Present	15 (65.2)	8 (34.8)	0.060	_
	Absent	50 (86.2)	8 (13.8)
Neoadjuvant radiotherapy	Present	15 (68.2)	7 (31.8)	0.120	_
	Absent	50 (84.7)	9 (15.3)
Anastomosis	Mechanical	39 (73.6)	14 (26.4)	0.044	0.115
	Manual	26 (92.9)	2 (7.1)
Defunctioning stoma	Transversostomy	53 (81.5)	12 (18.5)	0.726	_
	Ileostomy	12 (75)	4 (25)
Surgical radicality	0	0	16 (20.3)	0.477	_
	2	2	0 (0)
Distal margin (cm)	Mean ± SD	2.5 ± 1.4	1.6 ± 1.3
	Median	2	1.25	0.039	0.230
	Min - Max	0.6 - 7	0.2 - 5
Adjuvant chemotherapy	Present	41 (74.5)	41 (74.5)	0.077	_
	Absent	24 (92.3)	24 (92.3)
Adjuvant radiotherapy	Present	23 (82.1)	5 (17.9)	0.755	_
	Absent	42 (79.2)	11 (20.8)
Postoperative complication	Present	11 (64.7)	6 (35.3)	0.090	_
	Absent	54 (84.4)	10 (15.6)
Anastomosis complication	Present	4 (36.4)	7 (63.6)	7 (63.6)	0.008
	Absent	61 (87.1)	9 (12.9)	9 (12.9)
Stoma complication	Present	30 (78.9)	8 (21.1)	0.788	_
	Absent	35 (81.4)	8 (18.6)
Follow-up complication	Present	3 (30)	7 (70)	< 0.001	0.007
	Absent	62 (87.3)	9 (12.7)

Sociedade Brasileira de Coloproctologia Av. Marechal Câmara, 160/916, 20020-080 Rio de Janeiro/RJ Brasil, Tel.: (55 21) 2240-8927, Fax: (55 21) 2220-5803 - Rio de Janeiro - RJ - Brazil
E-mail: sbcp@sbcp.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: E-mail: fformiga@colband.com.br /coloproctologiaheliopolis@yahoo.com.br (F.B. Formiga)

Brasil

Brasil

Predictive factors for temporary defunctioning stoma permanence in the treatment of rectal adenocarcinoma* * Study carried out at: Service of Coloproctology of Hospital Heliópolis, São Paulo, SP, Brazil

Fatores preditivos da permanência do estoma derivativo temporário no tratamento do adenocarcinoma de reto

PURPOSE:

METHODS:

RESULTS:

CONCLUSION:

Predictive factors for temporary defunctioning stoma permanence in the treatment of rectal adenocarcinoma^* * Study carried out at: Service of Coloproctology of Hospital Heliópolis, São Paulo, SP, Brazil