İsmail Cem ERAY, Ahmet RENCÜZOĞULLARI, Orçun YALAV, Uğur TOPAL, Ahmet Gökhan SARITAŞ, Kubilay DALCI

Rektum kanser cerrahisi sonrası kalıcı ileostomi insidansı ve risk faktörleri

Amaç: Rektum kanseri cerrahisi sonrası anastomoz komplikasyonlarının etkilerini azaltmak amacı ile geçici amaçla uygulanan koruyucu stomaların önemli bir kısmı kapatılamayarak kalıcı hale gelmektedir. Bu çalışmada kalıcı stomaya neden olabilecek nedenler araştırılmıştır.Gereç ve Yöntem: 2015-2018 tarihleri arasında elektif şartlarda rektum kanseri nedeni ile aşağıanterior rezeksiyon ve koruyucu ileostomi uygulanan hastalar çalışmaya alındı. Bir yıl içerisinde stoması kapatılamayan hastalar kalıcı stoma olarak değerlendirildi.Bulgular: Çalışmaya 66 hasta dahil oldu. Stomaların ortalama kapatılma süresi 5,6 +2,5 (1-12) ay olarak bulundu. On iki hastanın (%18,2) stoması kapatılamayarak kalıcı hale geldi. Tanı anında metastatik hastalık varlığı, anastomozun anal girime yakınlığı, koloanalanastomoz yapılması, cerrahi sonrası patoloji sonucunun evre IIIC olmasıstoma kapatılamaması açısından risk faktörü olarak bulundu.Sonuç: Rektum kanseri cerrahi tedavisinde geçici amaçla uygulanan stomaların bir kısmı kalıcı hale gelmektedir. İndeks operasyondan önce hasta ve yakınlarına, bazı risk faktörü ya da faktörleri varlığında bu stomaların kapatılamayarak kalıcı hale gelebileceği bilgisi verilmelidir.

Anahtar Kelimeler:

Rektum kanseri, kalıcı stoma

Incidence of permanent stoma after rectal cancer surgery and its risk factors

Purpose: A significant number of the protective stomas temporarily applied in order to reduce the effects of anastomosis complications after rectal cancer surgery cannot be closed and become permanent. In this study, the causes that can lead to a permanent stoma were investigated.Materials and Methods: Patients who underwent elective surgery with low anterior resection and protective ileostomy due to rectal cancer were included in the study. Patients whose stoma could not be closed within one year were evaluated as permanent stoma.Results: 66 patients were included in the study. The mean closing time for the stomas were found as 5, 6 +2,5 (1-12)months. The stomas of twelve (18.2%) of the patients could not be closed and became permanent. The presence of metastatic disease at the time of diagnosis, the proximity of the anastomosis to the anal entry, coloanal anastomosis, and the final pathology showing stage IIIC were found to be risk factors for permanent stoma.Conclusion: Some of the stomas applied temporarily due to surgical treatment of rectal cancer became permanent. Before the index operation, the patient and their relatives should be informed that in the presence of certain risk factors, these stomas may not be closed and become permanent.

Keywords:

Rectum cancer, permenant stoma,

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1. Mak JCK, Foo DCC, Wei R, Law WL. Sphincterpreserving surgery for low rectal cancers: incidence and risk factors for permanent stoma. World J Surg. 2017;41:2912-22.
2. Matthiessen P, Hallböök O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207-14.
3. Gessler B, Haglind E, Angenete E. Loop ileostomies in colorectal cancer patientsd morbidity and risk factors for nonreversal. J Surg Res.2012;178:708–14.
4. Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis. 2004;6:462–9.
5. Kim MJ, Kim YS, Park SC, Sohn DK, Kim DY, Chang HJ et al. Risk factors for permanent stoma after rectal cancer surgery with temporary ileostomy. Surgery. 2016;159:721–7.
6. O’leary DP, Fide CJ, Foy C, Lucarotti ME. Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg. 2001;88:1216–20.
7. Herrle F, Sandra-Petrescu F, Weiss C, Post S, Runkel N, Kienle P. Quality of life and timing of stoma closure in patients with rectal cancer undergoing low anterior resection with diverting stoma: a multicenter longitudinal observational study. Dis Colon Rectum. 2016;59:281-290
8. David GG,Slavin JP, Willmott S, Corless DJ, Khan Au, Selvasekar CR. Loop ileostomy following anterior resection: is it really temporary?. Colorectal Dis. 2010;12:428-32.
9. Bakx R, Busch OR, Bemelman WA, Veldink GJ, Slors JF, van Lanschot JJ. Morbidity of temporary loop ileostomies. Dig Surg. 2004;21:277-81.
10. Tang CL, Seow-Choen F, Fook-Chong S, Eu KW. Bioresorbable adhesion barrier facilates early closure of the defunctioning ileostomy after rectal excision: A prospective, randomized trial. Dis Colon Rectum. 2003;46:1200–7.
11. Memon S, Heriot AG, Atkin CE, Lynch AC. Facilated early ileostomy closure after rectal cancer surgery: A case-matched study. Tech Coloproctol. 2012;16:285–90.
12. Menegaux F, Jordi-Galais P, Turren N, Chigot JD. Closure of small bowel stomas on postoperative day 10. Eur J Surg. 2002;168:713–5.
13. Matzel KE, Bittorf B, Gunther K, Stadelmaier U, Hohenberger W. Rectal resection with low anastomosis: functional outcome. Colorectal Dis. 2003;5:458-64.
14. Fucini C, Gattai R, Urena C, Bandettini L, Elbetti C. Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol. 2008;15:1099-106.
15. Celerier B, Denost Q, Geluwe BV, Pontallier A, Rullier E. The risk of definitive stoma formation at 10 years after low and ultralow anterior resection for rectal cancer. Colorectal disease. 2015;18:59-66.
16. Lim SW, Kim HJ, Kim CH, Huh JW, Kim YJ, Kim HR. Risk factors for permanent stoma after low anterior resection for rrecral cancer. Langenbecks Arch Surg. 2013;398:259-64.
17. Waterland P, Goonetilleke K, Naumann DN, Sutcliff M, Soliman F. Defunctioning ileostomy reversal rates and reasons for delayed reversal: Does delay impact on complications of ileostomy reversal? A study of 170 defunctionining ileostomies. J Clin Med Res. 2015;7:685-9.
18. Holmgren K, KvernengHultberg D, Rutegård M. High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multi-centre study. Colorectal Dis. 2017;19:1067–75.
19. Bailey CMH, Wheeler JMD, Birks M, Farouk R. The incidence and causes of permanent stoma after anterior resection. Colorectal Dis. 2003;5:331–4.
20. Pan HD, Peng YF, Wang L, Li M, Yao YF, Zhao J et al. Risk factors for non-closure of a temporary defunctioning ileostomy following anterior resection of rectal cancer. Dis Colon Rectum. 2016;59:94-100.
21. Moran BJ, Heald B Anastomotic leakage after colorectal anastomosis. Semin Surg Oncol. 2000;18:244–8.
22. Moran BJ. Stapling instruments for intestinal anastomosis in colorectal surgery. Br J Surg. 1996;83:902–9.