Cemal ULUSOY, Mehmet Güray DUMAN, Sıla GÜÇLÜ METE, Andrej NİKOLOVSKİ

Rektal kanser cerrahisinde koruyucu ileostomi, koruyucu ileostomi gerçekten geçici mi?

Amaç: Bu tek merkezli retrospektif çalışma, rektosigmoid ve rektum kanseri hastalarında koruyucu ileostomi kapatılması oranlarını değerlendirmeyi ve ileostomi kapatılmasını engelleyen faktörleri araştırmayı amaçlamıştır. Metod: Neoadjuvan tedavi almış veya almamış rektum kanseri hastaları çalışmaya dahil edilmiştir. Bütün hastalara anterior rezeksiyon ve koruyucu ileostomi ameliyatı yapılmıştır. İleostomi kapatılması kararları, tanımlanmış ileostomi kapatılma prosedürüne uygun olarak verilmiştir. Toplamda 115 hasta çalışmaya dahil edilmiştir (17 rektosigmoid, 98 rektum kanseri. Hastaların 98’i daha önceden neoadjuvan tedavi almıştır. İleostomi kapatılma oranları %73.9 ’dur. İleostomi kapatılma süreleri neoadjuvan tedavi alan hastalarda ortalama 227..8 gün almayanlarda daha az olmak üzere 168.3 gündür ancak bu fark istatistiksel olarak anlamlı değildir. Multivariate analiz primer cerrahi sırasında yapılan anastomozun endoskopik olarak değerlendirilmesinin ileostomi kapatılması üzerinde bağımsız prognostik faktör olduğunu göstermiştir. Sonuç: Koruyucu ileostomili hastaların ¼’ünden fazlası değişik sebeplerle stoma kapatılma deneyimlerini yaşayamamaktadır. Primer cerrahi sırasında yapılan endoskopik değerlendirme ileostomi kapatılmasını etkileyen prognostik faktördür.

Anahtar Kelimeler:

koruyucu ileostomi, loop ileostomi, ileostomi kapatılması, rektal kanser

Protective ileostomy in rectal cancer surgery-is it really temporary?

Aim: This single-center retrospective study aimed to evaluate the rate of protective ileostomy closure in patients with rectosigmoid junction/rectal cancer and to investigate the factors that prevent ileostomy reversal. Material and Method: Patients with rectal cancer treated with/without neoadjuvant chemoradiotherapy were included in this study. All were treated with anterior rectal resection and temporary protective ileostomy creation. Decision for ileostomy closure was brought upon predefined ileostomy closure protocol. Results: Total number of 115 patients (17 with rectosigmoid junction and 98 with rectal cancer) were operated. Neoadjuvant chemoradiotherapy was conducted in 90 of them. Ileostomy closure rate was 73.9%. Mean time for stoma closure in patients with chemoradiotherapy conduction was 227.8 days, while in the rest, time was shorter (168.3 days), without statistical difference. Multivariate analysis revealed that endoscopic examination of the anastomosis during its creation was independent prognostic factor that affected ileostomy closure. Conclusion: More than one quarter of the patients with protective ileostomy experienced non-closure of their stoma due to various events after index rectal cancer surgery. Endoscopic examination of the anastomosis during its creation presented as independent factor affecting ileostomy closure.

Keywords:

Loop ileostomy protective ileostomy, ileostomy reversal, ileostomy closure, rectal cancer,

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