Nao Obara, Shigeki Yakaguchi, Yasumitsu Hirano, Toshimasa Ishii, Hiroka Kondo, Kiyoka Hara, Shintaro Ishikawa, Takuhisa Okada, Liming Wong. Saitama medical university International medical Center
Introduction: Recently, the opportunity to perform laparoscopic intersphincteric resection (ISR) has been increased to preserve the anus. Temporary feacal diversion reduces the consequences of anastomotic leakage, and resulted in the increasing numbers of patients with loop ostomy after laparoscopic ISR. The aim of this study was to clarify the rate of stoma reversal and the postoperative complications after laparoscopic ISR for rectal cancer.
Patients and Methods: We retrospectively examined 139 patients who have underwent laparoscopic ISR for rectal cancer with defunctioning ostomy in our hospital between 2010 and 2017 with a follow-up period of at least one year.
Results: The median age at the time of creation of the stoma was 65-years old, and median BMI was 22.8 kg/m2. Of these, 102 were male and 37 were female. The preoperative comorbidities were 34 hypertensions, 25 diabetes, 11 respiratory diseases, 9 ischemic heart diseases, 8 cerebrovascular diseases, 5 arrhythmias and 4 hepatitis. The treatment performed before laparoscopic ISR included 18 chemo-radio therapies, 13 endoscopic tumor resections, 2 trans-anal tumor resections and one chemotherapy. The positions of defunctioning ostomy were 131 ileums and 8 transverse colons. Postoperative complications after laparoscopic ISR were 18 anastomotic leakages, 9 anastomotic strictures, 8 stoma outlet obstructions, 6 rectal prolapses, 5 bowel obstructions, 3 dysuria and one peri-stomal fistula. One hundred and twenty three patients (88%) had stoma reversal, and median time to reversal was 4.2 months. In 16 patients (12%), stoma reversal was not performed. The reasons were 10 tumor metastasis or recurrence of rectal cancer, 3 anastomotic leakage or stricture and 3 patients’ reques. In 16 patients (13%) after stoma reversal, reconstructions of ostomy were performed because of 6 anastomotic recurrences of cancer, 3 anastomotic strictures, 2 late anastomotic leakages, 2 poor anal function, one recto-seminal vesicle fistula, one perforation of colon and one perforation of small intestine. In 110 patients (79%), stoma reversal was performed in the follow-up period of at least one year.
Conclusion: Twenty nine patients (21%) undergone laparoscopic ISR with defuntioning ostomy did not have stoma reversal or had stoma recreation after reversal in the follow-up period. It is important to detect the patient who may not have stoma reversal preoperatively and should be considered for permanent stoma.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94077
Program Number: P289
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster