Hiroki Shimizu1, Shigeki Yamaguchi1, Toshimasa Ishii1, Jo Tashiro1, Hiroka Kondo1, Kiyoka Hara1, Kenichi Takemoto1, Asami Suzuki1, Kojun Okamoto2, Shinichi Sakuramoto2, Isamu Koyama2. 1Saitama Medical University, International Medical Center, Division of Colorectal Surgery, 2Saitama Medical University, International Medical Center, Division of Gastroenterological Surgery
Anastomotic leakage is the most serious complication of low anterior resection (LAR) for rectal cancer and temporary ileostomy is common procedure preventing it. The aim of this study is to clarify the usefulness and safety of temporary ileostomy with laparoscopic LAR in rectal cancer patients.
Four hundred and eighteen rectal cancer patients who underwent laparoscopic LAR with (n=226, LAR-I group) or without ileostomy (n=192, LAR-non I group) at Saitama Medical University, International Medical Center, between 2007 and 2015 were included in this study. The short-term results of primary and secondary (ileostomy closure) operation were retrospectively analyzed.
The characteristics of patients in LAR-I and LAR-non I group were; male/female: 175/51 and 100/92 (p<0.001), mean±SD age: 62±11 (19-86) and 63±11 (22-86) (p=0.325), respectively. The anastomotic leakage after primary operation was occurred in 20 (8.8%) and 18 (9.4%) patients in LAR-I and LAR-non I group (p=0.866), and 5 (2.2%) and 8 (4.2%) of them required re-operation in LAR-I and LAR-non I group (p=0.273). Of 226 patients in LAR-I group, 22 (9.7%) patients had ileostomy-related complications. In details, outlet syndrome (obstruction at ileostomy site), surgical site infection (SSI) and bleeding were occurred in 19, 3 and 1 cases, respectively. The contrast study of rectal anastomosis was performed in all patients, and it revealed that asymptomatic anastomotic leakage was found in 3 patients, who were conservatively observed and underwent secondary operation after confirming the leakage undetected. The secondary operation was performed in 210 (92.9%) patients after 118 (median, 30-502) days after the primary operation. Sixteen (7.1%) patients avoided the secondary operation because of treatments for metastatic lesions, patient’s will and complications of the primary operation in 10, 3 and 3 patients, respectively. The complications after the secondary operation were occurred in 19 (19/210, 9.0%) patients, including SSI, intestinal obstruction, anastomotic bleeding and anastomotic leakage in 11, 4, 3 and 1 patients, respectively.
Although the overall rate of anastomotic leakage was not significant different between LAR-I and LAR-non I groups, fewer cases required re-operation in LAR-I group and ileostomy closure was safely performed in most cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79893
Program Number: P182
Presentation Session: Poster (Non CME)
Presentation Type: Poster