ObjectiveTo analyze risk factors of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. MethodData were collected retrospectively for consecutive patients undergoing defunctioning ileostomy following sphincter preservation surgery for rectal cancer, from January 2014 to December 2014. ResultsOne hundred and thirty patients were included (median time to reversal 132 d, range 39-692 d), of whom 35 patients (26.92%) had postoperative complications after stoma reversal. The main complications included 23 cases of diarrhea, 6 cases of bowel obstruction, 9 cases of incision infection, and 4 cases of perianal eczema. The results of univariate analysis showed that the distant of tumor from anal verge <5 cm (P=0.010), postoperative adjuvant chemotherapy (P=0.002), and time to reversal (P=0.025) were related to the postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. The result of multivariate analysis by using a logistic regression model showed that the time to reversal (OR=1.006, P=0.021) was a significant independent risk factor for it. ConclusionDelay reversal of defunctiong ileostomy might increase risk of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery.
ObjectiveThis study aimed to discuss the risk factors associated with the delay reversal ileostomy following sphincter-preserving surgery for rectal cancer.MethodsClinical data were collected retrospectively on 130 consecutive patients undergoing defunctioning ileostomy following sphincter-preserving surgery for rectal cancer, between January 2014 and December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University. According to the reversal time of ileostomy, the patients were divided into two groups, including the delay reversal ileostomy group (≥120 d, n=72) and the normal ileostomy group (<120 d, n=58).ResultsOne hundred and thirty patients were studied (median time to reversal 132 d, range 39–692 d). Logistic regression model showed that adjuvant chemotherapy (OR=14.106, P=0.002), distance of tumor from the anal verge (OR=0.019, P=0.002), and anastomotic leakage (OR=32.440, P=0.001) were significant independent risk factors for delayed reversal. Time to reversal was significantly longer in those patients who had adjuvant chemotherapy, anastomotic leakage, and short distance of tumor from the anal verge.ConclusionAdjuvant chemotherapy, short distance of tumor from the anal verge, and anastomotic leakage are the independent risk factors for delay reversal ileostomy following sphincter-preserving surgery for rectal cancer.
Objective To investigate factors for surgical difficulty and complications following closure of temporary ileostomy for rectal cancer. Methods The clinical data of 103 patients with low rectal cancer treated with closure of temporary ileostomy from January 2014 to July 2017 in the Northern Theater Command General Hospital were retrospectively analyzed. The associated factors of surgical difficulty and postoperative complications were identified by the univariate and multivariate logistic regression analyses. Results In this study, there were 11 (10.7%) patients with surgical difficulty (operation time >100 min) in the 103 patients. The multivariate logistic regression analysis showed that the history of previous abdominal surgery ［OR=5.272, 95% CI (1.325, 20.977), P=0.018］ and minimally invasive surgery ［OR=0.166, 95% CI (0.037, 0.758), P=0.020］ were the independent influencing factors of the difficulty of surgery. The complications following closure of temporary ileostomy included 16 (15.5%) patients with the incision infection, 5 (4.9%) patients with the intestinal obstruction, and 3 patients with the pulmonary infection (2.9%). The multivariate logistic regression analysis showed that the diabetes ［OR=4.855, 95% CI (1.133, 20.804), P=0.033］, operation time >100 min ［OR=11.914, 95% CI (2.247, 63.171), P=0.004］, and peristomal dermatitis ［OR=18.814, 95% CI (3.978, 88.988), P<0.001］ were the independent influencing factors for the incision infection. Conclusions History of previous abdominal surgery is main cause for difficulty of surgery and minimally invasive surgery can reduce difficulty of surgery. Diabetes mellitus, longer operation time, and peristomal dermatitis are main causes of postoperative incision infection.
ObjectiveTo explore the causes of colon-anal anastomotic stenosis in patients with low rectal cancer after prophylactic ileostomy under complete laparoscopy. MethodsA total of 194 patients with low rectal cancer who received complete laparoscopic radical resection of rectal cancer combined with preventive ileostomy in our hospital from January 2020 to December 2020 were selected as the study objects, and were divided into non-stenosis group (n=136) and stenosis group (n=58) according to postoperative colon-anal anastomosis stenosis. The clinical data of the two groups were compared. Univariate and multivariate logistic regression were used to analyze the factors affecting postoperative colon-anal anastomotic stenosis, and stepwise regression was used to evaluate the importance of each factor. The risk prediction model of postoperative colon-anal anastomotic stenosis was constructed and evaluated. ResultsIn the stenosis group, the proportion of males, tumor diameter ＞3 cm, NRS2002 score >3 points, manual anastomosis, left colic artery not preserved, anastomotic leakage, pelvic infection and patients undergoing neoadjuvant radiotherapy and neoadjuvant chemotherapy were higher than those in the non-stenosis group (P<0.05). The results of univariate logistic analysis showed that female and preserving the left colonic artery were the protective factors for postoperative colon-anal anastomotic stenosis (P<0.05), and the tumor diameter >3 cm, NRS2002 score >3 points, manual anastomosis, anastomotic leakage, pelvic infection, neoadjuvant radiotherapy and neoadjuvant chemotherapy were the risk factors for postoperative colon-anal anastomotic stenosis (P<0.05). Multivariate logistic regression analysis showed that gender, tumor diameter, NRS 2002 score, anastomotic mode, anastomotic leakage, and pelvic infection were independent influencing factors for postoperative colon-anal anastomotic stenosis (P<0.05). Stepwise regression analysis showed that the top three factors affecting postoperative colon-anal anastomotic stenosis were NRS 2002 score, gender and anastomotic leakage. Multivariate Cox risk proportional model analysis showed that the multivariate model composed of NRS 2002 score, gender and anastomotic leakage had a good consistency in the risk assessment of postoperative colon-anal anastomotic stenosis. Based on this, a risk prediction model for postoperative colon-anal anastomotic stenosis was constructed. The results of strong influence point analysis show that there are no data points in the modeling data that have a strong influence on the model parameter estimation (Cook distance <1). Receiver operating characteristic curve results showed that the model had good differentiation ability, the area under curve was 0.917, 95%CI was (0.891, 0.942). The calibration curve was approximately a diagonal line, showing that the model has good predictive power (Brier value was 0.097). The results of the clinical decision curve showed that better clinical benefits can be obtained by using the predictive model to identify the corresponding risk population and implement clinical intervention. ConclusionThe prediction model based on NRS 2002 score, gender and anastomotic fistula can effectively evaluate the risk of colon-anal anastomotic stenosis after preventive ileostomy in patients with low rectal cancer under complete laparoscopy.