TY - JOUR
T1 - Permanent stoma rate and long-term stoma complications in laparoscopic, robot-assisted, and transanal total mesorectal excisions
T2 - a retrospective cohort study
AU - Burghgraef, T. A.
AU - Geitenbeek, R. T. J.
AU - Broekman, M.
AU - Hol, J. C.
AU - Hompes, R.
AU - Consten, E. C. J.
N1 - Funding Information: On behalf of the MIRECA (Minimal invasive rectal cancer surgery) group, R.M.P.H. Crolla; A.A.W. van Geloven, MD, PhD; J.C. Hol, MD; J.W.A. Leijtens, MD, PhD; F. Polat, MD, PhD; A. Pronk, MD, PhD; M.L. Rutgers, MD; C. Sietses, MD, PhD; A.B. Smits, MD, PhD; J.B. Tuynman, MD, PhD; E.G.G. Verdaasdonk, MD, PhD; and P.M. Verheijen, MD, PhD are gratefully acknowledged. Publisher Copyright: © 2023, The Author(s).
PY - 2024/1
Y1 - 2024/1
N2 - Background: The surgical resection of rectal carcinoma is associated with a high risk of permanent stoma rate. Primary anastomosis rate is suggested to be higher in robot-assisted and transanal total mesorectal excision, but permanent stoma rate is unknown. Methods: Patients undergoing total mesorectal excision for MRI-defined rectal cancer between 2015 and 2017 in 11 centers highly experienced in laparoscopic, robot-assisted or transanal total mesorectal excision were included in this retrospective study. Permanent stoma rate, stoma-related complications, readmissions, and reoperations were registered. A multivariable regression analysis was performed for permanent stoma rate, stoma-related complications, and stoma-related reoperations. Results: In total, 1198 patients were included. Permanent stoma rate after low anterior resection (with anastomosis or with an end colostomy) was 40.1% in patients undergoing laparoscopic surgery, 21.3% in patients undergoing robot-assisted surgery, and 25.6% in patients undergoing transanal surgery (P < 0.001). Permanent stoma rate after low anterior resection with an anastomosis was 17.3%, 11.8%, and 15.1%, respectively. The robot-assisted and transanal techniques were independently associated with a reduction in permanent stoma rate in patients who underwent a low anterior resection (with anastomosis or with an end colostomy) (OR 0.39 [95% CI 0.25, 0.59] and OR 0.35 [95% CI 0.22, 0.55]), while this was not seen in patients who underwent a restorative low anterior resection. 45.4% of the patients who had a stoma experienced stoma-related complications, 4.0% were at least once readmitted, and 8.9% underwent at least one reoperation. Conclusions: The robot-assisted and transanal techniques are associated with a lower permanent stoma rate in patients who underwent a low anterior resection.
AB - Background: The surgical resection of rectal carcinoma is associated with a high risk of permanent stoma rate. Primary anastomosis rate is suggested to be higher in robot-assisted and transanal total mesorectal excision, but permanent stoma rate is unknown. Methods: Patients undergoing total mesorectal excision for MRI-defined rectal cancer between 2015 and 2017 in 11 centers highly experienced in laparoscopic, robot-assisted or transanal total mesorectal excision were included in this retrospective study. Permanent stoma rate, stoma-related complications, readmissions, and reoperations were registered. A multivariable regression analysis was performed for permanent stoma rate, stoma-related complications, and stoma-related reoperations. Results: In total, 1198 patients were included. Permanent stoma rate after low anterior resection (with anastomosis or with an end colostomy) was 40.1% in patients undergoing laparoscopic surgery, 21.3% in patients undergoing robot-assisted surgery, and 25.6% in patients undergoing transanal surgery (P < 0.001). Permanent stoma rate after low anterior resection with an anastomosis was 17.3%, 11.8%, and 15.1%, respectively. The robot-assisted and transanal techniques were independently associated with a reduction in permanent stoma rate in patients who underwent a low anterior resection (with anastomosis or with an end colostomy) (OR 0.39 [95% CI 0.25, 0.59] and OR 0.35 [95% CI 0.22, 0.55]), while this was not seen in patients who underwent a restorative low anterior resection. 45.4% of the patients who had a stoma experienced stoma-related complications, 4.0% were at least once readmitted, and 8.9% underwent at least one reoperation. Conclusions: The robot-assisted and transanal techniques are associated with a lower permanent stoma rate in patients who underwent a low anterior resection.
KW - Minimally invasive
KW - Permanent stoma
KW - Rectal cancer
KW - Total mesorectal excision
UR - http://www.scopus.com/inward/record.url?scp=85175863303&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00464-023-10517-9
DO - https://doi.org/10.1007/s00464-023-10517-9
M3 - Article
C2 - 37932600
SN - 0930-2794
VL - 38
SP - 105
EP - 115
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 1
ER -