Investigation on the influencing factors of the choice of simultaneously defunctioning stoma in the sphincter saving surgery for low and middle rectal cancer / 国际外科学杂志

ABSTRACT

Objective:To investigate the clinical features of patients undergoing simultaneously defunctioning stoma for sphincter saving surgery for low and middle rectal cancer in our center, and to analyze the influencing factors of physicians′ choice of defunctioning stoma, which is expected to be used to guide clinicians′ preoperative prediction and decisions.Methods:Patients who underwent laparoscopic assisted sphincter saving surgery for low and middle rectal cancer between Jan. 2015 and Dec. 2020 in the Department of Gastrointestinal and Anal Surgery, the First Hospital of Jilin University were surveyed. The clinical data for each patient were collected and analyzed. Statistical software SPSS24.0 was used for statistical analysis. Factors which could influence the choice of defunctioning stoma probably were conducted by univariate analysis and Logistic analysis.Results:Six hundred and twenty-seven patients were inciuded in this study. There were 376 males and 251 females, median age was 62 years old (aged from 23 to 89). And 285 patients underwent simultaneously defunctioning stoma and 342 patients did not.Patients with middle rectal cancer were 495 and with low rectal cancer were 132. The factors influencing the choice of defunctioning stoma were selected in univariate analysis: male( P<0.001), BMI≥28 kg/m 2( P<0.001), diabetes( P<0.001), neoadjuvant chemoradiation( P<0.001), taTME or ISR operation( P<0.001), anastomosis height <5 cm( P<0.001) and length of surgery more than 180 min ( P<0.001), all of which were statistically significant ( P<0.05). Logistic analysis showed the factors of defunctioning stoma were as follows BMI≥28 kg/m 2( OR=2.541, 95% CI 1.079~5.977, P=0.033), diabetes( OR=4.216, 95% CI 2.258~7.873, P<0.001), neoadjuvant chemoradiation ( OR=4.254, 95% CI 1.193~15.170, P=0.026), taTME or ISR operation( OR=3.222, 95% CI 1.678~6.185, P<0.001), anastomosis height <5 cm( OR=10.475, 95% CI 6.663~16.466, P<0.001) and length of surgery more than 180 min( OR=2.881, 95% CI 1.713~4.845, P<0.001)( P<0.05). Conclusions:According to single-center experience, physicians' choice of simultaneously defunctioning stoma during sphincter saving surgery for low rectal cancer in abdominal endoscopy is related to many factors, among which diabetes, preoperative neoadjuvant chemoradiation, taTME or ISR operation, anastomosis height <5 cm, long operation time, physicians prefer to choose simultaneously defunctioning stoma. For patients with the above features, they should be adequately prepared preoperatively.