Long-term stoma-related reinterventions after anterior resection for rectal cancer with or without anastomosis: population data from the Dutch snapshot study

S J A Hazen; I Vogel; W A A Borstlap; J W T Dekker; J B Tuynman; P J Tanis; M Kusters; Dutch Snapshot Research Group

doi:10.1007/s10151-021-02543-3

Long-term stoma-related reinterventions after anterior resection for rectal cancer with or without anastomosis: population data from the Dutch snapshot study

Tech Coloproctol. 2022 Feb;26(2):99-108. doi: 10.1007/s10151-021-02543-3. Epub 2021 Nov 26.

Authors

S J A Hazen^#¹, I Vogel^#², W A A Borstlap², J W T Dekker³, J B Tuynman¹, P J Tanis⁴, M Kusters⁵; Dutch Snapshot Research Group

Collaborators

Dutch Snapshot Research Group:
C L Deijen, M den Dulk, H J Bonjer, C J van de Velde, P J Tanis, A G J Aalbers, Y Acherman, G D Algie, B Alting von Geusau, F Amelung, T S Aukema, I S Bakker, S A Bartels, S Basha, A J N M Bastiaansen, E Belgers, W Bleeker, J Blok, R J I Bosker, J W Bosmans, M C Boute, N D Bouvy, H Bouwman, A Brandt-Kerkhof, D J Brinkman, S Bruin, E R J Bruns, J P M Burbach, J W A Burger, C J Buskens, S Clermonts, P P L O Coene, C Compaan, E C J Consten, T Darbyshire, S M L de Mik, E J R de Graaf, I de Groot, R J L de Vos Tot Nederveen Cappel, J H W de Wilt, J van der Wolde, F C den Boer, J W T Dekker, A Demirkiran, M Derkx-Hendriksen, F R Dijkstra, P van Duijvendijk, M S Dunker, Q E Eijsbouts, H Fabry, F Ferenschild, J W Foppen, E J B Furnee, M F Gerhards, P Gerven, J A H Gooszen, J A Govaert, W M U Van Grevenstein, R Haen, J J Harlaar, E Harst, K Havenga, J Heemskerk, J F Heeren, B Heijnen, P Heres, C Hoff, W Hogendoorn, P Hoogland, A Huijbers, J A H Gooszen, P Janssen, A C Jongen, F H Jonker, E G Karthaus, A Keijzer, J M A Ketel, J Klaase, F W H Kloppenberg, M E Kool, R Kortekaas, P M Kruyt, J T Kuiper, B Lamme, J F Lange, T Lettinga, D J Lips, F Logeman, M F Lutke Holzik, E Madsen, A Mamound, C C Marres, I Masselink, M Meerdink, A G Menon, J S Mieog, D Mierlo, G D Musters, P A Neijenhuis, J Nonner, M Oostdijk, S J Oosterling, P M P Paul, K C M J C Peeters, I T A Pereboom, F Polat, P Poortman, M Raber, B M M Reiber, R J Renger, C C van Rossem, H J Rutten, A Rutten, R Schaapman, M Scheer, L Schoonderwoerd, N Schouten, A M Schreuder, W H Schreurs, G A Simkens, G D Slooter, H C E Sluijmer, N Smakman, R Smeenk, H S Snijders, D J A Sonneveld, B Spaansen, E J Spillenaar Bilgen, E Steller, W H Steup, C Steur, E Stortelder, J Straatman, H A Swank, C Sietses, H A Ten Berge, H G Ten Hoeve, W W Ter Riele, I M Thorensen, B Tip-Pluijm, B R Toorenvliet, L Tseng, J B Tuynman, J van Bastelaar, S C van Beek, A W H van de Ven, M A J van de Weijer, C van den Berg, I van den Bosch, J D W van der Bilt, S J van der Hagen, R van der Hul, G van der Schelling, A van der Spek, N van der Wielen, E van Duyn, C van Eekelen, J A van Essen, K van Gangelt, A A W van Geloven, C van Kessel, Y T van Loon, A van Rijswijk, S J van Rooijen, T van Sprundel, L van Steensel, W F van Tets, H L van Westreenen, S Veltkamp, T Verhaak, P M Verheijen, L Versluis-Ossenwaarde, S Vijfhuize, W J Vles, S Voeten, F J Vogelaar, W W Vrijland, E Westerduin, M E Westerterp, M Wetzel, K Wevers, B Wiering, A C Witjes, M W Wouters, S T K Yauw, E C Zeestraten, D D Zimmerman, T Zwieten

Affiliations

¹ Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, PO Box 7057, 1000 SN, Amsterdam, The Netherlands.
² Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
³ Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands.
⁴ Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
⁵ Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, PO Box 7057, 1000 SN, Amsterdam, The Netherlands. [email protected].

^# Contributed equally.

PMID: 34837140
DOI: 10.1007/s10151-021-02543-3

Abstract

Background: The aim of this study was to analyze the stoma-related reinterventions, complications and readmissions after an anterior resection for rectal cancer, based on a cross-sectional nationwide cohort study with 3-year follow-up.

Methods: Rectal cancer patients who underwent a resection with either a functional anastomosis, a defunctioned anastomosis, or Hartmann's procedure (HP) with an end colostomy in 2011 in 71 Dutch hospitals were included. The primary outcome was number of stoma-related reinterventions.

Results: Of the 2095 patients with rectal cancer, 1400 patients received an anterior resection and were included in this study; 257 received an initially functional anastomosis, 741 a defunctioned anastomosis, and 402 patients a HP. Of the 1400 included patients, 62% were males, 38% were females and the mean age was 67 years (SD 11.1). Following a primary functional anastomosis, 48 (19%) patients received a secondary stoma. Stoma-related complications occurred in six (2%) patients, requiring reintervention in one (0.4%) case. In the defunctioned anastomosis group, stoma-related complications were present in 92 (12%) patients, and required reintervention in 23 (3%) patients, in 10 (1%) of these more than 1 year after initial resection. Stoma-related complications occurred in 92 (23%) patients after a HP, and required reintervention in 39 (10%) patients in 17 (4%) of cases more than 1 year after initial resection. The permanent stoma rate was 11% and 20%, in the functional anastomosis and the defuctioned anastomosis group, respectively. The end colostomy in the HP group was reversed in 4% of cases.

Conclusions: Construction of a stoma after resection for rectal cancer with preservation of the sphincter is accompanied with long-term stoma-related morbidity. Stoma complications are more frequent after a HP. Even after 1 year, a significant number of reinterventions are required.

Keywords: Anastomosis; Anterior resection; Hartmann’s procedure; Permanent stoma; Rectal cancer.

MeSH terms

Aged
Anastomosis, Surgical / adverse effects
Cohort Studies
Colostomy / adverse effects
Cross-Sectional Studies
Female
Humans
Male
Rectal Neoplasms* / etiology
Rectal Neoplasms* / surgery
Retrospective Studies
Surgical Stomas* / adverse effects