BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient sel...BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient selection and operative strategies to avoid stoma formation need further elucidation.METHODS This study enrolled 505 consecutive patients,including 84 who underwent stoma-free(SF)intersphincteric resection.After matching,patients were divided into SF(n=78)and DS(n=78)groups.The primary endpoint was the anastomotic leakage(AL)rate within 6 months and its protective factors for both the total and SF cohorts.The secondary endpoints included overall survival and disease-free survival.RESULTS The AL rate was greater in the SF group than in the DS group(12.8%vs 2.6%,P=0.035).Male sex[(odds ratio(OR)=2.644,P=0.021],neoadjuvant chemoradiotherapy(nCRT)(OR=6.024,P<0.001),and tumor height from the anal verge≤4 cm(OR=4.160,P=0.007)were identified as independent risk factors.Preservation of the left colic artery(LCA)was protective in both the total cohort(OR=0.417,P=0.013)and the SF cohort(OR=0.312,P=0.027).The female patients who did not undergo nCRT and had preservation of the LCA experienced a significantly lower incidence of AL(2/97,2.1%).The 3-year overall survival or disease-free survival did not significantly differ be-tween the groups.CONCLUSION Female patients who do not receive nCRT may avoid the need for DS by preserving the LCA without increasing the risk of AL or compromising oncological outcomes.展开更多
基金Supported by Beijing Natural Science Foundation,No.L222054 and No.4232058.
文摘BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient selection and operative strategies to avoid stoma formation need further elucidation.METHODS This study enrolled 505 consecutive patients,including 84 who underwent stoma-free(SF)intersphincteric resection.After matching,patients were divided into SF(n=78)and DS(n=78)groups.The primary endpoint was the anastomotic leakage(AL)rate within 6 months and its protective factors for both the total and SF cohorts.The secondary endpoints included overall survival and disease-free survival.RESULTS The AL rate was greater in the SF group than in the DS group(12.8%vs 2.6%,P=0.035).Male sex[(odds ratio(OR)=2.644,P=0.021],neoadjuvant chemoradiotherapy(nCRT)(OR=6.024,P<0.001),and tumor height from the anal verge≤4 cm(OR=4.160,P=0.007)were identified as independent risk factors.Preservation of the left colic artery(LCA)was protective in both the total cohort(OR=0.417,P=0.013)and the SF cohort(OR=0.312,P=0.027).The female patients who did not undergo nCRT and had preservation of the LCA experienced a significantly lower incidence of AL(2/97,2.1%).The 3-year overall survival or disease-free survival did not significantly differ be-tween the groups.CONCLUSION Female patients who do not receive nCRT may avoid the need for DS by preserving the LCA without increasing the risk of AL or compromising oncological outcomes.
