Осложнения при формировании превентивных стом при хирургическом лечении рака прямой кишки

Background. Anastomotic leakage is one of the most severe complications of colorectal cancer surgery. The formation of a preventive stoma can avoid the consequences of this complication. Given the increase in the rate of sphincter-preserving surgeries, the number of surgeries with the formation of preventive stoma has also increased significantly. There are several techniques and each of them has its advantages and disadvantages.The aim of the study was to compare the effectiveness of surgical treatment and techniques of preventive stoma formation.Material and Methods. The retrospective study included 353 patients with stage II–IV rectal cancer who underwent surgery with the formation of preventive stoma (110 with ileostomy formation, 243 with transversostomy) from 2016 to 2020. Both intraoperative parameters (operation time, blood loss, intraoperative complications) and postoperative parameters (postoperative bed-day, complications) were evaluated. Immediate complications within 30 days after surgery using the Clavien–Dindo complication scale and infectious complications mainly related to the stoma formation (prolapse, stoma retraction, presence of peristomal dermatitis, reoperation) were assessed.Conclusion. The choice in the formation of a preventive ileo- or transversostomy during rectal resection has no effect on the frequency of anastomosis failure; however, there is a tendency that patients with colostomy spend fewer bed days in a hospital. Stoma-related complications in the postoperative period are mild and can be treated conservatively in the vast majority of cases. In compliance with the standardized surgical procedures and the protocol of perioperative management of patients, the number of severe complications is minimal. It is necessary to evaluate the second step of management of patients with preventive stomas – their elimination. Актуальность. Несостоятельность анастомоза после резекции прямой кишки при колоректальном раке является одним из самых жизнеугрожающих осложнений. Формирование превентивной стомы – основной способ избежать последствий этого осложнения. С учетом неуклонного роста сфинктеросохраняющих операций количество операций, заканчивающихся формированием стомы, также значительно выросло. Существует несколько методик, и каждая из них имеет свои преимущества и недостатки.Цель исследования – сравнить эффективность хирургического лечения и методик формирования превентивной стомы.Материал и методы. Проведено ретроспективное исследование, в которое включены 353 больных раком прямой кишки II–IV стадии, перенесших первый этап хирургического лечения рака с формированием стомы (110 – с формированием илеостомы, 243 – с трансверзостомы) в отделении колопроктологии ГБУЗ СПбКНПЦ СВМП(о) с 2016 по 2020 г. Оценке подверглись общие интраоперационные (длительность, кровопотеря, интраоперационные осложнения) и послеоперационные показатели (послеоперационный койко-день). Главный интерес представляли общие осложнения (с использованием шкалы осложнений Clavien–Dindo в течение 30 дней после операции) и осложнения, связанные с формирование стомы, – инфекционные осложнения, пролапс стомы, ретракция стомы, наличие перистомального дерматита, повторные вмешательства.Заключение. Выбор при формировании превентивной илео- или трансверзостомы при резекции прямой кишки не влияет на частоту несостоятельности анастомоза, однако отмечено, что пациенты с колостомой проводят меньшее число койко-дней в условиях стационара. Осложнения со стороны стомы в послеоперационном периоде в подавляющем большинстве случаев легкой степени тяжести и могут быть купированы консервативно. При соблюдении стандартной техники хирургического вмешательства, протокола периоперационного ведения пациентов количество осложнений тяжелой степени минимально. Необходима оценка второго этапа ведения пациентов с превентивными стомами – их устранения

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups