Factors preventing restoration of bowel continuity in patients with rectal cancer submitted to anterior rectal resection and protective ileostomy.

ABSTRACT Objective: to evaluate the factors associated with non-closure of protective ileostomy after anterior resection of the rectum with total mesorectum excision for rectal cancer, the morbidity associated with the closure of ileostomies and the rate of permanent ileostomy in patients with rectal adenocarcinoma. Methods: we conducted a retrospective study with 174 consecutive patients diagnosed with rectal tumors, of whom 92 underwent anterior resection of the rectum with coloanal or colorectal anastomosis and protective ileostomy, with curative intent. We carried out a multivariate analysis to determine the factors associated with definite permanence of the stoma, as well as studied the morbidity of patients who underwent bowel continuity restoration. Results: In the 84-month follow-up period, 54 of the 92 patients evaluated (58.7%) had the ileostomy closed and 38 (41.3%) remained with the stoma. Among the 62 patients who had the ileostomy closed, 11 (17.7%) presented some type of postoperative complication: three had ileal anastomosis dehiscence, five had intestinal obstruction, two had surgical wound infection, and one, pneumonia. Eight of these patients required a new stoma. Conclusion: according to the multivariate analysis, the factors associated with stoma permanence were anastomotic fistula, presence of metastases and closure of the ileostomy during chemotherapy.

摘要
目的：本研究旨在评估直肠癌患者接受全直肠系膜切除术（total mesorectum excision）联合直肠前切除术（anterior resection of the rectum）后，保护性回肠造口（protective ileostomy）未闭合的相关影响因素、回肠造口关闭术后并发症发生率，以及直肠腺癌（rectal adenocarcinoma）患者永久性回肠造口的形成比例。
方法：本研究为一项回顾性研究，纳入174例经确诊的直肠肿瘤连续患者，其中92例接受了根治性直肠前切除术，并行结肠肛管或结肠直肠吻合术及保护性回肠造口。我们通过多变量分析（multivariate analysis）明确与造口永久性留存相关的影响因素，并对接受肠道连续性恢复手术的患者的术后并发症情况展开研究。
结果：在84个月的随访周期内，92例评估对象中共有54例（58.7%）完成回肠造口关闭术，38例（41.3%）仍保留造口。在完成造口关闭的62例患者中，11例（17.7%）出现各类术后并发症：其中3例发生回肠吻合口漏，5例出现肠梗阻，2例存在手术切口感染，1例并发肺炎。上述患者中有8例需再次施行造口手术。
结论：经多变量分析结果显示，与造口永久性留存相关的影响因素包括吻合口瘘、存在远处转移，以及化疗期间行回肠造口关闭术。