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Risk Factors Associated With Nonclosure of Defunctioning Stomas After Sphincter-Preserving Low Anterior Resection of Rectal Cancer: A Meta-Analysis.

Abstract Some patients receiving defunctioning stomas will never undergo stoma reversal, but it is difficult to preoperatively predict which patients will be affected.
PMID
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Authors

Mayor MeshTerms

Colectomy

Colostomy

Postoperative Complications

Keywords
Journal Title diseases of the colon and rectum
Publication Year Start




PMID- 28383455
OWN - NLM
STAT- MEDLINE
DA  - 20170406
DCOM- 20170418
LR  - 20170418
IS  - 1530-0358 (Electronic)
IS  - 0012-3706 (Linking)
VI  - 60
IP  - 5
DP  - 2017 May
TI  - Risk Factors Associated With Nonclosure of Defunctioning Stomas After
      Sphincter-Preserving Low Anterior Resection of Rectal Cancer: A Meta-Analysis.
PG  - 544-554
LID - 10.1097/DCR.0000000000000819 [doi]
AB  - BACKGROUND: Some patients receiving defunctioning stomas will never undergo stoma
      reversal, but it is difficult to preoperatively predict which patients will be
      affected. OBJECTIVE: The aim of this meta-analysis was to identify the risk
      factors associated with nonclosure of temporary stomas after sphincter-preserving
      low anterior resection for rectal cancer. DATA SOURCES: We performed a
      comprehensive search of the PubMed, Embase, and Cochrane Central Library
      databases for all of the studies analyzing risk factors for nonclosure of
      defunctioning stomas. STUDY SELECTION: We only included articles published in
      English in this meta-analysis. The inclusion criteria were as follows: 1)
      original article with extractable data, 2) studies including only defunctioning
      stomas created after low anterior resection for rectal cancer, 3) studies with
      nonclosure rather than delayed closure as the main end point, and 4) studies
      analyzing risk factors for nonclosure. INTERVENTION: Defunctioning stomas were
      created after low anterior resection for rectal cancer. MAIN OUTCOME MEASURES:
      Stoma nonclosure was the only end point, and it included nonclosure and permanent
      stoma creation after primary stoma closure. The Newcastle-Ottawa Scale was used
      to assess methodologic quality of the studies, and risk ratios and 95% CIs were
      used to assess risk factors. RESULTS: Ten studies with 8568 patients were
      included. The nonclosure rate was 19% (95% CI, 13%-24%; p < 0.001; I= 96.2%).
      Three demographic factors were significantly associated with nonclosure: older
      age (risk ratio= 1.50 (95% CI, 1.12-2.02); p = 0.007; I= 39.3%), ASA score >2
      (risk ratio = 1.66 (95% CI, 1.51-1.83); p < 0.001; I= 0%), and comorbidities
      (risk ratio = 1.58 (95% CI, 1.29-1.95); p < 0.001; I= 52.6%). Surgical
      complications (risk ratio = 1.89 (95% CI, 1.48-2.41); p < 0.001; I= 29.7%),
      postoperative anastomotic leakage (risk ratio = 3.39 (95% CI, 2.41-4.75); p <
      0.001; I= 53.0%), stage IV tumor (risk ratio = 2.96 (95% CI, 1.73-5.09); p <
      0.001; I= 88.1%), and local recurrence (risk ratio = 2.84 (95% CI, 2.11-3.83); p 
      < 0.001; I= 6.8%) were strong clinical risk factors for nonclosure. Open surgery 
      (risk ratio = 1.47 (95% CI, 1.01-2.15); p = 0.044; I= 63.6%) showed a borderline 
      significant association with nonclosure. LIMITATIONS: Data on some risk factors
      could not be pooled because of the low number of studies. There was conspicuous
      heterogeneity between the included studies, so the pooled data were not
      absolutely free of exaggeration or influence. CONCLUSIONS: Older age, ASA score
      >2, comorbidities, open surgery, surgical complications, anastomotic leakage,
      stage IV tumor, and local recurrence are risk factors for nonclosure of
      defunctioning stomas after low anterior resection in patients with rectal cancer,
      whereas tumor height, radiotherapy, and chemotherapy are not. Patients with these
      risk factors should be informed preoperatively of the possibility of nonreversal,
      and joint decision-making is preferred.
FAU - Zhou, Xin
AU  - Zhou X
AD  - Department of General Surgery, Peking University Third Hospital, Beijing, China.
FAU - Wang, Bingyan
AU  - Wang B
FAU - Li, Fei
AU  - Li F
FAU - Wang, Jilian
AU  - Wang J
FAU - Fu, Wei
AU  - Fu W
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Dis Colon Rectum
JT  - Diseases of the colon and rectum
JID - 0372764
SB  - IM
MH  - *Colectomy/adverse effects/methods
MH  - *Colostomy/adverse effects/methods
MH  - Humans
MH  - *Postoperative Complications/diagnosis/etiology/surgery
MH  - Rectal Neoplasms/pathology/*surgery
MH  - Reoperation
MH  - Risk Factors
EDAT- 2017/04/07 06:00
MHDA- 2017/04/19 06:00
CRDT- 2017/04/07 06:00
AID - 10.1097/DCR.0000000000000819 [doi]
AID - 00003453-201705000-00012 [pii]
PST - ppublish
SO  - Dis Colon Rectum. 2017 May;60(5):544-554. doi: 10.1097/DCR.0000000000000819.

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