PDF(Pubmed)
Abstract：
(1) Background: In recent years, there has been a change in practice for diverting stomas in rectal cancer surgery, shifting from routine diverting stomas to a more selective approach. Studies suggest that the benefits of temporary ileostomies do not live up to their risks, such as high-output stomas, stoma dysfunction, and reoperation. (2) Methods: All rectal cancer patients treated with a robotic resection in a single tertiary colorectal centre in the UK from 2013 to 2021 were analysed. In 2015, our unit made a shift to a more selective approach to temporary diverting ileostomies. The cohort was divided into a routine diversion group treated before 2015 and a selective diversion group treated after 2015. Both groups were analysed and compared for short-term outcomes and morbidities. (3) Results: In group A, 63/70 patients (90%) had a diverting stoma compared to 98/135 patients (72.6%) in group B (p = 0.004). There were no significant differences between the groups in anastomotic leakages (11.8% vs. 17.8%, p = 0.312) or other complications (p = 0.117). There were also no significant differences in readmission (3.8% vs. 2.6%, p = 0.312) or reoperation (3.8% vs. 2.6%, p = 1.000) after stoma closure. After 1 year, 71.6% and 71.9% (p = 1.000) of patients were stoma-free. One major reason for the delay in stoma reversal was the COVID-19 pandemic, which only occurred in group B (0% vs. 22%, p = 0.054). (4) Conclusions: A more selective approach to diverting stomas for robotic rectal cancer patients does not lead to more complications or leaks and can be considered in the treatment of rectal cancer tumours.
摘要：
(1)背景:近年来,直肠癌手术中转移气孔的做法发生了变化，从常规的转移气孔转向更具选择性的方法。研究表明，临时回肠造口术的好处并不符合他们的风险，比如高输出气孔，造口功能障碍,再操作。（2）方法：分析了2013年至2021年在英国单个三级结直肠中心接受机器人切除术治疗的所有直肠癌患者。2015年，我们的部门转向了一种更具选择性的方法来临时转移回肠造口术。将该队列分为2015年前治疗的常规改道组和2015年后治疗的选择性改道组。分析并比较两组的短期结果和发病率。(3)结果:A组,63/70患者（90％）的造口转移，而B组中的98/135患者（72.6％）（p=0.004）。两组吻合口漏之间没有显着差异（11.8％vs.17.8%,p=0.312）或其他并发症（p=0.117）。再入院率也没有显著差异(3.8%与2.6%,p=0.312)或再次手术(3.8%与2.6%,p=1.000)造口关闭后。一年后，71.6%和71.9%(p=1.000)的患者无气孔。气孔逆转延迟的一个主要原因是COVID-19大流行，仅发生在B组(0%vs.22%,p=0.054)。（4）结论：对于机器人直肠癌患者，采用更具选择性的方法来转移气孔不会导致更多的并发症或泄漏，可以在直肠癌肿瘤的治疗中考虑。
