The relationship between systemic inflammation and stoma formation following anterior resection for rectal cancer: a cross-sectional study

Khor, B. Y., McSorley, S. T. , Horgan, P. G. and McMillan, D. C. (2017) The relationship between systemic inflammation and stoma formation following anterior resection for rectal cancer: a cross-sectional study. International Journal of Surgery, 37, pp. 79-84. (doi:10.1016/j.ijsu.2016.12.010) (PMID:27940290)

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Abstract

Introduction: There is evidence that temporary defunctioning stoma formation in patients undergoing anterior resection reduces the risk of anastomotic leakage. The aim of the present study was to investigate the relationship between stoma formation, the postoperative systemic inflammatory response and complications following anterior resection for rectal cancer. Methods: Data was recorded prospectively for patients who underwent anterior resection for histologically proven rectal cancer, from 2008 to 2015 at a single centre, n = 167. Patients had routine preoperative and postoperative blood sampling including serum C-reactive protein (CRP). Postoperative complications including anastomotic leakage were recorded. Results: Of the 167 patients, the majority were male (61%) and over 65 years old (56%) with node negative disease (60%). 36 patients (22%) underwent preoperative neoadjuvant treatment. 100 patients (60%) had a stoma formed at the time of surgery. Stoma formation was significantly associated with male sex (69% vs. 50%, p = 0.017), neoadjuvant chemoradiotherapy (30% vs 9%, p = 0.001) and open surgery (71% vs. 55%, p = 0.040). Of those 100 patients who had a stoma formed, 80 had it reversed. Permanent stoma was significantly associated with increasing age (p = 0.011), exceeding the established CRP threshold of 150 mg/L on postoperative day 4 (67% vs 37%, p = 0.039), higher incidence of postoperative complications (76% vs 47%, p = 0.035), anastomotic leakage (24% vs 2%, p = 0.003) and higher Clavien Dindo score (p = 0.036). Conclusions: There was no significant association between stoma formation during anterior resection and the postoperative systemic inflammatory response. However, in these patients both the postoperative systemic inflammatory response and complications were associated with permanent stoma.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Horgan, Professor Paul and McMillan, Professor Donald and McSorley, Dr Stephen
Authors: Khor, B. Y., McSorley, S. T., Horgan, P. G., and McMillan, D. C.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:International Journal of Surgery
Publisher:Elsevier
ISSN:1743-9191
ISSN (Online):1743-9159
Published Online:09 December 2016
Copyright Holders:Copyright © 2016 IJS Publishing Group Ltd.
First Published:First published in International Journal of Surgery 37: 79-94
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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