Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer

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  1. 1. BIOPSY Dr Arjun Rajagopalan Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer
  2. 2. We know Anastomotic leakage (AL) after low anterior resection (LAR) for rectal cancer is a complication that is associated with high mortality (6 - 22%), and possibly increased rates of local recurrence. Diverting stoma (DS) have been recommended as a strategy to lower the incidence of AL. We dont know The impact of DS on AL in terms of the above mentioned problems has not be scientically examined. BIOPSY Background Dr Arjun Rajagopalan
  3. 3. BIOPSY 1: Population Patient selection for study 606 330 Study group Omitted from study From this population, a subgroup was picked out using a Propensity Score Matching to distribute confounding factors evenly. 2: Indicator variable 4: Comparison Patients with rectal adenocarcinoma located within 10 cm of the anal verge > 20 years of age. Treated with low anterior resection (LAR) using a circular stapler. Seen at 40 specialised institutions in Japan. Dr Arjun Rajagopalan After Propensity Score Matching 165 165 With Stoma Without stoma
  4. 4. BIOPSY 3: Outcomes All grades Grades B & C Grade C 0.6% 10.9% 14.5% 9.1% 15.8% 15.8% Without stoma With stoma Dr Arjun Rajagopalan Symptomatic anastamotic leakage Emission of gas, pus or feces from the drain, wound or vagina. AL conrmed by contrast radiography or CT. Grading of severity of anastamotic leakage Grade A: requiring no change in patient management. Grade B: requiring therapeutic intervention but not re-laparotomy. Grade C: requiring re-laparotomy. p = 0.001 NS NS
  5. 5. Sampling Centre 40 specialised institutions in Japan. TImeframe August 2010 - December 2012 Analysis Case-control using a propensity scoring matching system. Sample sizing Not done. Exclusions Previous colorectal surgery, emergency operations. Numbers From the cohort of 936 patients; 330 were extracted. Comparison Controls Randomisation Protocols Comparability - matched - * Measurement Training Blinding Multi- observers Duplication - - - - * Achieved by the propensity scoring matching method of patient recruitment. CHECKLIST Dr Arjun RajagopalanDr Arjun Rajagopalan The author(s) conclude: Diverting stoma did not have a significant relationship with symptomatic anastomotic leakage after propensity score m a t c h i n g . H o w e v e r, a diverting stoma does seem to mitigate the consequences of leakage, reducing the need for urgent abdominal reoperation.