Patient selection and operative strategies for laparoscopic intersphincteric resection without diverting stoma  

作　　者：Gang Hu Ji Ma Wen-Long Qiu Shi-Wen Mei Meng Zhuang Jun Xue Jun-Guang Liu Jian-Qiang Tang 

机构地区：[1]Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China [2]Department of General Surgery,Datong Third People’s Hospital,Datong 037008,Shanxi Province,China [3]Department of General Surgery,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,Hebei Province,China [4]Department of General Surgery,Peking University First Hospital,Beijing 100034,China

出　　处：《World Journal of Gastrointestinal Surgery》2025年第3期338-348,共11页世界胃肠外科杂志(英文)

基　　金：Supported by Beijing Natural Science Foundation,No.L222054 and No.4232058.

摘　　要：BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient selection and operative strategies to avoid stoma formation need further elucidation.METHODS This study enrolled 505 consecutive patients,including 84 who underwent stoma-free(SF)intersphincteric resection.After matching,patients were divided into SF(n=78)and DS(n=78)groups.The primary endpoint was the anastomotic leakage(AL)rate within 6 months and its protective factors for both the total and SF cohorts.The secondary endpoints included overall survival and disease-free survival.RESULTS The AL rate was greater in the SF group than in the DS group(12.8%vs 2.6%,P=0.035).Male sex[(odds ratio(OR)=2.644,P=0.021],neoadjuvant chemoradiotherapy(nCRT)(OR=6.024,P<0.001),and tumor height from the anal verge≤4 cm(OR=4.160,P=0.007)were identified as independent risk factors.Preservation of the left colic artery(LCA)was protective in both the total cohort(OR=0.417,P=0.013)and the SF cohort(OR=0.312,P=0.027).The female patients who did not undergo nCRT and had preservation of the LCA experienced a significantly lower incidence of AL(2/97,2.1%).The 3-year overall survival or disease-free survival did not significantly differ be-tween the groups.CONCLUSION Female patients who do not receive nCRT may avoid the need for DS by preserving the LCA without increasing the risk of AL or compromising oncological outcomes.

关 键 词：Anastomotic leakage Diverting stoma Laparoscopic intersphincteric resection Ultralow rectal cancer 

分 类 号：R656.2[医药卫生—外科学]