An Institutional Shift from Routine to Selective Diversion of Low Anastomosis in Robotic TME Surgery for Rectal Cancer Patients Using the KHANS Technique: A Single-Centre Cohort Study

Overview

Journal J Pers Med

Date 2024 Jul 27

PMID 39063979

Authors

Rauand Duhoky

Guglielmo Niccolo Piozzi

Marieke L W Rutgers

Ioannis Mykoniatis

Najaf Siddiqi

Syed Naqvi

Jim S Khan

Affiliations

Soon will be listed here.

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 ( = 0.004). There were no significant differences between the groups in anastomotic leakages (11.8% vs. 17.8%, = 0.312) or other complications ( = 0.117). There were also no significant differences in readmission (3.8% vs. 2.6%, = 0.312) or reoperation (3.8% vs. 2.6%, = 1.000) after stoma closure. After 1 year, 71.6% and 71.9% ( = 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%, = 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.

References

Ashraf S, Burns E, Jani A, Altman S, Young J, Cunningham C . The economic impact of anastomotic leakage after anterior resections in English NHS hospitals: are we adequately remunerating them?. Colorectal Dis. 2013; 15(4):e190-8. DOI: 10.1111/codi.12125. View

Borstlap W, Westerduin E, Aukema T, Bemelman W, Tanis P . Anastomotic Leakage and Chronic Presacral Sinus Formation After Low Anterior Resection: Results From a Large Cross-sectional Study. Ann Surg. 2017; 266(5):870-877. DOI: 10.1097/SLA.0000000000002429. View

Eckmann C, Kujath P, Schiedeck T, Shekarriz H, Bruch H . Anastomotic leakage following low anterior resection: results of a standardized diagnostic and therapeutic approach. Int J Colorectal Dis. 2004; 19(2):128-33. DOI: 10.1007/s00384-003-0498-8. View

Currie A, Askari A, Nachiappan S, Sevdalis N, Faiz O, Kennedy R . A systematic review of patient preference elicitation methods in the treatment of colorectal cancer. Colorectal Dis. 2014; 17(1):17-25. DOI: 10.1111/codi.12754. View

Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P . Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011; 253(5):890-9. DOI: 10.1097/SLA.0b013e3182128929. View

Burghgraef T, Hol J, Rutgers M, Crolla R, van Geloven A, Hompes R . Laparoscopic Versus Robot-Assisted Versus Transanal Low Anterior Resection: 3-Year Oncologic Results for a Population-Based Cohort in Experienced Centers. Ann Surg Oncol. 2021; 29(3):1910-1920. PMC: 8810464. DOI: 10.1245/s10434-021-10805-5. View

Frye J, Bokey E, Chapuis P, Sinclair G, Dent O . Anastomotic leakage after resection of colorectal cancer generates prodigious use of hospital resources. Colorectal Dis. 2009; 11(9):917-20. DOI: 10.1111/j.1463-1318.2008.01728.x. View

Denost Q, Rouanet P, Faucheron J, Panis Y, Meunier B, Cotte E . Impact of early biochemical diagnosis of anastomotic leakage after rectal cancer surgery: long-term results from GRECCAR 5 trial. Br J Surg. 2021; 108(6):605-608. DOI: 10.1093/bjs/znab003. View

Hain E, Maggiori L, Manceau G, Mongin C, Prost A la Denise J, Panis Y . Oncological impact of anastomotic leakage after laparoscopic mesorectal excision. Br J Surg. 2016; 104(3):288-295. DOI: 10.1002/bjs.10332. View

10.

Hol J, Burghgraef T, Rutgers M, Crolla R, van Geloven A, de Jong G . Impact of a diverting ileostomy in total mesorectal excision with primary anastomosis for rectal cancer. Surg Endosc. 2022; 37(3):1916-1932. PMC: 10017638. DOI: 10.1007/s00464-022-09669-x. View

11.

Yeh C, Changchien C, Wang J, Chen J, Chen H, Chiang J . Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg. 2004; 241(1):9-13. PMC: 1356840. DOI: 10.1097/01.sla.0000150067.99651.6a. View

12.

Borstlap W, Musters G, Stassen L, van Westreenen H, Hess D, van Dieren S . Vacuum-assisted early transanal closure of leaking low colorectal anastomoses: the CLEAN study. Surg Endosc. 2017; 32(1):315-327. PMC: 5770507. DOI: 10.1007/s00464-017-5679-6. View

13.

Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J . Incidence and Risk Factors for Anastomotic Failure in 1594 Patients Treated by Transanal Total Mesorectal Excision: Results From the International TaTME Registry. Ann Surg. 2018; 269(4):700-711. DOI: 10.1097/SLA.0000000000002653. View

14.

Burghgraef T, Sikkenk D, Crolla R, Fahim M, Melenhorst J, El Moumni M . Assessing the learning curve of robot-assisted total mesorectal excision: a multicenter study considering procedural safety, pathological safety, and efficiency. Int J Colorectal Dis. 2023; 38(1):9. PMC: 9834356. DOI: 10.1007/s00384-022-04303-7. View

15.

Waqas A, Mykoniatis I, Sidiqi N, Ahmed A, Stefan S, Naqvi S . Early Experience of Undertaking Robotic Assisted Total Mesorectal Excision in Rectal Resections, Avoiding a Diverting Stoma: Key eHancement of the Anastomosis for No Stoma Technique - A Case Series. Surg Innov. 2022; 30(2):158-165. DOI: 10.1177/15533506221108833. View

16.

Wrenn S, Cepeda-Benito A, Ramos-Valadez D, Cataldo P . Patient Perceptions and Quality of Life After Colon and Rectal Surgery: What Do Patients Really Want?. Dis Colon Rectum. 2018; 61(8):971-978. DOI: 10.1097/DCR.0000000000001078. View

17.

Kawada K, Hasegawa S, Hida K, Hirai K, Okoshi K, Nomura A . Risk factors for anastomotic leakage after laparoscopic low anterior resection with DST anastomosis. Surg Endosc. 2014; 28(10):2988-95. PMC: 4186976. DOI: 10.1007/s00464-014-3564-0. View

18.

Jung S, Yu C, Choi P, Dong Kim D, Park I, Kim H . Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. Dis Colon Rectum. 2008; 51(6):902-8. DOI: 10.1007/s10350-008-9272-x. View

19.

Hayden D, Pinzon M, Francescatti A, Saclarides T . Patient factors may predict anastomotic complications after rectal cancer surgery: Anastomotic complications in rectal cancer. Ann Med Surg (Lond). 2015; 4(1):11-6. PMC: 4323762. DOI: 10.1016/j.amsu.2014.12.002. View

20.

Ito M, Sugito M, Kobayashi A, Nishizawa Y, Tsunoda Y, Saito N . Relationship between multiple numbers of stapler firings during rectal division and anastomotic leakage after laparoscopic rectal resection. Int J Colorectal Dis. 2008; 23(7):703-7. DOI: 10.1007/s00384-008-0470-8. View