Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for...
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BIOPSY
Dr Arjun Rajagopalan
Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer
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 don’t know … • The impact of DS on AL in terms of the above
mentioned problems has not be scientifically examined.
BIOPSY
Background
Dr Arjun Rajagopalan
BIOPSY
1: Population
Patient selection for study
606 330
Study groupOmitted 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 StomaWithout stoma
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3: OutcomesAll grades
Grades B & C
Grade C0.6%
10.9%
14.5%
9.1%
15.8%
15.8%
Without stomaWith stoma
Dr Arjun Rajagopalan
“Symptomatic” anastamotic leakage • Emission of gas, pus or feces from the drain, wound or vagina. • AL confirmed 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
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.
ComparisonControls Randomisation Protocols Comparability
✅ - matched ⛔️ - ✅ *
MeasurementTraining 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.