Observational Study

. 2020 Jun;35(6):1087-1093.

doi: 10.1007/s00384-020-03559-1. Epub 2020 Mar 24.

Risk factors for non-closure of an intended temporary defunctioning stoma after emergency resection of left-sided obstructive colon cancer

S J van Ommeren-Olijve¹, J P M Burbach², E J B Furnée³; Dutch Snapshot Research Group

Collaborators, Affiliations

Collaborators

Dutch Snapshot Research Group:
H Algera, G D Algie, C S Andeweg, F J Amelung, T E Argillander, M N N J Arron, K Arts, T H J Aufenacker, I S Bakker, M van Basten Batenburg, A J N M Bastiaansen, G L Beets, W A Bemelman, A van den Berg, B van de Beukel, R L G M Blom, B Blomberg, E G Boerma, F C den Boer, F Ter Borg, W A A Borstlap, N D Bouvy, J E Bouwman, N D A Boye, A R M Brandt-Kerkhof, H T Bransma, A Breijer, W T van den Broek, M E E Bröker, J P M Burbach, E R J Bruns, T A Burghgraef, E C J Consten, R M P H Crolla, M Dam, L Daniels, J W T Dekker, A Demirkiran, K W van Dongen, S F Durmaz, A van Esch, J A van Essen, P Fockens, J W Foppen, A A W van Geloven, M F Gerhards, E A Gorter, W M U van Grevenstein, J van Groningen, I A J de Groot-van Veen, H E Haak, J W A de Haas, P van Hagen, E E van Halsema, J T H Hamminga, K Havenga, M van Heinsbergen, B van den Hengel, E van der Harst, J Heemskerk, J Heeren, B H M Heijnen, L Heijnen, J T Heikens, M van Heinsbergen, D A Hess, N Heuchemer, C Hoff, W Hogendoorn, J E van Hooft, A P J Houdijk, N Hugen, B Inberg, T L Janssen, D Jean Pierre, W J de Jong, A C H M Jongen, A V Kamman, J M Klaase, W Kelder, E F Kelling, R Klicks, G W De Klein, F W H Kloppenberg, J L M Konsten, L J E R Koolen, V Kornmann, R T J Kortekaas, A Kreiter, B Lamme, J F Lange, T Lettinga, D Lips, G Lo, F Logeman, Y T van Loon, M F Lutke Holzik, C C M Marres, I Masselink, A Mearadji, G Meisen, A G Menon, J W S Merkus, D J L M de Mey, H C J van der Mijle, D E Moes, C J L Molenaar, M J Nieboer, K Nielsen, G A P Nieuwenhuijzen, P A Neijenhuis, P Oomen, N van Oorschot, K Parry, K C M J Peeters, T Paulides, I Paulusma, F B Poelmann, S W Polle, P Poortman, M H Raber, R J Renger, B M M Reiber, R Roukema, W M J de Ruijter, M J A M Russchen, H J T Rutten, J Scheerhoorn, S Scheurs, H Schippers, V N E Schuermans, H J Schuijt, J C Sierink, P D Siersema, C Sietses, R Silvis, J van der Slegt, G D Slooter, M van der Sluis, P van der Sluis, N Smakman, D Smit, A B Smits, T C van Sprundel, D J A Sonneveld, C Steur, J Straatman, M C Struijs, H A Swank, A K Talsma, P J Tanis, M Tenhagen, J A M G Tol, J L Tolenaar, L Tseng, J B Tuynman, M J F van Veen, J V Veld, S C Veltkamp, A W H van de Ven, L Verkoele, M Vermaas, H P Versteegh, L Verslijs, T Visser, D van Uden, W J Vles, R J de Vos Tot Nederveen Cappel, H S de Vries, S T van Vugt, G Vugts, J A Wegdam, T J Weijs, B J van Wely, M Westerterp, H L van Westreenen, B Wiering, N A T Wijffels, A A Wijkmans, L H Wijngaarden, J H W de Wilt, M van de Wilt, D D Wisselink, F Wit, E S van der Zaag, D D E Zimmerman, T L R Zwols

Affiliations

¹ Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
² Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
³ Department of Surgery, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. e.j.b.furnee@umcg.nl.

PMID: 32211956
PMCID: PMC7245586
DOI: 10.1007/s00384-020-03559-1

Observational Study

Risk factors for non-closure of an intended temporary defunctioning stoma after emergency resection of left-sided obstructive colon cancer

S J van Ommeren-Olijve et al. Int J Colorectal Dis. 2020 Jun.

. 2020 Jun;35(6):1087-1093.

doi: 10.1007/s00384-020-03559-1. Epub 2020 Mar 24.

Authors

S J van Ommeren-Olijve¹, J P M Burbach², E J B Furnée³; Dutch Snapshot Research Group

Collaborators

Dutch Snapshot Research Group:
H Algera, G D Algie, C S Andeweg, F J Amelung, T E Argillander, M N N J Arron, K Arts, T H J Aufenacker, I S Bakker, M van Basten Batenburg, A J N M Bastiaansen, G L Beets, W A Bemelman, A van den Berg, B van de Beukel, R L G M Blom, B Blomberg, E G Boerma, F C den Boer, F Ter Borg, W A A Borstlap, N D Bouvy, J E Bouwman, N D A Boye, A R M Brandt-Kerkhof, H T Bransma, A Breijer, W T van den Broek, M E E Bröker, J P M Burbach, E R J Bruns, T A Burghgraef, E C J Consten, R M P H Crolla, M Dam, L Daniels, J W T Dekker, A Demirkiran, K W van Dongen, S F Durmaz, A van Esch, J A van Essen, P Fockens, J W Foppen, A A W van Geloven, M F Gerhards, E A Gorter, W M U van Grevenstein, J van Groningen, I A J de Groot-van Veen, H E Haak, J W A de Haas, P van Hagen, E E van Halsema, J T H Hamminga, K Havenga, M van Heinsbergen, B van den Hengel, E van der Harst, J Heemskerk, J Heeren, B H M Heijnen, L Heijnen, J T Heikens, M van Heinsbergen, D A Hess, N Heuchemer, C Hoff, W Hogendoorn, J E van Hooft, A P J Houdijk, N Hugen, B Inberg, T L Janssen, D Jean Pierre, W J de Jong, A C H M Jongen, A V Kamman, J M Klaase, W Kelder, E F Kelling, R Klicks, G W De Klein, F W H Kloppenberg, J L M Konsten, L J E R Koolen, V Kornmann, R T J Kortekaas, A Kreiter, B Lamme, J F Lange, T Lettinga, D Lips, G Lo, F Logeman, Y T van Loon, M F Lutke Holzik, C C M Marres, I Masselink, A Mearadji, G Meisen, A G Menon, J W S Merkus, D J L M de Mey, H C J van der Mijle, D E Moes, C J L Molenaar, M J Nieboer, K Nielsen, G A P Nieuwenhuijzen, P A Neijenhuis, P Oomen, N van Oorschot, K Parry, K C M J Peeters, T Paulides, I Paulusma, F B Poelmann, S W Polle, P Poortman, M H Raber, R J Renger, B M M Reiber, R Roukema, W M J de Ruijter, M J A M Russchen, H J T Rutten, J Scheerhoorn, S Scheurs, H Schippers, V N E Schuermans, H J Schuijt, J C Sierink, P D Siersema, C Sietses, R Silvis, J van der Slegt, G D Slooter, M van der Sluis, P van der Sluis, N Smakman, D Smit, A B Smits, T C van Sprundel, D J A Sonneveld, C Steur, J Straatman, M C Struijs, H A Swank, A K Talsma, P J Tanis, M Tenhagen, J A M G Tol, J L Tolenaar, L Tseng, J B Tuynman, M J F van Veen, J V Veld, S C Veltkamp, A W H van de Ven, L Verkoele, M Vermaas, H P Versteegh, L Verslijs, T Visser, D van Uden, W J Vles, R J de Vos Tot Nederveen Cappel, H S de Vries, S T van Vugt, G Vugts, J A Wegdam, T J Weijs, B J van Wely, M Westerterp, H L van Westreenen, B Wiering, N A T Wijffels, A A Wijkmans, L H Wijngaarden, J H W de Wilt, M van de Wilt, D D Wisselink, F Wit, E S van der Zaag, D D E Zimmerman, T L R Zwols

Affiliations

¹ Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
² Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
³ Department of Surgery, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. e.j.b.furnee@umcg.nl.

PMID: 32211956
PMCID: PMC7245586
DOI: 10.1007/s00384-020-03559-1

Abstract

Purpose: A substantial part (21-35%) of defunctioning stomas created during resection for colorectal cancer will never be reversed. Known risk factors for non-closure are age, peri- or postoperative complications, comorbidity, and tumor stage. However, studies performed to identify these risk factors mostly focus on rectal cancer and include both preoperative and postoperative factors. This study aims to identify preoperative risk factors for non-reversal of intended temporary stomas created during acute resection of left-sided obstructive colon cancer (LSOCC) with primary anastomosis.

Methods: All patients who underwent emergency resection for LSOCC with primary anastomosis and a defunctioning stoma between 2009 and 2016 were selected from the Dutch ColoRectal Audit, and additional data were collected in the local centers. Multivariable analysis was performed to identify independent preoperative factors for non-closure of the stoma.

Results: A total of 155 patients underwent acute resection for LSOCC with primary anastomosis and a defunctioning stoma. Of these, 51 patients (32.9%) did not have their stoma reversed after a median of 53 (range 7-104) months of follow-up. In multivariable analysis, hemoglobin < 7.5 mmol/L (odds ratio (OR) 4.79, 95% confidence interval (95% CI) 1.60-14.38, p = 0.005), estimated glomerular filtration rate (eGFR) ≤ 45 mL/min/1.73 m² (OR 4.64, 95% CI 1.41-15.10, p = 0.011), and metastatic disease (OR 6.12, 95% CI 2.35-15.94, p < 0.001) revealed to be independent predictors of non-closure.

Conclusions: Anemia, impaired renal function, and metastatic disease at presentation were found to be independent predictors for non-reversal of intended temporary stomas in patients who underwent acute resection for LSOCC. In patients who have an increased risk of non-reversal, the surgeon should consider a Hartmann's procedure.

Keywords: Colorectal cancer; Defunctioning stoma; Non-closure; Obstructive colon cancer; Stoma reversal; Surgical oncology.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

**Fig. 1**
Flow-chart of patient inclusion

See this image and copyright information in PMC

References

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Risk factors for non-closure of an intended temporary defunctioning stoma after emergency resection of left-sided obstructive colon cancer

Collaborators

Affiliations

Risk factors for non-closure of an intended temporary defunctioning stoma after emergency resection of left-sided obstructive colon cancer

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous