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The Innovation Medicine > 2024 Vol. 2 > No. 3 > 100079
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Safety of the stent-based diverting technique after low anterior resection in patients with rectal cancer

  • 1.

    Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China

  • 2.

    Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China

  • 3.

    Department of Colorectal Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China

  • 4.

    Department of Colorectal Surgery, Zhejiang Cancer Hospital, Chinese Academy of Sciences, Hangzhou 310000, China

  • 5.

    Department of Surgical Oncology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China

  • 6.

    Department of Clinical Research Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China

  • 7.

    National Engineering Center for Minimally invasive Devices and Innovative Applications, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China

  • 8.

    These authors contributed equally

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The Innovation Medicine  2(3),  https://doi.org/10.59717/j.xinn-med.2024.100079  |  Cite this article
    GRAPHICAL ABSTRACT
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    1. Stent-based diverting technique did not raise the incidence of complication.

      Stent-based diverting technique reduced postoperative hospital stays.

      Stent-based diverting technique lowered medical costs.

      Stent-based diverting technique improved quality-of-life.

    • ABSTRACT
  • Given that anastomotic leakage (AL) is a severe complication of low anterior resection (LAR) for rectal cancer, ileostomy is the most common method for reducing the severity of AL, which in turn has stoma-related side effects. A self-developed technique named the stent-based diverting technique (SDT) not only protects the anastomosis but also avoids the stoma. From December 2021 to March 2023, 80 patients were randomized into the ileostomy arm (n = 43) or the SDT arm (n = 37). Demographic characteristics, laboratory test results, surgical outcomes, and oncological features were compared between the groups. For the primary endpoint, the incidence of severe complications was 14.0% in the ileostomy arm and 8.1% in the SDT arm (relative risk=0.58, 95% confidence interval=0.156-2.163, p=0.494). For the second endpoint, the incidences of mild and total complications were comparable. The shorter the hospital stay, the lower the cost and quality of life, which could be improved by the SDT procedure. This prospective randomized clinical trial preliminarily evaluated the usefulness of SDT after LAR for patients with rectal cancer, suggesting that SDT might be an alternative operation for patients who need to receive ileostomy after rectal surgery.
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  • [1] Bonjer, H.J., Deijen, C.L., Abis, G.A., et al. (2015). A randomized trial of laparoscopic versus open surgery for rectal cancer. N. Engl. J. Med. 372: 1324−1332. DOI: 10.1056/NEJMoa1414882.

    View in Article CrossRef Google Scholar Scopus

    [2] Tang, R.K., Sansonetti, P.J., and Gao, Y.Z. (2023). Stem cell retrograde: A new reason why colorectal cancer is more common than small intestinal cancer. The Innovation 4: 100387. DOI: 10.1016/j.xinn.2023.100387.

    View in Article CrossRef Google Scholar Scopus

    [3] Borstlap, W.A., Westerduin, E., Aukema, T.S., et al. (2017). Anastomotic leakage and chronic presacral sinus formation after low anterior resection: Results from a large cross-sectional study. Ann. Surg. 266: 870−877. DOI: 10.1097/SLA.0000000000002429.

    View in Article CrossRef Google Scholar

    [4] Zhou, S.C., Zhou, H.T., Zheng, Z.X., et al. (2019). Predictive risk factors for anastomotic leakage after anterior resection of rectal cancer in elderly patients over 80 years old: An analysis of 288 consecutive patients. World J. Surg. Oncol. 17: 112. DOI: 10.1186/s12957-019-1655-z.

    View in Article CrossRef Google Scholar Scopus

    [5] Chen, H., Cai, H.K., and Tang, Y.H. (2018). An updated meta-analysis of transanal drainage tube for prevention of anastomotic leak in anterior resection for rectal cancer. Surg. Oncol. 27: 333−340. DOI: 10.1016/j.suronc.2018.05.018.

    View in Article CrossRef Google Scholar Scopus

    [6] Mrak, K., Uranitsch, S., Pedross, F., et al. (2016). Diverting ileostomy versus no diversion after low anterior resection for rectal cancer: A prospective, randomized, multicenter trial. Surgery 159: 1129−1139. DOI: 10.1016/j.surg.2015.11.006.

    View in Article CrossRef Google Scholar Scopus

    [7] Song, Z.F., Huang, X.F., Dai, S., et al. (2022). A stent-based diverting technique after low anterior resection of rectal cancer: our preliminary experience. Langenbecks Arch. Surg. 407: 1751−1756. DOI: 10.1007/s00423-022-02433-8.

    View in Article CrossRef Google Scholar Scopus

    [8] Glynne-Jones, R., Wyrwicz, L., Tiret, E., et al. (2017). Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 1: iv22−iv40. DOI: 10.1093/annonc/mdx224.

    View in Article CrossRef Google Scholar

    [9] Rahbari, N.N., Weitz, J., Hohenberger, W., et al. (2010). Definition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the International Study Group of Rectal Cancer. Surgery 147: 339−351. DOI: 10.1016/j.surg.2009.10.012.

    View in Article CrossRef Google Scholar Scopus

    [10] Dindo, D., Demartines, N., and Clavien, P.A. (2004). Classifcation of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 240: 205−213. DOI: 10.1097/01.sla.0000133083.54934.ae.

    View in Article CrossRef Google Scholar

    [11] Jutesten, H., Draus, J., Frey, J., et al. (2018). Late leakage after anterior resection: A defunctioning stoma alters the clinical course of anastomotic leakage. Colorectal Dis. 20: 150−159. DOI: 10.1111/codi.13914.

    View in Article CrossRef Google Scholar

    [12] Challine, A., Lefèvre, J.H., Creavin, B., et al. (2020). Can a local drainage salvage a failed colorectal or coloanal anastomosis? a prospective cohort of 54 patients. Dis. Colon Rectum 63 : 93-100. DOI: 10.1097/DCR.0000000000001516.

    View in Article Google Scholar

    [13] Paun, B.C., Cassie, S., MacLean, A.R., et al. (2010). Postoperative complications following surgery for rectal cancer. Ann. Surg. 251: 807−818. DOI: 10.1097/SLA.0b013e3181dae4ed.

    View in Article CrossRef Google Scholar Scopus

    [14] Hajibandeh, S., Hajibandeh, S., Sarma, D.R., et al. (2019). Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection: The dilemma remains. Int. J. Colorectal Dis. 34: 1151−1159. DOI: 10.1007/s00384-019-03321-2.

    View in Article CrossRef Google Scholar

    [15] Shinji, S., Ueda, Y., Yamada, T., et al. (2018). Male sex and history of ischemic heart disease are major risk factors for anastomotic leakage after laparoscopic anterior resection in patients with rectal cancer. BMC Gastroenterol. 18: 117. DOI: 10.1186/s12876-018-0846-3.

    View in Article CrossRef Google Scholar Scopus

    [16] Erlandsson, J., Holm, T., Pettersson, D., et al. (2017). Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): A multicenter, randomized, nonblinded, phase 3, noninferiority trial. Lancet Oncol. 18: 336−346. DOI: 10.1016/S1470-2045(17)30086-4.

    View in Article CrossRef Google Scholar

    [17] Qin, Q., Ma, T., Deng, Y., et al. (2016). Impact of preoperative radiotherapy on anastomotic leakage and stenosis after rectal cancer resection: Post hoc analysis of a randomized controlled trial. Dis. Colon Rectum 59: 934−942. DOI: 10.1097/DCR.0000000000000665.

    View in Article CrossRef Google Scholar

    [18] Qin, Q., Huang, B.J., Wu, A.W., et al. (2023). Development and validation of a postradiotherapy prediction model for bowel dysfunction after rectal cancer resection. Gastroenterology 165: 1430−1442.e14. DOI: 10.1053/j.gastro.2023.08.022.

    View in Article CrossRef Google Scholar

    [19] Yang, J.G., Luo, Y.J., Tian, T.T., et al. (2022). Effects of neoadjuvant radiotherapy on postoperative complications in rectal cancer: A meta-analysis. J. Oncol. 5: 8197701. DOI: 10.1155/2022/8197701.

    View in Article Google Scholar

    [20] Zhang, W., Lou, Z., Liu, Q., et al. (2017). Multicenter analysis of risk factors for anastomotic leakage after middle and low rectal cancer resection without diverting stoma: A retrospective study of 319 consecutive patients. Int. J. Colorectal Dis. 32: 1431−1437. DOI: 10.1007/s00384-017-2875-8.

    View in Article CrossRef Google Scholar

    [21] van der Pas, M.H., Haglind, E., Cuesta, M.A., et al. (2013). Laparoscopic versus open surgery for rectal cancer (COLOR II): Short-term outcomes of a randomized, phase 3 trial. Lancet Oncol. 14: 210−218. DOI: 10.1016/S1470-2045(13)70016-0.

    View in Article CrossRef Google Scholar

    [22] Kawada, K., and Sakai, Y. (2016). Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis. World J. Gastroenterol 22: 5718−5727. DOI: 10.3748/wjg.v22.i25.5718.

    View in Article CrossRef Google Scholar Scopus

    [23] Caulfield, H., and Hyman, N.H. (2013). Anastomotic leak after low anterior resection: A spectrum of clinical entities. JAMA Surg. 148: 177−182. DOI: 10.1001/jamasurgery.2013.413.

    View in Article CrossRef Google Scholar Scopus

    [24] Kim, C.W., Baek, S.J., Hur, H., et al. (2016). Anastomotic leakage after low anterior resection for rectal cancer is different between minimally invasive surgery and open surgery. Ann. Surg. 263: 130−137. DOI: 10.1097/SLA.0000000000001157.

    View in Article CrossRef Google Scholar Scopus

    [25] Cho, S.H., Lee, I.K., Lee, Y.S., et al. (2021). The usefulness of transanal tube for reducing anastomotic leak in mid rectal cancer: Compared to diverting stoma. Ann. Surg. Treat. Res. 100: 100−108. DOI: 10.4174/astr.2021.100.2.100.

    View in Article CrossRef Google Scholar Scopus

    [26] Tamura, K., Matsuda, K., Horiuchi, T., et al. (2021). Laparoscopic anterior resection with or without transanal tube for rectal cancer patients - A multicenter randomized controlled trial. Am. J. Surg. 222: 606−612. DOI: 10.1016/j.amjsurg.2020.12.054.

    View in Article CrossRef Google Scholar

    [27] Hidaka, E., Ishida, F., Mukai, S., et al. (2015). Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: A retrospective cohort study in a single institution. Surg. Endosc. 29: 863−867. DOI: 10.1007/s00464-014-3740-2.

    View in Article CrossRef Google Scholar

    [28] Zhao, S., Zhang, L.Y., Gao, F., et al. (2021). Transanal drainage tube use for preventing anastomotic leakage after laparoscopic low anterior resection in patients with rectal cancer: a randomized clinical trial. AMA Surg. 156: 1151−1158. DOI: 10.1001/jamasurg.2021.4568.

    View in Article CrossRef Google Scholar

    [29] Reshef, A., Ben-Arie, G., and Pinsk, I. (2019). Protection of colorectal anastomosis with an intraluminal bypass device for patients undergoing an elective anterior resection: A pilot study. Tech. Coloproctol 23: 565−571. DOI: 10.1007/s10151-019-02015-9.

    View in Article CrossRef Google Scholar

    [30] Kim, J.H., Kim, S.H., and Jung, S.H. (2019). Fecal diverting device for the substitution of defunctioning stoma: Preliminary clinical study. Surg. Endosc. 33: 333−340. DOI: 10.1007/s00464-018-6389-4.

    View in Article CrossRef Google Scholar

    [31] Chen, S.J., Zhang, P.X., Duan, H.M. et al. (2023). Gut microbiota in muscular atrophy development, progression, and treatment: New therapeutic targets and opportunities. The Innovation 4: 100479. DOI: 10.1016/j.xinn.2023.100479.

    View in Article CrossRef Google Scholar Scopus

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  • Cite this article:

    Tong Y., Chen M., Song Z., et al., (2024). Safety of the stent-based diverting technique after low anterior resection in patients with rectal cancer. The Innovation Medicine 2(3): 100079. https://doi.org/10.59717/j.xinn-med.2024.100079
    Tong Y., Chen M., Song Z., et al., (2024). Safety of the stent-based diverting technique after low anterior resection in patients with rectal cancer. The Innovation Medicine 2(3): 100079. https://doi.org/10.59717/j.xinn-med.2024.100079

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