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Protektives Stoma nach tiefer anteriorer Rektumresektion: Pro

Protective stoma after deep anterior rectal resection: pro

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Zusammenfassung

Die Notwendigkeit eines protektiven Stomas nach tiefer anteriorer Rektumresektion mit totaler mesorektaler Exzision wird weiterhin kontrovers diskutiert. In den letzten Jahren hat sich jedoch die Datenlage durch weitere randomisiert kontrollierte Studien und Metaanalysen deutlich gebessert. So konnte ein signifikanter Vorteil für die Anlage des protektiven Stomas in Bezug auf die klinisch relevante Anastomoseninsuffizienz- und Reoperationsrate gezeigt werden. Der Einfluss auf die Mortalität ist nicht so deutlich. Nach Auswertung der Daten aus 19 Beobachtungsstudien mit über 9000 eingeschlossenen Patienten erreicht aber auch hier der Vorteil der Stomaanlage Signifikanzniveau. Zusätzlich ist die Rate an permanenten Stomata nach primärer Anlage geringer.

Ziel dieser Arbeit ist es, die Vorteile und damit die Notwendigkeit der protektiven Stomaanlage anhand der aktuellen Literatur aufzuzeigen.

Abstract

There is still controversy about the necessity of a diverting stoma after deep anterior resection with total mesorectal excision for rectal cancer. Recent results of randomized controlled trials and from systematic reviews have improved the currently available data. A significant benefit was shown for patients with diverting stoma in terms of clinically relevant anastomotic leakage and re-operation rates. The influence on mortality is not as clear. However, analysis of the data of 19 prospective studies within a systematic review including more than 9,000 patients, revealed a significant benefit for stoma creation. Furthermore, the rate of patients with stoma 5 years after primary resection was lower in the group of patients with diverting stoma. The purpose of this manuscript is to show the necessity of a diverting stoma based on the currently available data.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Ruprecht-Karls-Universität, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    A. Ulrich, J. Weitz & M.W. Büchler

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  1. A. Ulrich
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  2. J. Weitz
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  3. M.W. Büchler
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Correspondence to A. Ulrich.

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Ulrich, A., Weitz, J. & Büchler, M. Protektives Stoma nach tiefer anteriorer Rektumresektion: Pro. Chirurg 81, 962–967 (2010). https://doi.org/10.1007/s00104-010-1928-0

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  • DOI: https://doi.org/10.1007/s00104-010-1928-0

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