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Risk factors for outlet obstruction after laparoscopic surgery and diverting ileostomy for rectal cancer

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Abstract

Purpose

Outlet obstruction is defined as bowel obstruction at the stoma opening. The aim of this study was to evaluate the risk factors for outlet obstruction in patients with rectal cancer who underwent laparoscopic surgery and diverting ileostomy.

Methods

Among consecutive patients who underwent laparoscopic curative resection for primary rectal cancer between 2013 and 2015, 261 patients with diverting ileostomy were included in the analysis. The thickness of the abdominal wall, including the thickness of the rectus abdominis muscle, was measured using preoperative computed tomography. The clinicopathological factors were compared between the patients with and without outlet obstruction.

Results

Fourteen (5.4%) patients were diagnosed with outlet obstruction, but reoperation was not required. The rectus abdominis muscle was significantly thicker in male patients with outlet obstruction compared to those without outlet obstruction, but not in females. In a multivariate analysis, a rectus abdominis muscle thickness of 10 mm or more was determined to be an independent risk factor for outlet obstruction (odds ratio, 7.0482; p = 0.0061).

Conclusions

The thickness of the rectus abdominis muscle may be used to predict the occurrence of outlet obstruction in male patients with rectal cancer who undergo laparoscopic surgery and diverting ileostomy.

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Authors and Affiliations

  1. Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Shigemasa Sasaki, Toshiya Nagasaki, Takashi Akiyoshi, Toshiki Mukai, Tomohiro Yamaguchi & Yosuke Fukunaga

  2. Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bukyo-ku, Tokyo, 113-0033, Japan

    Koji Oba

  3. Omiya Ichonaika Clinic, 2-24-2 Nakacho, Omiya-ku, Saitama city, Saitama Prefecture, 330-0845, Japan

    Yoshiya Fujimoto

Authors
  1. Shigemasa Sasaki
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  2. Toshiya Nagasaki
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  4. Takashi Akiyoshi
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  5. Toshiki Mukai
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  6. Tomohiro Yamaguchi
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  7. Yosuke Fukunaga
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  8. Yoshiya Fujimoto
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Contributions

SS, YF, and TN mainly designed the study. All coauthors substantially contributed to this study and fulfilled the requirements for authorship as per the guidelines of the International Committee of Medical Journal Editors. All authors have read and approved the final version of the manuscript.

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Correspondence to Toshiya Nagasaki.

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Sasaki, S., Nagasaki, T., Oba, K. et al. Risk factors for outlet obstruction after laparoscopic surgery and diverting ileostomy for rectal cancer. Surg Today 51, 366–373 (2021). https://doi.org/10.1007/s00595-020-02096-2

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  • DOI: https://doi.org/10.1007/s00595-020-02096-2

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