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Long-term stoma-related reinterventions after anterior resection for rectal cancer with or without anastomosis: population data from the Dutch snapshot study

  • Original Article
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Abstract

Background

The aim of this study was to analyze the stoma-related reinterventions, complications and readmissions after an anterior resection for rectal cancer, based on a cross-sectional nationwide cohort study with 3-year follow-up.

Methods

Rectal cancer patients who underwent a resection with either a functional anastomosis, a defunctioned anastomosis, or Hartmann’s procedure (HP) with an end colostomy in 2011 in 71 Dutch hospitals were included. The primary outcome was number of stoma-related reinterventions.

Results

Of the 2095 patients with rectal cancer, 1400 patients received an anterior resection and were included in this study; 257 received an initially functional anastomosis, 741 a defunctioned anastomosis, and 402 patients a HP. Of the 1400 included patients, 62% were males, 38% were females and the mean age was 67 years (SD 11.1). Following a primary functional anastomosis, 48 (19%) patients received a secondary stoma. Stoma-related complications occurred in six (2%) patients, requiring reintervention in one (0.4%) case. In the defunctioned anastomosis group, stoma-related complications were present in 92 (12%) patients, and required reintervention in 23 (3%) patients, in 10 (1%) of these more than 1 year after initial resection. Stoma-related complications occurred in 92 (23%) patients after a HP, and required reintervention in 39 (10%) patients in 17 (4%) of cases more than 1 year after initial resection. The permanent stoma rate was 11% and 20%, in the functional anastomosis and the defuctioned anastomosis group, respectively. The end colostomy in the HP group was reversed in 4% of cases.

Conclusions

Construction of a stoma after resection for rectal cancer with preservation of the sphincter is accompanied with long-term stoma-related morbidity. Stoma complications are more frequent after a HP. Even after 1 year, a significant number of reinterventions are required.

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Acknowledgements

We acknowledge the Dutch Snapshot Research Group who provided the data used for this study. We acknowledge Tania C. Sluckin for helping with reviewing and revising the manuscript for grammar and syntax.

Collaborators of the Dutch Snapshot Research Group: CL Deijen, M den Dulk, HJ Bonjer, CJ van de Velde, PJ Tanis, AGJ Aalbers, Y Acherman, GD Algie, B Alting von Geusau, F Amelung, TS Aukema, IS Bakker, SA Bartels, S Basha, AJNM Bastiaansen, E Belgers, W Bleeker, J Blok, RJI Bosker, JW Bosmans, MC Boute, ND Bouvy, H Bouwman, A Brandt-Kerkhof, DJ Brinkman, S Bruin, ERJ Bruns, JPM Burbach, JWA Burger, CJ Buskens, S Clermonts, PPLO Coene, C Compaan, ECJ Consten, T Darbyshire, SML de Mik, EJR de Graaf, I de Groot, RJL de vos tot Nederveen Cappel, JHW de Wilt, J van der Wolde, FC den Boer, JWT Dekker, A Demirkiran, M Derkx-Hendriksen, FR Dijkstra, P van Duijvendijk, MS Dunker, QE Eijsbouts, H Fabry, F Ferenschild, JW Foppen, EJB Furnee, MF Gerhards, P Gerven, JAH Gooszen, JA Govaert, WMU Van Grevenstein, R Haen, JJ Harlaar, E Harst, K Havenga, J Heemskerk, JF Heeren, B Heijnen, P Heres, C Hoff, W Hogendoorn, P Hoogland, A Huijbers, JAH Gooszen, P Janssen, AC Jongen, FH Jonker, EG Karthaus, A Keijzer, JMA Ketel, J Klaase, FWH Kloppenberg, ME Kool, R Kortekaas, PM Kruyt, JT Kuiper, B Lamme, JF Lange, T Lettinga, DJ Lips, F Logeman, MF Lutke Holzik, E Madsen, A Mamound, CC Marres, I Masselink, M Meerdink, AG Menon, JS Mieog, D Mierlo, GD Musters, PA Neijenhuis, J Nonner, M Oostdijk, SJ Oosterling, PMP Paul, KCMJC Peeters, ITA Pereboom, F Polat, P Poortman, M Raber, BMM Reiber, RJ Renger, CC van Rossem, HJ Rutten, A Rutten, R Schaapman, M Scheer, L Schoonderwoerd, N Schouten, AM Schreuder, WH Schreurs, GA Simkens, GD Slooter, HCE Sluijmer, N Smakman, R Smeenk, HS Snijders, DJA Sonneveld, B Spaansen, EJ Spillenaar Bilgen, E Steller, WH Steup, C Steur, E Stortelder, J Straatman, HA Swank, C Sietses, HA ten Berge, HG ten hoeve, WW ter Riele, IM Thorensen, B Tip-Pluijm, BR Toorenvliet, L Tseng, JB Tuynman, J van Bastelaar, SC van beek, AWH van de Ven, MAJ van de Weijer, C van den Berg, I van den Bosch, JDW van der Bilt, SJ van der Hagen, R van der hul, G van der Schelling, A van der Spek, N van der Wielen, E van duyn, C van Eekelen, JA van Essen, K van Gangelt, AAW van Geloven, C van kessel, YT van Loon, A van Rijswijk, SJ van Rooijen, T van Sprundel, L van Steensel, WF van Tets, HL van Westreenen, S Veltkamp, T Verhaak, PM Verheijen, L Versluis-Ossenwaarde, S Vijfhuize, WJ Vles, S Voeten, FJ Vogelaar, WW Vrijland, E Westerduin, ME Westerterp, M. Wetzel, K Wevers, B Wiering, AC Witjes, MW Wouters, STK Yauw, EC Zeestraten, DD Zimmerman, T Zwieten.

Funding

No funding was received for conducting this study. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Author information

Author notes

  1. S. J. A. Hazen and I. Vogel have shared first authorship.

Authors and Affiliations

  1. Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, PO Box 7057, 1000 SN, Amsterdam, The Netherlands

    S. J. A. Hazen, J. B. Tuynman & M. Kusters

  2. Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands

    I. Vogel & W. A. A. Borstlap

  3. Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands

    J. W. T. Dekker

  4. Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands

    P. J. Tanis

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  1. S. J. A. Hazen
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Consortia

The Dutch Snapshot Research Group

  • C. L. Deijen
  • , M. den Dulk
  • , H. J. Bonjer
  • , C. J. van de Velde
  • , P. J. Tanis
  • , A. G. J. Aalbers
  • , Y. Acherman
  • , G. D. Algie
  • , B. Alting von Geusau
  • , F. Amelung
  • , T. S. Aukema
  • , I. S. Bakker
  • , S. A. Bartels
  • , S. Basha
  • , A. J. N. M. Bastiaansen
  • , E. Belgers
  • , W. Bleeker
  • , J. Blok
  • , R. J. I. Bosker
  • , J. W. Bosmans
  • , M. C. Boute
  • , N. D. Bouvy
  • , H. Bouwman
  • , A. Brandt-Kerkhof
  • , D. J. Brinkman
  • , S. Bruin
  • , E. R. J. Bruns
  • , J. P. M. Burbach
  • , J. W. A. Burger
  • , C. J. Buskens
  • , S. Clermonts
  • , P. P. L. O. Coene
  • , C. Compaan
  • , E. C. J. Consten
  • , T. Darbyshire
  • , S. M. L. de Mik
  • , E. J. R. de Graaf
  • , I. de Groot
  • , R. J. L. de vos tot Nederveen Cappel
  • , J. H. W. de Wilt
  • , J. van der Wolde
  • , F. C. den Boer
  • , J. W. T. Dekker
  • , A. Demirkiran
  • , M. Derkx-Hendriksen
  • , F. R. Dijkstra
  • , P. van Duijvendijk
  • , M. S. Dunker
  • , Q. E. Eijsbouts
  • , H. Fabry
  • , F. Ferenschild
  • , J. W. Foppen
  • , E. J. B. Furnee
  • , M. F. Gerhards
  • , P. Gerven
  • , J. A. H. Gooszen
  • , J. A. Govaert
  • , W. M. U. Van Grevenstein
  • , R. Haen
  • , J. J. Harlaar
  • , E. Harst
  • , K. Havenga
  • , J. Heemskerk
  • , J. F. Heeren
  • , B. Heijnen
  • , P. Heres
  • , C. Hoff
  • , W. Hogendoorn
  • , P. Hoogland
  • , A. Huijbers
  • , J. A. H. Gooszen
  • , P. Janssen
  • , A. C. Jongen
  • , F. H. Jonker
  • , E. G. Karthaus
  • , A. Keijzer
  • , J. M. A. Ketel
  • , J. Klaase
  • , F. W. H. Kloppenberg
  • , M. E. Kool
  • , R. Kortekaas
  • , P. M. Kruyt
  • , J. T. Kuiper
  • , B. Lamme
  • , J. F. Lange
  • , T. Lettinga
  • , D. J. Lips
  • , F. Logeman
  • , M. F. Lutke Holzik
  • , E. Madsen
  • , A. Mamound
  • , C. C. Marres
  • , I. Masselink
  • , M. Meerdink
  • , A. G. Menon
  • , J. S. Mieog
  • , D. Mierlo
  • , G. D. Musters
  • , P. A. Neijenhuis
  • , J. Nonner
  • , M. Oostdijk
  • , S. J. Oosterling
  • , P. M. P. Paul
  • , K. C. M. J. C. Peeters
  • , I. T. A. Pereboom
  • , F. Polat
  • , P. Poortman
  • , M. Raber
  • , B. M. M. Reiber
  • , R. J. Renger
  • , C. C. van Rossem
  • , H. J. Rutten
  • , A. Rutten
  • , R. Schaapman
  • , M. Scheer
  • , L. Schoonderwoerd
  • , N. Schouten
  • , A. M. Schreuder
  • , W. H. Schreurs
  • , G. A. Simkens
  • , G. D. Slooter
  • , H. C. E. Sluijmer
  • , N. Smakman
  • , R. Smeenk
  • , H. S. Snijders
  • , D. J. A. Sonneveld
  • , B. Spaansen
  • , E. J. Spillenaar Bilgen
  • , E. Steller
  • , W. H. Steup
  • , C. Steur
  • , E. Stortelder
  • , J. Straatman
  • , H. A. Swank
  • , C. Sietses
  • , H. A. ten Berge
  • , H. G. ten hoeve
  • , W. W. ter Riele
  • , I. M. Thorensen
  • , B. Tip-Pluijm
  • , B. R. Toorenvliet
  • , L. Tseng
  • , J. B. Tuynman
  • , J. van Bastelaar
  • , S. C. van beek
  • , A. W. H. van de Ven
  • , M. A. J. van de Weijer
  • , C. van den Berg
  • , I. van den Bosch
  • , J. D. W. van der Bilt
  • , S. J. van der Hagen
  • , R. van der hul
  • , G. van der Schelling
  • , A. van der Spek
  • , N. van der Wielen
  • , E. van duyn
  • , C. van Eekelen
  • , J. A. van Essen
  • , K. van Gangelt
  • , A. A. W. van Geloven
  • , C. van kessel
  • , Y. T. van Loon
  • , A. van Rijswijk
  • , S. J. van Rooijen
  • , T. van Sprundel
  • , L. van Steensel
  • , W. F. van Tets
  • , H. L. van Westreenen
  • , S. Veltkamp
  • , T. Verhaak
  • , P. M. Verheijen
  • , L. Versluis-Ossenwaarde
  • , S. Vijfhuize
  • , W. J. Vles
  • , S. Voeten
  • , F. J. Vogelaar
  • , W. W. Vrijland
  • , E. Westerduin
  • , M. E. Westerterp
  • , M. Wetzel
  • , K. Wevers
  • , B. Wiering
  • , A. C. Witjes
  • , M. W. Wouters
  • , S. T. K. Yauw
  • , E. C. Zeestraten
  • , D. D. Zimmerman
  •  & T. Zwieten

Contributions

All authors have made substantial contributions to all aspects of the manuscript including the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article or critical appraisal and revisions. All authors have read and approved the final version of the manuscript that is being submitted.

Corresponding author

Correspondence to M. Kusters.

Ethics declarations

Conflict of interest

This manuscript has no conflicts of interest and did not receive any form of financial support of funding to complete this study.

Ethics approval

The study was approved by the Medical Ethical Committee of the Academic Medical Center in Amsterdam.

Informed Consent

Informed Consent was not necessary due to its retrospective design.

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Members of The Dutch Snapshot Research Group are listed in the Acknowledgement section.

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Hazen, S.J.A., Vogel, I., Borstlap, W.A.A. et al. Long-term stoma-related reinterventions after anterior resection for rectal cancer with or without anastomosis: population data from the Dutch snapshot study. Tech Coloproctol 26, 99–108 (2022). https://doi.org/10.1007/s10151-021-02543-3

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