See the published version of this preprint at World Journal of Surgical Oncology.
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Research
Marcin Zeman
Centrum Onkologii Instytut im Marii Sklodowskiej-Curie Oddzial w Gliwicach
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8607-7994
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
One of the most severe complications of low anterior resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the frequency of AL requiring surgical intervention, but up to one-third of temporary stomas may never be closed.
The first aim of the study is to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study is to assess preoperative PS risk factors in patients with LI.
Methods
A total of 286 consecutive patients who underwent low anterior resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and values of selected peripheral blood parameters were analysed.
Results
PS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p <0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p <0.001). In the LI group, the only significant risk factor for PS in multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.008, 97.5% CI 1.003-1.014, p = 0.003).
Conclusions
Protective LI significantly reduces the incidence of symptomatic AL, but a higher risk of PS is observed in this group of patients. The preoperative serum fibrinogen concentration is a risk factor for PS in LI patients and may be a helpful variable in decision models.
Keywords
low anterior resection, rectal cancer, loop ileostomy, permanent stoma, anastomotic leakage, fibrinogen
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Peer Review Timeline
CURRENT STATUS: Published
View the published article at World Journal of Surgical Oncology.
No community comments so far
Editorial decision: Accept
On 27 Jul, 2020
Reviewer #5 agreed
On 19 Jul, 2020
Review #3 received
Received 17 Jul, 2020
Editor assigned
On 17 Jul, 2020
Reviewers invited
Invitations sent on 17 Jul, 2020
Reviewer #1 agreed
On 17 Jul, 2020
Reviewer #2 agreed
On 17 Jul, 2020
Reviewer #3 agreed
On 17 Jul, 2020
Reviewer #4 agreed
On 17 Jul, 2020
Review #1 received
Received 17 Jul, 2020
Review #2 received
Received 17 Jul, 2020
Submission checks complete
On 16 Jul, 2020
Editor invited
On 16 Jul, 2020
Version 1
Posted 05 Jun, 2020
No comments provided
Editorial decision: Major Revision
On 17 Jun, 2020
Review #4 received
Received 15 Jun, 2020
Review #3 received
Received 14 Jun, 2020
Review #5 received
Received 07 Jun, 2020
Review #6 received
Received 07 Jun, 2020
Reviewer #5 agreed
On 04 Jun, 2020
Reviewer #6 agreed
On 04 Jun, 2020
Reviewer #7 agreed
On 04 Jun, 2020
Reviewer #1 agreed
On 02 Jun, 2020
Reviewer #2 agreed
On 02 Jun, 2020
Reviewer #3 agreed
On 02 Jun, 2020
Reviewer #4 agreed
On 02 Jun, 2020
Review #1 received
Received 02 Jun, 2020
Review #2 received
Received 02 Jun, 2020
Editor assigned
On 01 Jun, 2020
Reviewers invited
Invitations sent on 01 Jun, 2020
Submission checks complete
On 31 May, 2020
Editor invited
On 31 May, 2020
First submitted
On 29 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Oncology
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A new preprint design is coming!
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See the published version of this preprint at World Journal of Surgical Oncology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Marcin Zeman
Centrum Onkologii Instytut im Marii Sklodowskiej-Curie Oddzial w Gliwicach
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8607-7994
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at World Journal of Surgical Oncology.
No community comments so far
Editorial decision: Accept
On 27 Jul, 2020
Reviewer #5 agreed
On 19 Jul, 2020
Review #3 received
Received 17 Jul, 2020
Editor assigned
On 17 Jul, 2020
Reviewers invited
Invitations sent on 17 Jul, 2020
Reviewer #1 agreed
On 17 Jul, 2020
Reviewer #2 agreed
On 17 Jul, 2020
Reviewer #3 agreed
On 17 Jul, 2020
Reviewer #4 agreed
On 17 Jul, 2020
Review #1 received
Received 17 Jul, 2020
Review #2 received
Received 17 Jul, 2020
Submission checks complete
On 16 Jul, 2020
Editor invited
On 16 Jul, 2020
Version 1
Posted 05 Jun, 2020
No comments provided
Editorial decision: Major Revision
On 17 Jun, 2020
Review #4 received
Received 15 Jun, 2020
Review #3 received
Received 14 Jun, 2020
Review #5 received
Received 07 Jun, 2020
Review #6 received
Received 07 Jun, 2020
Reviewer #5 agreed
On 04 Jun, 2020
Reviewer #6 agreed
On 04 Jun, 2020
Reviewer #7 agreed
On 04 Jun, 2020
Reviewer #1 agreed
On 02 Jun, 2020
Reviewer #2 agreed
On 02 Jun, 2020
Reviewer #3 agreed
On 02 Jun, 2020
Reviewer #4 agreed
On 02 Jun, 2020
Review #1 received
Received 02 Jun, 2020
Review #2 received
Received 02 Jun, 2020
Editor assigned
On 01 Jun, 2020
Reviewers invited
Invitations sent on 01 Jun, 2020
Submission checks complete
On 31 May, 2020
Editor invited
On 31 May, 2020
First submitted
On 29 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Oncology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at World Journal of Surgical Oncology.
Background
One of the most severe complications of low anterior resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the frequency of AL requiring surgical intervention, but up to one-third of temporary stomas may never be closed.
The first aim of the study is to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study is to assess preoperative PS risk factors in patients with LI.
Methods
A total of 286 consecutive patients who underwent low anterior resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and values of selected peripheral blood parameters were analysed.
Results
PS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p <0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p <0.001). In the LI group, the only significant risk factor for PS in multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.008, 97.5% CI 1.003-1.014, p = 0.003).
Conclusions
Protective LI significantly reduces the incidence of symptomatic AL, but a higher risk of PS is observed in this group of patients. The preoperative serum fibrinogen concentration is a risk factor for PS in LI patients and may be a helpful variable in decision models.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
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