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Risk factors for small bowel obstruction after open rectal cancer resection
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Colorectal Unit, Department of Surgery, Västmanland’s Hospital Västerås, 72189, Västerås, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Colorectal Unit, Department of Surgery, Västmanland’s Hospital Västerås, 72189, Västerås, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Colorectal Unit, Department of Surgery, Västmanland’s Hospital Västerås, 72189, Västerås, Sweden.ORCID iD: 0000-0002-7056-670x
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Colorectal Unit, Department of Surgery, Västmanland’s Hospital Västerås, 72189, Västerås, Sweden.
2021 (English)In: BMC Surgery, E-ISSN 1471-2482, Vol. 21, no 1, article id 63Article in journal (Refereed) Published
Abstract [en]

Background: Small bowel obstruction (SBO) is observed in around 10% of patients with prior open abdominal surgery. Rectal resection causes the highest readmission rates. The aim of this study was to investigate risk factors for readmission for SBO and causes for SBO in patients who needed surgery following rectal cancer surgery.

Methods: A population-based registry with prospectively gathered data on 752 consecutive patients with rectal cancer who underwent open pelvic surgery between January 1996 and January 2017 was used. Univariable and multivariable regression analysis was performed, and the risk of SBO was assessed.

Results: In total, 84 patients (11%) developed SBO after a median follow-up time of 48 months. Of these patients, 57% developed SBO during the 1st year after rectal cancer surgery. Surgery for SBO was performed in 32 patients (4.3%), and the cause of SBO was stoma-related in one-fourth of these patients. In the univariable analysis previous RT and re-laparotomy were found as risk factors for readmission for SBO. Re-laparotomy was an independent risk factor for readmission for SBO (OR 2.824, CI 1.129-7.065, P = 0.026) in the multivariable analysis, but not for surgery for SBO. Rectal resection without anastomoses, splenic flexors mobilization, intraoperative bleeding, operative time were not found as risk factors for SBO.

Conclusions: One-tenth of rectal cancer patients who had open surgery developed SBO, most commonly within the 1st postoperative year. The risk of SBO is greatest in patients with complications after rectal cancer resection that result in a re-laparotomy.

Place, publisher, year, edition, pages
BMC BioMed Central (BMC), 2021. Vol. 21, no 1, article id 63
Keywords [en]
Small bowel obstruction, Rectal cancer, Surgery, Admission, Risk factors
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-435183DOI: 10.1186/s12893-021-01072-yISI: 000613227000001PubMedID: 33509187OAI: oai:DiVA.org:uu-435183DiVA, id: diva2:1531601
Available from: 2021-02-26 Created: 2021-02-26 Last updated: 2024-07-04Bibliographically approved
In thesis
1. Surgical Aspects and Prognostic Factors in the Management of Rectal Cancer
Open this publication in new window or tab >>Surgical Aspects and Prognostic Factors in the Management of Rectal Cancer
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Survival among patients with stage IV rectal cancer is poor and surgical treatment for this disease is associated with morbidities such as small bowel obstruction, complications with a diverting loop ileostomy, and functional bowel disturbances. The overall aim of this thesis was to assess risk factors and morbidity after surgery for rectal cancer and to evaluate factors affecting survival in patients with stage IV rectal cancer.

Paper I a prospective study on patients with rectal cancer with loop ileostomy who underwent stoma closure in a 23-hour hospital stay setting. Results were compared with a group who underwent standard in-hospital stoma closure prior to the start of the study, selected retrospectively as controls. No differences were found in the number of complications or the frequency of re-hospitalization or re-operation, indicating that ileostomy closure in a 23-hour hospital stay setting in these selected patients was feasible and safe with high patient satisfaction.

Paper II a population-based study with data gathered prospectively. In total, 11% of the patients developed small bowel obstruction (SBO), mostly during the first year after rectal cancer surgery. Surgical treatment for SBO was performed in 4.2% of the patients, and the mechanism was stoma-related in one-fourth. Rectal resection without anastomoses, age, morbidity, and previous radiotherapy (RT) was not associated with admission to the hospital or surgery for SBO. Re-laparotomy due to complications after rectal cancer surgery was an independent risk factor for admission for treating SBO.

Paper III a population-based study with data gathered prospectively on bowel function at 1 year after anterior resection or stoma reversal. No associations were found between any defecatory dysfunction and the part of the colon used for anastomosis, the level of the vascular tie, or gender. An association was observed between higher anastomotic level and a lower risk of incontinence and clustering. At 1 year after loop ileostomy closure, the risks of incontinence, clustering, and urgency increased by up to fourfold.

Paper IV a case-control study aiming to identify patient-, tumor-, and treatment-related prognostic factors for 5-year survival in patients with rectal cancer with synchronous stage IV disease. Patient-related factors did not differ between groups. Among the tumor-related factors, multiple site metastases, bilobar liver metastases, and increasing numbers of liver metastases were associated with poor survival. Prognostic treatment-related factors were preoperative RT, metastasectomy, and radical resection of the primary tumor. The most important prognostic factor for long-term survival was metastasectomy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2021. p. 73
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1764
Keywords
Loop ileostomy, Small bowel obstruction, Defecatory dysfunction, Stage IV rectal cancer
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-450799 (URN)978-91-513-1268-2 (ISBN)
Public defence
2021-10-08, Centrum för klinisk forskning Västerås,, Ingång 29, Västmanlands sjukhus, Västerås, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2021-09-17 Created: 2021-08-18 Last updated: 2021-10-19

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Afshari, KevinChabok, AbbasSmedh, KennetNikberg, Maziar

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