PMID- 29337769
OWN - NLM
STAT- MEDLINE
DCOM- 20180508
LR  - 20181202
IS  - 1530-0358 (Electronic)
IS  - 0012-3706 (Linking)
VI  - 61
IP  - 2
DP  - 2018 Feb
TI  - Morbidity Following Coloanal Anastomosis: A Comparison of Colonic J-Pouch vs
      Straight Anastomosis.
PG  - 156-161
LID - 10.1097/DCR.0000000000000960 [doi]
AB  - BACKGROUND: Low rectal tumors are often treated with sphincter-preserving
      resection followed by coloanal anastomosis. OBJECTIVE: The purpose of this study 
      was to compare the short-term complications following straight coloanal
      anastomosis vs colonic J-pouch anal anastomosis. DESIGN: Patients were identified
      who underwent proctectomy for rectal neoplasia followed by coloanal anastomosis
      in the 2008 to 2013 American College of Surgeons National Surgical Quality
      Improvement Program database. Demographic characteristics and 30-day
      postoperative complications were compared between groups. SETTINGS: A national
      sample was extracted from the American College of Surgeons National Surgical
      Quality Improvement Project database. PATIENTS: Inpatients following proctectomy 
      and coloanal anastomosis for rectal cancer were selected. MAIN OUTCOME MEASURES: 
      Demographic characteristics and 30-day postoperative complications were compared 
      between the 2 groups. RESULTS: One thousand three hundred seventy patients were
      included, 624 in the straight anastomosis group and 746 in the colonic J-pouch
      group. Preoperative characteristics were similar between groups, with the
      exception of preoperative radiation therapy (straight anastomosis 35% vs colonic 
      J-pouch 48%, p = 0.0004). Univariate analysis demonstrated that deep surgical
      site infection (3.7% vs 1.4%, p = 0.01), septic shock (2.25% vs 0.8%, p = 0.04), 
      and return to the operating room (8.8% vs 5.0%, p = 0.0006) were more frequent in
      the straight anastomosis group vs the colonic J-pouch group. Major complications 
      were also higher (23% vs 14%, p = 0.0001) and length of stay was longer in the
      straight anastomosis group vs the colonic J-pouch group (8.9 days vs 8.1 days, p 
      = 0.02). After adjusting for covariates, major complications were less following 
      colonic J-pouch vs straight anastomosis (OR, 0.57; CI, 0.38-0.84; p = 0.005).
      Subgroup analysis of patients who received preoperative radiation therapy
      demonstrated no difference in major complications between groups. LIMITATIONS:
      This study had those limitations inherent to a retrospective study using an
      inpatient database. CONCLUSION: Postoperative complications were less following
      colonic J-pouch anastomosis vs straight anastomosis. Patients who received
      preoperative radiation had similar rates of complications, regardless of the
      reconstructive technique used following low anterior resection. See Video
      Abstract at http://links.lww.com/DCR/A468.
FAU - Brown, Shaun
AU  - Brown S
AD  - Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans,
      Louisiana.
FAU - Margolin, David A
AU  - Margolin DA
FAU - Altom, Laura K
AU  - Altom LK
FAU - Green, Heather
AU  - Green H
FAU - Beck, David E
AU  - Beck DE
FAU - Kann, Brian R
AU  - Kann BR
FAU - Whitlow, Charles B
AU  - Whitlow CB
FAU - Vargas, Herschel David
AU  - Vargas HD
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Dis Colon Rectum
JT  - Diseases of the colon and rectum
JID - 0372764
SB  - IM
MH  - Aged
MH  - Anal Canal/*surgery
MH  - Anastomosis, Surgical/adverse effects/*methods/statistics & numerical data
MH  - Colon/pathology/*surgery
MH  - Colonic Pouches/adverse effects/*statistics & numerical data
MH  - Female
MH  - Humans
MH  - Length of Stay/trends
MH  - Male
MH  - Middle Aged
MH  - Morbidity
MH  - Postoperative Complications
MH  - Preoperative Period
MH  - Proctocolectomy, Restorative/methods
MH  - Radiotherapy/methods
MH  - Rectal Neoplasms/*surgery
MH  - Rectum/pathology/*surgery
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2018/01/18 06:00
MHDA- 2018/05/09 06:00
CRDT- 2018/01/17 06:00
PHST- 2018/01/17 06:00 [entrez]
PHST- 2018/01/18 06:00 [pubmed]
PHST- 2018/05/09 06:00 [medline]
AID - 10.1097/DCR.0000000000000960 [doi]
AID - 00003453-201802000-00006 [pii]
PST - ppublish
SO  - Dis Colon Rectum. 2018 Feb;61(2):156-161. doi: 10.1097/DCR.0000000000000960.