PMID- 37161674
OWN - NLM
STAT- MEDLINE
DCOM- 20230511
LR  - 20230623
IS  - 2474-9842 (Electronic)
IS  - 2474-9842 (Linking)
VI  - 7
IP  - 3
DP  - 2023 May 5
TI  - Defunctioning loop ileostomy in anterior resection for rectal cancer and 
      subsequent renal failure: nationwide population-based study.
LID - 10.1093/bjsopen/zrad010 [doi]
LID - zrad010
AB  - BACKGROUND: Electrolyte disturbances and dehydration are common after anterior 
      resection for rectal cancer with a defunctioning loop ileostomy. High-quality 
      population-based studies on the impact of a defunctioning loop ileostomy on renal 
      failure are lacking. METHODS: This was a nationwide observational study, based on 
      the Swedish Colorectal Cancer Registry of patients undergoing anterior resection 
      for rectal cancer between 2008 and 2016, with follow-up until 2017. Patients with 
      severe co-morbidity, with age greater than 80 years, and with pre-existing renal 
      failure were excluded. Loop ileostomy at index surgery constituted exposure, 
      while a diagnosis of renal failure was the outcome. Acute and chronic events were 
      analysed separately. Inverse probability weighting with adjustment for 
      confounding derived from a causal diagram was employed. Hazards ratios (HRs) with 
      95 per cent c.i. are reported. RESULTS: A total of 5355 patients were eligible 
      for analysis. At 5-year follow-up, all renal failure events (acute and chronic) 
      were 7.2 per cent and 3.3 per cent in the defunctioning stoma and no stoma groups 
      respectively. In the weighted analysis, a HR of 11.59 (95 per cent c.i. 5.68 to 
      23.65) for renal failure in ostomates was detected at 1 year, with the largest 
      effect from acute renal failure (HR 24.04 (95 per cent c.i. 8.38 to 68.93)). 
      Later follow-up demonstrated a similar pattern, but with smaller effect sizes. 
      CONCLUSION: Patients having a loop ileostomy in combination with anterior 
      resection for rectal cancer are more likely to have renal failure, especially 
      early after surgery. Strategies are needed, such as careful fluid management 
      protocols, and further research into alternative stoma types or reduction in 
      stoma formation.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of BJS 
      Society Ltd.
FAU - Rutegard, Martin
AU  - Rutegard M
AUID- ORCID: 0000-0002-0974-6373
AD  - Department of Surgical and Perioperative Sciences, Surgery, Umea University, 
      Umea, Sweden.
AD  - Wallenberg Centre for Molecular Medicine, Umea University, Umea, Sweden.
FAU - Haggstrom, Jenny
AU  - Haggstrom J
AUID- ORCID: 0000-0002-9086-7403
AD  - Department of Statistics, Umea School of Business, Economics and Statistics, Umea 
      University, Umea, Sweden.
FAU - Back, Erik
AU  - Back E
AD  - Department of Surgical and Perioperative Sciences, Surgery, Umea University, 
      Umea, Sweden.
FAU - Holmgren, Klas
AU  - Holmgren K
AUID- ORCID: 0000-0002-8611-1304
AD  - Department of Surgical and Perioperative Sciences, Surgery, Umea University, 
      Umea, Sweden.
FAU - Wixner, Jonas
AU  - Wixner J
AD  - Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.
FAU - Rutegard, Jorgen
AU  - Rutegard J
AD  - Department of Surgical and Perioperative Sciences, Surgery, Umea University, 
      Umea, Sweden.
FAU - Matthiessen, Peter
AU  - Matthiessen P
AUID- ORCID: 0000-0003-4939-4189
AD  - Department of Surgery, Faculty of Medicine and Health, Orebro University, Orebro, 
      Sweden.
FAU - Sjostrom, Olle
AU  - Sjostrom O
AD  - Department of Radiation Sciences, Umea University, Umea, Sweden.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - BJS Open
JT  - BJS open
JID - 101722685
SB  - IM
CIN - BJS Open. 2023 May 5;7(3):. PMID: 37161671
EIN - BJS Open. 2023 May 5;7(3):. PMID: 37350496
MH  - Humans
MH  - Aged, 80 and over
MH  - Ileostomy/adverse effects
MH  - *Surgical Stomas
MH  - *Renal Insufficiency/epidemiology
MH  - *Rectal Neoplasms/surgery
MH  - Registries
PMC - PMC10170252
EDAT- 2023/05/10 06:42
MHDA- 2023/05/11 06:42
PMCR- 2023/05/10
CRDT- 2023/05/10 04:06
PHST- 2022/11/23 00:00 [received]
PHST- 2022/12/29 00:00 [revised]
PHST- 2023/01/06 00:00 [accepted]
PHST- 2023/05/11 06:42 [medline]
PHST- 2023/05/10 06:42 [pubmed]
PHST- 2023/05/10 04:06 [entrez]
PHST- 2023/05/10 00:00 [pmc-release]
AID - 7158799 [pii]
AID - zrad010 [pii]
AID - 10.1093/bjsopen/zrad010 [doi]
PST - ppublish
SO  - BJS Open. 2023 May 5;7(3):zrad010. doi: 10.1093/bjsopen/zrad010.