晚期卵巢癌手术中的气孔泄漏率：保护性气孔使用限制政策的结果

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-04-05 DOI:10.1016/j.ygyno.2025.03.032

Virginia Vargiu , Francesco Santullo , Giovanni Scambia , Angelica Naldini , Diana Giannarelli , Valerio Gallotta , Claudio Lodoli , Carlo Abatini , Lorena Quagliozzi , Giovanni Esposito , Mara Iasevoli , Fabio Pacelli , Anna Fagotti

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引用次数: 0

摘要

目的评价晚期卵巢癌直肠乙状结肠切除术后施行限制性造口术后吻合口漏率。次要目的包括确定造口的预测因素，分析吻合口漏处理和围手术期结果。背景资料直肠-乙状结肠切除术在晚期卵巢癌治疗中是必不可少的，但存在吻合口裂开等风险。保护性气孔的作用仍然不确定，因此需要有针对性的策略。方法：本回顾性研究包括2020年1月至2023年12月期间在罗马的Fondazione Policlinico Universitario A. Gemelli IRCCS接受直肠乙状结肠切除术的722例患者的数据。患者被分为自由（2020 - 2021）或限制性（2022 - 2023）造口政策。自由方法依赖于普通外科医生的偏好，没有预定义的标准，而限制性政策引入了由妇科肿瘤学家和外科团队中的普通外科医生在进行造口之前对风险因素进行系统评估。结果限制政策显著降低气孔率，由38.8%降至11.1% (p <；0.001)，没有增加吻合口瘘（稳定在2.5%,p = 1.000）。预测因素包括多次肠切除术、肠系膜下动脉关闭、低位吻合和肿瘤残留。有造口的患者术后并发症更严重（p = 0.007），住院时间更长(p <；0.001)，延迟化疗（p = 0.018）。吻合口漏的处理在有造口和没有造口的患者中没有差异。结论限制性造口术在不影响漏瘘率和死亡率的情况下降低了造口率，支持卵巢癌的个体化手术决策。需要前瞻性研究来澄清泄漏的危险因素，并验证保护性造口的必要性。

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STOMA study SToma-leak ratio in advanced ovarian cancer surgery: Results of a restrictive policy on the use of protective stoMAs

Objective

Assessemnet of anastomotic leak rates following recto-sigmoid resection in advanced ovarian cancer surgery after implementing a restrictive stoma policy. Secondary objectives include identifying predictive factors for stoma creation, analyzing anastomotic leak management, and perioperative outcomes.

Summary background data

Recto-sigmoid resection is essential in advanced ovarian cancer treatment but carries risks like anastomotic dehiscence. The role of protective stomas remains uncertain, highlighting the need for targeted strategies.

Methods

This retrospective study includes data from 722 patients who underwent recto-sigmoid resection between January-2020 and December-2023 at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. Patients were classified under liberal (2020−2021) or restrictive (2022−2023) stoma policies. The liberal approach relied on general surgeon preference without predefined criteria, while the restrictive policy introduced a systematic evaluation of risk factors by the gynecologic oncologist and the general surgeon in the surgical team before proceeding with ostomy creation.

Results

The restrictive policy significantly reduced stoma rates from 38.8 % to 11.1 % (p < 0.001) without increasing anastomotic leaks (stable at 2.5 %, p = 1.000). Predictive factors for stoma included multiple bowel resections, inferior mesenteric artery closure, low anastomosis, and residual tumor. Patients with stomas experienced more severe postoperative complications (p = 0.007), prolonged hospital stays (p < 0.001), and delayed chemotherapy (p = 0.018). No differences in anastomotic leak management were recorded among patients with and without ostomy.

Conclusions

A restrictive stoma policy reduced ostomy rates without affecting leak rates or mortality, supporting individualized surgical decision-making in ovarian cancer. Prospective studies are needed to clarify risk factors for leaks and validate the necessity of protective stomas.

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy