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Master Thesis

Incidence et facteurs de risque de fistule anastomotique (FA) après Exérèse Totale du Mésorectum (TME) par coelioscopie pour adénocarcinome rectal. Évaluation d’un score prédictif de fistule

Abstract : Purpose : AL after proctectomy is a major problem for the functional and oncological prognosis of patients. Current recommendations advise systematic loop ileostomy for subdouglasian anastomoses. The aim of our study was to define risk factors for AL after laparoscopic TME for rectal adenocarcinoma in a high-volume center and to test the reproducibility of a predictive score of AL after TME in order to define for which patients loop ileostomy could be avoided. Materials and methods : Monocentric and retrospective study, including all patients undergoing surgery for partial or total mesorectal excision (TME) over 5 years for rectal cancer. The incidence and risk factors for AL were studied in the overall series and then more specifically in the TME subgroup. The predictive risk score of AL tested was that of the international TME registry, included 5 criteria: gender, BMI, smoking, diabetes and tumor size (25). Results : Between January 2014 and December 2019, 434 patients underwent laparoscopic conservative rectal excision for cancer. The TME group included 292 patients, the overall AL rate was 16 % and the early AL rate was 7.8 %. The risk factors for overall AL were undernutrition (p = 0.035), tumor size (p = 0.014), first perineal approach (p = 0.027) and manual anastomosis (p < 0.01). Risk factors for early AL were tumor size (p = 0.035) and smoking (p = 0.012). In multivariate analysis, only tumor size (p = 0.038), first perineal approach (p = 0.044) and manual anastomosis (p = 0.03) were independent risk factors for AL. Smoking (p = 0.012) was an independent risk factor for early AL. The score assessed was not predictive of AL in our study. The occurrence of an AL was significantly associated with increased locoregional recurrence (p <0.01) and decreased overall survival (p = 0.023). Conclusion : With a rate of AL similar to the literature on a large cohort, we did not validate the chosen predictive risk score. The severity of AL and the absence of an identified modifiable risk factor should make us very cautious about changing the practice of temporary stomia. Ongoing prospective studies could allow us to select the patients for which it would be appropriate not to propose the systematic temporary loop ileostomy.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03426446
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Submitted on : Friday, November 12, 2021 - 11:49:39 AM
Last modification on : Wednesday, November 24, 2021 - 3:41:01 AM
Long-term archiving on: : Sunday, February 13, 2022 - 7:02:23 PM

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  • HAL Id : dumas-03426446, version 1

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Alisson Pluchon. Incidence et facteurs de risque de fistule anastomotique (FA) après Exérèse Totale du Mésorectum (TME) par coelioscopie pour adénocarcinome rectal. Évaluation d’un score prédictif de fistule. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03426446⟩

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