Large variation in the use of defunctioning stomas after rectal cancer surgery. A lack of consensus. (2nd April 2016)

• Record Type: Journal Article
• Authors: Snijders, Heleen S.; Kunneman, Marleen; Tollenaar, Rob A. E. M.; Boerma, Djamila; Pieterse, Arwen H.; Wouters, Michel J. W. M.; Stiggelbout, Anne M.
• Is Part Of: Acta oncologica. Volume 55:Number 4(2016)
• Page Start: 509
• Page End: 515
• Publication Date: 2016-04-02
• Subjects: Oncology -- Periodicals; Cancer -- Treatment -- Periodicals; 616.992
• DOI: 10.3109/0284186X.2015.1091498
• Languages: English
• ISSNs: 0284-186X

Abstract

Abstract: Background and objectives : When deciding about the use of a defunctioning stoma in rectal cancer surgery, benefits and risks need to be weighed. This study investigated: (1a) factors associated with the use of defunctioning stomas; (1b) hospital variation; and (2) surgeons' perceptions regarding factors that determine this decision. Methods : Population-based data from the Dutch Surgical Colorectal Audit were used. Factors for receiving a defunctioning stoma were analyzed with multivariate logistic regression analysis. Hospital variation was assessed before and after case-mix adjustment. A survey was performed among gastroenterological surgeons on the importance of factors for the decision to construct a defunctioning stoma. Results : In total 4368 patients were analyzed and 103 (34%) surgeons participated. Male gender, higher body mass index, lower tumors, preoperative radiotherapy, and treatment in a teaching/university hospital increased the odds for a defunctioning stoma. Unadjusted hospital variation ranged from 0% to 98%. Variation remained after case-mix adjustment (0–100%). There was large variation in factors considered important for the decision; almost all factors were ranked as 'most important' at least once. Conclusions : There is large variation in the use of defunctioning stomas for patients with rectal cancer, and a lack in uniformity of the selection criteria. These results underline the need to improve current decision making and identification of high-risk patients.