Selective Defunctioning Stoma in Low Anterior Resection for Rectal Cancer
SELective Defunctioning Stoma Approach in Low Anterior Resection for Rectal Cancer (SELSA): a Prospective Study With a Nested Randomised Clinical Trial
Skane University Hospital
212 participants
Sep 1, 2024
INTERVENTIONAL
Conditions
Summary
The goal of this observational trial with a nested randomized controlled trial is to investigate a selective approach of defunctioning stoma in low anterior resection in rectal cancer patients. The primary outcome is a hybrid so-called textbook outcome; stoma-free survival at two years without major LARS, reflecting a functionally appropriate outcome after low anterior resection for rectal cancer. Secondary outcomes include anastomotic leakage, postoperative mortality, reinterventions, stoma-related complications, quality of life measures, LARS, and permanent stoma rate up to two years after index surgery.
Eligibility
Inclusion Criteria6
- Adult patients with rectal cancer planned for a low anterior resection with anastomosis by TME with any surgical approach
- Patients aged less than 80 years
- Patients with American Society of Anesthetists' (ASA) fitness grade I or II as determined by the anaesthesiologist or the surgeon
- Patients without clear radiological signs of distant disease before rectal cancer surgery (previous metastatic surgery is no exclusion criterion)
- Anastomotic leak risk score of 0-1
- Willingness to be randomised
Exclusion Criteria16
- Insufficient command of Swedish, Norwegian, Danish or English to understand questionnaires or consent
- Emergency rectal resection (tumour resection due to large bowel obstruction, perforation, etc)
- Previous pelvic irradiation (due to e.g. gynaecological or urological cancer)
- Preoperative tumour perforation or pelvic sepsis
- Beyond TME surgery and/or concurrent resection of other organ
- Concurrent corticosteroid treatment (prednisone-equivalent dosage ≥10 mg daily)
- Planned postoperative chemotherapy
- Smoking not completely ceased four weeks before surgery
- \>2 staple firings for rectal transection
- Intraoperative blood loss ≥250 ml for minimally invasive surgery
- Intraoperative blood loss ≥500 ml for open or converted surgery
- More than one intraabdominal anastomosis performed
- Incomplete doughnuts
- Air-leak test positive
- Any significant intraoperative adverse event at the discretion of the operating surgeon (e.g. ureterotomy, bowel or tumour perforation, major medical event - pulmonary embolism, cardiac arrhythmia) (Gawria, 2022)
- TME with anastomosis ultimately not done
Interventions
With randomisation to this experimental arm (selective approach), no defunctioning stoma is constructed.
Locations(1)
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NCT06214988