title: [Risk factor analysis on postoperative complications after laparoscopic total mesorectal excision with preventive terminal ileostomy and timing of stoma closure in rectal cancer].
abstract: OBJECTIVE
  To summarize the application of protective terminal ileostomy in laparoscopic total mesorectal excision for rectal cancer patients, and explore the risk factors associated with postoperative complications and timing of stoma closure.
  
  
  METHODS
  Clinical data of 77 patients with middle or low rectal cancer undergoing laparoscopic total mesorectal excision (TME) with preventive terminal ileostomy in our department from January 2007 to December 2013 were retrospectively analyzed. Independent risk factors associated to postoperative complications of terminal ileostomy were examined by logistic regression and timing of stoma closure was investigated.
  
  
  RESULTS
  The total postoperative complication morbidity was 57.1% (44/77). Electrolyte disturbance was found in 39 cases (50.6%, 39/77), including 1 case of hypovolemic syncope. Parastomal hernia occurred in 9 cases (11.7%, 9/77). Peristomal dermatitis and subcutaneous abscess was observed in 1 case (1.3%, 1/77). The result of the single factor analysis of the water electrolyte disturbance after operation, the risk factors of P<0.2 were new adjuvant chemotherapy (P=0.094), tumor antigen (P=0.086) and TNM staging (P=0.026); Postoperative parastomal hernia of the single factor analysis results, the risk factors of P<0.2 included uses of antidiabetic drugs (P=0.172), ASA anesthesia (P=0.168) grading and TNM stage(P=0.161); But multivariate analysis revealed no risk factors associated with the above complications (all P>0.05). Sixty-five patients underwent stoma closure during follow-up, including 2 cases (3.1%) within 90 days, 20 cases (30.8%) from 90 to 180 days, and 43 cases (66.2%) more than 180 days.
  
  
  CONCLUSIONS
  No risk factors were found to be associated with main postoperative complications of protective terminal ileostomy after laparoscopic TME for rectal cancer patients, such as electrolytes imbalance and parastomal hernia. The timing of stoma closure should be longer than 180 days.
authors.affiliation: Department of General Surgery, Peking University Third Hospital, Peking University, Beijing 100191, China. fuwei0720@sohu.com.
authors.forename: Lingduo
authors.initials: L
authors.lastname: Xie
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.forename: Haiting
authors.initials: H
authors.lastname: Xie
authors.forename: Yunkai
authors.initials: Y
authors.lastname: Zhang
authors.forename: Huanhong
authors.initials: H
authors.lastname: Zeng
authors.forename: Tao
authors.initials: T
authors.lastname: Sun
authors.forename: Ning
authors.initials: N
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Fu
mesh_terms: D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D005163:Factor Analysis, Statistical; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy; D016015:Logistic Models; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012004:Rectal Neoplasms; D012189:Retrospective Studies; D012307:Risk Factors