Benefits and risks of diverting stoma creation during rectal cancer surgery

Abstract

Purpose: A consensus has been reached regarding diverting stoma (DS) construction in rectal cancer surgery to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we examined the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer. Methods: We included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer between 2005 and 2017. These participants were divided into the DS (+) and DS (-) groups, and the outcomes, including postoperative complications, were compared. Results: The incidence of ileus was higher in the DS (+) group than in the DS (-) group (P < 0.01); however, no patients in the DS (+) group showed grade 3 anastomotic leakage. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction-related stoma outlet syndrome occurred in 19 patients (12.4%). There was no significant intergroup difference in the incidence of grade 3b postoperative complications. However, the most common reason for reoperation was different in the 2 groups: anastomotic leakage in 91.7% of patients with grade 3b postoperative complications in the DS (-) group, and SRCs in 85.7% of patients with grade 3b postoperative complications in the DS (+) group. Conclusion: Patients with DS showed higher incidence rates of overall postoperative complications, severe postoperative complications (grade 3), and bowel obstruction, including stoma outlet syndrome, than patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

The Effectiveness of Adipose Tissue-Derived Mesenchymal Stem Cells Mixed with Platelet-Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats

“…The total cost of hospital stay, re-admissions, patient training, reoperations, disposable materials for stomas etc. seems to be tremendous [42].…”

Risk factors for anastomotic leakage in Low Anterior Resection with a Diverting stoma for rectal cancer: A case control study

“…All DSs used ileostomy, rather than colostomy. The criteria for constructing a DS included a tumor margin from the anal verge (AV) of < 5 cm, treatment with neoadjuvant chemotherapy (NAC) or chemoradiotherapy (CRT), positive for intraoperative leakage, steroid use, and hypoalbuminemia [4].…”

Postoperative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery – a multicentre retrospective study

“…The formation of an intestinal stoma is often a life-changing event for a patient and can result in a variety of complications. These complications have previously been subcategorized into early or late stoma-related complications (SRCs) [1,2]. Early SRCs, which tend to occur in the first 30 postoperative days, include peristomal skin excoriation, mucocutaneous separation, high stoma output, peristomal infections and ischaemia or necrosis.…”