Does temporary ileostomy via specimen extraction site affect the short outcomes and complications after laparoscopic low anterior resection in rectal cancer patients? A propensity score matching analysis

Abstract

Purpose The purpose of the current study was to compare the outcomes of temporary stoma through the specimen extraction site (SSES) and stoma through a new site (SNS) after laparoscopic low anterior resection. Methods The rectal cancer patients who underwent laparoscopic low anterior resection plus temporary ileostomy were recruited in a single clinical database from Jun 2013 to Jun 2020. The SSES group and the SNS group were compared using propensity score matching (PSM) analysis. Results A total of 257 rectal cancer patients were included in this study, there were 162 patients in the SSES group and 95 patients in the SNS group. After 1:1 ratio PSM, there was no difference in baseline information (p > 0.05). The SSES group had smaller intraoperative blood loss (p = 0.016 < 0.05), shorter operation time (p < 0.01) and shorter post-operative hospital stay (p = 0.021 < 0.05) than the SNS group before PSM. However, the SSES group shorter operation time (p = 0.006 < 0.05) than the SNS group after PSM, moreover, there was no significant difference in stoma-related complications (p > 0.05). In the multivariate analysis, longer operation time was an independent factor (p = 0.019 < 0.05, OR = 1.006, 95% CI = 1.001–1.011) for the stoma-related complications. Conclusion Based on the current evidence, the SSES group had smaller intraoperative blood loss, shorter operation time and shorter post-operative hospital stay before PSM, and shorter operation time after PSM. Therefore, SSES might be superior than SNS after laparoscopic low anterior resection for rectal cancer patients.

Which site is better for prophylactic ileostomy after laparoscopic rectal cancer surgery? By the specimen extraction site or new site: A systematic review and meta-analysis

“…Four studies were completed in China ( 19 , 21 , 25 , 27 ), two studies ( 18 , 20 ) in Korea and one study ( 26 ) in Turkey. Three studies ( 21 , 25 , 26 ) performed prophylactic ileostomy at the right lower abdominal SES, two studies ( 18 , 19 ) performed ileostomy at the left lower abdominal SES, one study ( 27 ) performed ileostomy at the median lower abdominal SES, and one study ( 20 ) performed ileostomy at either the left lower abdominal or right lower abdominal SES. All included studies were retrospective in design ( Table 2 ).…”

“…Six studies ( 19 – 21 , 25 – 27 ) reported operation time. The time of operation in the prophylactic ileostomy via the SES was shorter than that in the prophylactic ileostomy via NS after LRCS (MD = -0.43, 95% CI: -0.54 - -0.32 min; p<0.00001).…”

“…Five studies ( 19 – 21 , 25 , 27 ) reported blood loss. A pooled analysis performed using the fixed-effects model revealed a significantly reduced blood loss in the SES group compared with the NS group (MD = -0.38, 95% CI: -0.62 - -0.13; p=0.003).…”

“…Three studies ( 19 , 21 , 27 ) reported time to first flatus. This pooled analysis using a fixed effects model showed that the SES group had a significantly shorter time to first flatus than the NS group (MD = -0.23, 95% CI: -0.39 - -0.08; p=0.003).…”

“…However, there is controversy about the outcomes of prophylactic ileostomy via SES. Yoo SB reported that no statistical differences were found for prophylactic ileostomy through SES or new site (NS) after LRCS ( 18 ), however, several studies in recent years reported stoma through the SES was be superior than NS ( 19 – 21 ). We, therefore, performed a meta-analysis to determine the efficacy and safety of stoma through the SES versus NS.…”