Abstract
Rectal cancer surgery is moving from organ sacrificing abdominoperineal resection (APR) to organ-preserving anterior resection (AR). Neoadjuvant chemoradiation, low anterior resection and coloanal anastomosis play a major role in this context. Anastomotic leakage (AL) is the most feared complication of these procedures. Therefore, much importance is given to proximal diversions to protect anastomosis. This review has critically analysed the indications, various methods available, challenges, complications, benefits and patient selection for proximal diversions.
Highlights
Rectal cancer surgery has developed from organ sacrificing abdominoperineal resection to organ-preserving procedures with the introduction of Total Mesorectal Excision (TME), neoadjuvant chemoradiation and Trans-anal TME (TaTME)
Peter Ihnat et al[8]concluded in a publication in 2016 that diverting ileostomy does protect the anastomosis following laparoscopic rectal cancer surgery but at a high price in terms of ileostomy related complications and morbidity
What is the method to divert? A proximal diverting loop ileostomy is the most popular method of diversion owing to advantages over colostomy [9]
Summary
Rectal cancer surgery has developed from organ sacrificing abdominoperineal resection to organ-preserving procedures with the introduction of Total Mesorectal Excision (TME), neoadjuvant chemoradiation and Trans-anal TME (TaTME). Defunctioning or diverting stoma is created to minimize the impact of a subsequent anastomotic leak. Diversion or no diversion Whether to divert patients undergoing rectal cancer surgery or not was debated but has come up with mixed conclusions.
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