Abstract
BackgroundAfter a low anterior resection, creating a defunctioning stoma is vital for securing the anastomosis in low-lying rectal cancer patients receiving concurrent chemoradiotherapy. Although it decreases the complication and reoperation rates associated with anastomotic leakage, the complications that arise before and after stoma closure should be carefully evaluated and managed.MethodsThis study enrolled 95 rectal cancer patients who received neoadjuvant concurrent chemoradiotherapy and low anterior resection with anastomosis of the bowel between July 2010 and November 2012. A defunctioning stoma was created in 63 patients during low anterior resection and in another three patients after anastomotic leakage.ResultsThe total complication rate from stoma creation to closure was 36.4%. Ileostomy led to greater renal insufficiency than colostomy did and significantly increased the readmission rate (all p < 0.05). The complication rate related to stoma closure was 36.0%. Patients with ileostomy had an increased risk of developing complications (p = 0.017), and early closure of the defunctioning stoma yielded a higher incidence of morbidity (p = 0.006). Multivariate analysis revealed that a time to closure of ≤109 days was an independent risk factor for developing complications (p = 0.007).ConclusionsThe optimal timing of stoma reversal is at least 109 days after stoma construction in rectal cancer patients receiving concurrent chemoradiotherapy and low anterior resection.
Highlights
After a low anterior resection, creating a defunctioning stoma is vital for securing the anastomosis in low-lying rectal cancer patients receiving concurrent chemoradiotherapy
Yin et al World Journal of Surgical Oncology (2017) 15:80 colostomy is technically challenging when the splenic flexure is mobilized to allow for a tension-free colorectal anastomosis, opinions vary regarding the choice of ileostomy or colostomy for diverging the stool stream from the perspective of complications before and after stoma reversal
The total mesorectal excision (TME) technique was performed for all patients, and extended visceral resection was performed for patients with clinical T4 cancer
Summary
After a low anterior resection, creating a defunctioning stoma is vital for securing the anastomosis in low-lying rectal cancer patients receiving concurrent chemoradiotherapy. It decreases the complication and reoperation rates associated with anastomotic leakage, the complications that arise before and after stoma closure should be carefully evaluated and managed. Fecal diversion is a common technique for managing various surgical situations including congenital diseases, acute or chronic inflammation, acute or chronic colonic obstruction, and malignancy. Two common procedures for fecal diversion are loop transverse colostomy and. The optimal timing of defunctioning stoma closure ranges widely and is not yet clearly defined in literatures
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