Impact of a Diverting Stoma in an Enhanced Recovery Programme for Rectal Cancer

Abstract

PurposeThe association of a loop ileostomy decreases the severity of complications after rectal surgery but can increase the postoperative stay. The aim of this study is to investigate if a diverting ileostomy influences the postoperative outcomes in a series of patients included in a multimodal rehabilitation program (MMRP). MethodsWe analysed a series of 104 patients that underwent elective surgery with primary anastomosis for rectal adenocarcinoma using a MMRP: 66 men and 38 women, with a median age of 64 (IQR: 55–75) years. Group A included patients with an associated loop ileostomy, and Group B, those without a protective stoma. ResultsGroup A=58, group B=46 patients with neither differences in age, ASA, BMI and other risk factors nor in the surgical approach (laparoscopic in 34%), although there were more neoadjuvant treatments in group A: 77.5 vs 36.9%; P=.001. In group A, the most common operation was total mesorectal excision (96%) and in the group B, a subtotal mesorectal excision (90%). There were no differences in postoperative complications (Group A 34.4 vs group B 28.2%; P=.322), anastomotic leaks (8.3 vs 10.8%; P=.475), or postoperative ileus (20.7 vs 10.9%; P=.140), neither in postoperative stay (7.9 vs 6.9 days; P=.058), readmissions (7 vs 13.6%; P=.22) nor postoperative stay including readmissions (8.4 vs 9.1 days; P=.49). ConclusionsThe association of a loop ileostomy does not extend the length of stay nor increases the rate of complications in patients that underwent a rectal resection with anastomosis included in a MMRP.