Loop ostomy following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy

Xin Wu,Guole Lin,Miner Zhong,Bin Wu,Huizhong Qiu,Yi Xiao

doi:10.1186/s40001-018-0325-x

Abstract

BackgroundBoth loop ileostomy (LI) and loop transverse colostomy (LTC) could achieve absolute fecal diversion and have several advantages. This study compared LI and LTC following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy.MethodsBetween January 2009 and December 2016, 186 patients who underwent laparoscopic low anterior resection for rectal cancer and loop ostomy were included. All patients received preoperative neoadjuvant chemoradiotherapy. Of these, 77 underwent LI and 109 underwent LTC. Demographic characteristics, operative details, and complications were analyzed.ResultsIn the fecal diversion period, the LTC group showed significantly less dermatitis (p = 0.001) and electrolyte disturbance (p = 0.002), while LI group showed significantly shorter time to first defecation (p = 0.006) and lower incidence of parastomal hernia (p = 0.014). In the stoma closure period, a significantly higher incidence of wound infection was found in LTC group (p = 0.001).ConclusionsBoth LI and LTC have advantages and disadvantages. For its lower wound infection rate, lower incidence of parastomal hernia, and shorter time to first defecation, LI is recommended for all patients except those with potential electrolyte disturbance and sensitive skin.

Highlights

Both loop ileostomy (LI) and loop transverse colostomy (LTC) could achieve absolute fecal diversion and have several advantages
The development of laparoscopic technique and neoadjuvant chemoradiotherapy helps surgeons to challenge the limited capacity for anus preservation after operations for low rectal cancer
A total of 186 patients were divided into two groups: LI group with 77 patients, and LTC group with 109 patients

Summary

Introduction

Both loop ileostomy (LI) and loop transverse colostomy (LTC) could achieve absolute fecal diversion and have several advantages. This study compared LI and LTC following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy. The incidence of anastomotic leakage is high if the anastomosis involves the anal canal or distal rectum. Though it remains controversial, ostomy is effective in preventing abdominal contamination, septic shock, and other complications in case of anastomotic leakage [1,2,3,4]. Both loop ileostomy (LI) and loop transverse colostomy (LTC) could achieve absolute fecal diversion and reduce the incidence of anastomotic leakage. To the best of our knowledge, no dedicated study about ostomy following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy has been performed. We designed a retrospective clinical study, collected the data in our center, and compared LI and LTC in patients with the same background

Methods

Results

Discussion

Conclusion