Temporary Diverting Stoma Improves Recovery of Anastomotic Leakage after Anterior Resection for Rectal Cancer

Yuchen Wu,Tianan Guo,Hongtu Zheng,Fangqi Liu,Adili Keranmu,Ye Xu

doi:10.1038/s41598-017-16311-7

Abstract

Temporary diverting stoma might be a protective factor for the prevention of anastomotic leakage (AL) after anterior resection. Its role in leakage recovery is unknown. This study aimed to evaluate the effect of temporary diverting stoma on anastomotic leakage severity and recovery. We analyzed 323 patients who underwent anterior resection for rectal cancer and developed anastomotic leakage, in which 44 had temporary diverting stoma. Association between diverting stoma and occurrence of anastomotic leakage, recovery time, length of hospital stay, overall costs, local and distant relapse-free survival were further studied. In non-severe AL group, temporary diverting stoma improved leakage recovery by 4 days (mean: 20.7 days vs. 16.1 days, p = 0.031), especially in patients who did not receive neoadjuvant treatment (mean time: 20.9 days vs. 14.4 days, p = 0.016). However, it did not delay the occurrence of anastomotic leakage. Moreover, no significant difference was found in the overall length of hospital stay and costs among patients with versus without a diverting stoma. In severe AL group, however, no difference was detected. The advantage of shortened leakage recovery did not reduce the local and distant relapse-free survival. In conclusion, our findings indicated the recovery benefit from diverting stoma in patients with anterior resection.

Highlights

Many pre- and post-surgical factors are associated with increased risk of anastomotic leakage (AL), including male sex, The American Society of Anesthesiologists (ASA)score >2, history of neoadjuvant chemoradiotherapy, and intraoperative blood transfusion[8,9].On the contrary, temporary diverting stoma, including ileostomy and transverse colostomy, is associated with a decreased incidence of AL
26.2% and 15.9% of patients had a history of excess smoking and alcohol intake, respectively
The principal finding was its positive impact on recovery of AL after anterior resection of rectal tumors

Summary

Introduction

Many pre- and post-surgical factors are associated with increased risk of AL, including male sex, The American Society of Anesthesiologists (ASA)score >2, history of neoadjuvant chemoradiotherapy (neo-CRT), and intraoperative blood transfusion[8,9].On the contrary, temporary diverting stoma, including ileostomy and transverse colostomy, is associated with a decreased incidence of AL. A systematic review of 11 studies showed a reduced rate of AL in low anterior resections(relative risk: 0.38, 95% confidence interval (CI):0.30–0.48, p < 0.001) when a diverting stoma was applied[9]. Most studies far have investigated the etiology of AL, as well as the controversy about whether temporary could reduce the risk of leakage. The aim of this study was to evaluate diverting stoma as a factor affecting AL recovery in patients after anterior resection of rectal tumors

Objectives

Methods

Conclusion