The effect of diverting stoma on postoperative morbidity after low anterior resection for rectal cancer in patients treated within an ERAS program

Abstract

BackgroundAnastomotic leakage (AL) is a serious complication after low anterior resection (LAR) with total mesorectal excision (TME) for rectal cancer. Whether the Enhanced Recovery After Surgery (ERAS)-protocol influences the risk of short-term morbidity in relation to the use of a diverting stoma is unclear. MethodsBetween 2002 and 2011, 287 consecutive patients underwent LAR with TME for rectal cancer at Ersta Hospital, Sweden. All patients were treated according to the ERAS program and thereby included. Between 2002 and 2006 15% had a diverting stoma compared to 91 %, 2007 to 2011. ResultsOne hundred and thirty-nine patients were operated with a diverting stoma at primary surgery (S+), 148 patients were not (S−). The groups were comparable regarding pre- and peroperative data and patients' characteristics. Postoperative morbidity within 30 days after surgery (S+ 53% vs. S− 43%) and hospital stay (S+ 11 days vs. S− 9 days) did not differ. AL occurred in 22% of all patients. In a multivariate analysis, no significant difference in AL was found in relation to the use of a diverting stoma (S+ vs. S−, OR 0.64, 95% CI 0.34–1.19). Eleven patients (8%) in the S+ group underwent relaparotomy versus 22 (15%) in the S− group (p = 0.065). Total overall compliance to the ERAS program was 65%. Patients in S− had faster postoperative recovery. ConclusionA diverting stoma did not affect postoperative morbidity in this large cohort of patients undergoing LAR within an ERAS program. However, the routine use of a diverting stoma could be expected to delay postoperative recovery.