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KMID : 0356720130290020066
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Journal of the Korean Society of Coloproctology
2013 Volume.29 No. 2 p.66 ~ p.71
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The Role of Diverting Stoma After an Ultra-low Anterior Resection for Rectal Cancer
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Seo Seok-In
Yu Chang-Sik
Kim Gwon-Sik
Lee Jong-Lyul
Yoon Yong-Sik
Kim Chan-Wook
Lim Seok-Byung
Kim Jin-Cheon
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Abstract
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Purpose: A diverting stoma is known to reduce the consequences of distal anastomotic failure following colorectal surgery. The aim of this study was to evaluate the efficacy of a diverting stoma after an ultra-low anterior resection (uLAR) for rectal cancer.
Methods: Between 2000 and 2007, 836 patients who underwent an uLAR were divided into two groups, depending on the fecal diversion: 246 received fecal diversion, and 590 had no diversion. Patient- and disease-related variables were compared between the two groups.
Results: Thirty-two of the 836 patients (3.8%) had immediate anastomosis-related complications and required reoperation. Anastomosis leakage comprised 72% of the complications (23/32). The overall immediate complication rate was significantly lower in patients with a diverting stoma (0.8%, 2/246) compared to those without a diverting stoma (5.1%, 30/590; P = 0.005). The fecal diversion group had lower tumor location, lower anastomosis level, and more preoperative chemo-radiation therapy (P < 0.001). In total, 12% of patients in the diverting stoma group had complications either in making or reversing the stoma (30/246).
Conclusion: The diverting stoma decreased the rate of immediate anastomosis-related complications. However, the rate of complications associated with the diverting stoma was non-negligible, so strict criteria should be applied when deciding whether to use a diverting stoma.
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KEYWORD
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Rectal neoplasms, Ileostomy, Colorectal surgery
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