Impact of diverting stoma in low anterior resection for rectal cancer on short-term surgical outcomes and reoperation

Abstract

Introduction: The purpose of this study was to evaluate whether Protective diverting stoma after anterior resection of Dixon for rectal cancer has a significant impact on short-term surgical outcomes. Methods: All patients with rectal carcinoma referred to our surgical oncology department, south Egypt Cancer Institute for surgical management between July 2009, and July 2016, were involved in the study. 203 consecutive patients who underwent anterior resection for rectal cancer with or without diverting stoma were recruited from our retrospective database. The 61 patients who had diverting stoma were compared with the remaining 142 patients who did not have diverting stoma .Demographic, clinical, operative and short surgical outcomes were reviewed. Results: Sixty -one (32.3%) of 203 patients underwent temporary diverting stoma after anterior resection of Dixon for rectal cancer, the overall complications rate was 34.5%.The clinico -pathological features of patients who had a diverting stoma and those without stoma had no significant difference regarding similar as regard the age, gender, body mass index, medical co-morbidities, and tumor stage (P=>0.2). More patients in the stoma group have received a preoperative noeadjuvant therapy (P=>0.046).The operative critics between the 2 groups showed no significant difference in surgical approach, intraoperative contamination or way of anastomosis. Postoperatively, the overall complications rate was 34.5%. The stoma group had a statistically significant lower rate of complications compared to patients without stoma (21.3% vs 38.7,P=0.023).Significant differences were noted in postoperative ileus (P=0.03), pneumonia (P=0.03), surgical site infection (P=0.05), reoperation (P=0.04), and length of hospital stay, (P=0.001) . There was no significant statistical difference in incidence of thromboembolic disorders (P=0.52), anastomotic leaks (P=0.07) or hospital mortality (P=0.07) but there is a significant difference in ICU admission (P=0.05). Conclusion: The diverting stoma after anterior resection for rectal cancer significantly decreased postoperative complications and need for reoperation. So, its protective role was well established.