Defunctioning stoma in anterior resection for rectal cancer does not impact anastomotic leakage

1. For patients with rectal cancer undergoing anterior resection (AR), the rates of anastomotic leakage (AL) and re-operation did not change when diverting ileostomy (DLI) rates increased as an intended risk mitigation strategy.

Evidence Rating Level: 2 (Good)

The standard curative treatment for cancer of the middle and upper rectum is an anterior resection (AR). An anastomotic leakage (AL) is a complication of AR, with risk factors including male gender, excess alcohol, smoking, obesity, medical comorbidities, neoadjuvant therapy, and anastomotic height. Defunctioning ileostomies (DLI) have been previously shown to mitigate the risk of a symptomatic AL. However, DLIs are permanent 25% of the time, and can have a detrimental impact on quality of life. Considering that the use of DLIs has increased, this retrospective study based in Sweden aimed to determine if the frequency of AL has decreased at the same time, hypothesizing that without clear DLI indications, there would be no reduction in AL frequency with increasing DLI use. This study included rectal cancer patients with AR done in 2007-2009 and 2016-2018, with the latter group expected to have higher rates of DLI. In total, 3948 AR procedures were done in these two periods, with 71.6% of the 2007-2009 patients receiving DLI and 76.7% of the 2016-2018 patients (p < 0.001) receiving DLI. The study found no significant decrease in incidence of AL, with 9.2% in the 2007-2009 cohort and 8.2% in the 2016-2018 cohort (p = 0.35). Furthermore, the incidence of reoperations was unaltered (4% in 2007-2009 compared to 3% in 2016-2018). When examining the cohorts together, 72% of patients with an AL had a DLI and 74% of patients without an AL had a DLI (p = 0.36). In conclusion, when more DLI procedures were done for AR patients in this population study, there was no difference in rates of AL or re-operation.

Click to read the study in BMC Surgery

Image: PD

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