Who needs diverting ileostomy following laparoscopic low anterior resection in rectal cancer patients? Analysis of 417 patients in a single institute.
BACKGROUND
Anastomotic leakage (AL) is one of the most serious complications after low anterior resection (LAR) for rectal cancer, and the significance of diverting stoma to prevent AL is still controversial. The aim of this study is to clarify the potential benefits and safety of diverting ileostomy (DI) following laparoscopic LAR in rectal cancer patients.


METHODS
This was a retrospective cohort study of 417 rectal cancer patients who underwent laparoscopic LAR in a single institute. The risk factors for AL and the DI-related morbidity were assessed.


RESULTS
DI was performed in 226 patients (54.2%). The incidence rates of symptomatic AL showed no significant difference between patients with and without DI (8.4% vs. 10.0%, p = 0.612). AL requiring a surgical intervention was relatively lower in patients with DI than in those without DI (1.8% vs. 4.7%, p = 0.097). DI construction was an independent risk factor for AL requiring a surgical intervention (OR 3.47, p = 0.041), as was the serum albumin level (p = 0.003), and being male was a relative risk factor (p = 0.058). Focusing on sex, the rate of AL requiring a surgical intervention was significantly different in male (1.7 and 7.9%, p = 0.021) but not in female patients (1.9 and 1.1%, p = 1.000) with and without DI. The DI construction-related morbidity was 9.7%, and no patient required a reoperation. Of 226 patients with DI, 209 (92.5%) underwent stoma closure 118 days (median 30-509 days) after LAR. The stoma closure-related morbidity was 9.1% and 1 patient (0.5%) required a reoperation due to anastomotic leakage.


CONCLUSIONS
DI following laparoscopic LAR can decrease the risk of AL, requiring a surgical intervention, especially in male patients with malnutrition. However, due to DI-related morbidity, DI is not recommended in female patients.
['Shimizu|Hiroki|H|', 'Yamaguchi|Shigeki|S|0000-0003-3850-2818', 'Ishii|Toshimasa|T|', 'Kondo|Hiroka|H|', 'Hara|Kiyoka|K|', 'Takemoto|Kenichi|K|', 'Ishikawa|Shintaro|S|', 'Okada|Takuhisa|T|', 'Suzuki|Asami|A|', 'Koyama|Isamu|I|']
D000714:Anastomosis, Surgical D057868:Anastomotic Leak D005260:Female D006801:Humans D007081:Ileostomy D007564:Japan D010535:Laparoscopy D008297:Male D008875:Middle Aged D011183:Postoperative Complications D012004:Rectal Neoplasms D012086:Reoperation D012189:Retrospective Studies D012307:Risk Factors D012737:Sex Factors
Diverting ileostomy Laparoscopic low anterior resection Anastomotic leakage Sex Stoma complication