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J Am Coll Surg. 2015 Feb;220(2):186-94. doi: 10.1016/j.jamcollsurg.2014.10.017. Epub 2014 Nov 4.

Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients.

Author information

1
Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan. Electronic address: a.shiomi@scchr.jp.
2
Division of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan.
3
Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan.
4
Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
5
Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan.
6
Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
7
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
8
Department of Surgery, School of Medicine, Jichi Medical University, Tochigi, Japan.
9
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Abstract

BACKGROUND:

Routine creation of a diverting stoma (DS) in every patient who undergoes low anterior resection (LAR) remains controversial. We aimed to investigate the effect of DS on symptomatic anastomotic leakage (AL) after LAR.

STUDY DESIGN:

Patients with rectal cancer within 10 cm from the anal verge were eligible for this prospective, multicenter, cohort study (UMIN-CTR, number 000004017). Propensity score matching (PSM) was used to compare groups of patients with and without DS.

RESULTS:

One thousand fourteen consecutive patients were registered, of whom 936 patients who underwent LAR were analyzed. Before PSM, the overall rate of symptomatic AL was 13.2% (52 of 394) in patients with DS vs. 12.7% (69 of 542) in cases without DS (p = 0.84). Symptomatic AL requiring re-laparotomy occurred in 4.7% (44 of 936) of all patients, occurring in 1.0% (4 of 394) of patients with DS vs. 7.4% (40 of 542) of patients without DS (p < 0.001). After PSM, the 2 groups were nearly balanced, and the incidence rates of symptomatic AL in patients with and without DS were 10.9% and 15.8% (p = 0.26). The incidences of AL requiring re-laparotomy in patients with and without DS were 0.6% and 9.1% (p < 0.001). Multivariate analysis identified male sex (p < 0.001; odds ratio [OR] 3.2; 95% confidence interval [CI] 1.8 to 5.7) and tumor size (p < 0.001; OR 1.2; 95% CI 1.1 to 1.4) as independent risk factors of symptomatic AL.

CONCLUSIONS:

Diverting stoma did not have a significant relationship with symptomatic AL before and after PSM. However, DS does seem to mitigate the consequences of leakage, reducing the need for urgent abdominal reoperation.

[Indexed for MEDLINE]

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