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. 2023 Mar;37(3):1916-1932.
doi: 10.1007/s00464-022-09669-x. Epub 2022 Oct 18.

Impact of a diverting ileostomy in total mesorectal excision with primary anastomosis for rectal cancer

Jeroen C Hol  1   2 , Thijs A Burghgraef  3   4 , Marieke L W Rutgers  5 , Rogier M P H Crolla  6 , Anna A W van Geloven  7 , Gabie M de Jong  8 , Roel Hompes  5 , Jeroen W A Leijtens  9 , Fatih Polat  10 , Apollo Pronk  11 , Anke B Smits  12 , Jurriaan B Tuynman  13 , Emiel G G Verdaasdonk  14 , Esther C J Consten  3   4 , Colin Sietses  8
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Impact of a diverting ileostomy in total mesorectal excision with primary anastomosis for rectal cancer

Jeroen C Hol et al. Surg Endosc. 2023 Mar.

Abstract

Background: The role of diverting ileostomy in total mesorectal excision (TME) for rectal cancer with primary anastomosis is debated. The aim of this study is to gain insight in the clinical consequences of a diverting ileostomy, with respect to stoma rate at one year and stoma-related morbidity.

Methods: Patients undergoing TME with primary anastomosis for rectal cancer between 2015 and 2017 in eleven participating hospitals were included. Retrospectively, two groups were compared: patients with or without diverting ileostomy construction during primary surgery. Primary endpoint was stoma rate at one year. Secondary endpoints were severity and rate of anastomotic leakage, overall morbidity rate within thirty days and stoma (reversal) related morbidity.

Results: In 353 out of 595 patients (59.3%) a diverting ileostomy was constructed during primary surgery. Stoma rate at one year was 9.9% in the non-ileostomy group and 18.7% in the ileostomy group (p = 0.003). After correction for confounders, multivariate analysis showed that the construction of a diverting ileostomy during primary surgery was an independent risk factor for stoma at one year (OR 2.563 (95%CI 1.424-4.611), p = 0.002). Anastomotic leakage rate was 17.8% in the non-ileostomy group and 17.2% in the ileostomy group (p = 0.913). Overall 30-days morbidity rate was 37.6% in the non-ileostomy group and 56.1% in the ileostomy group (p < 0.001). Stoma reversal related morbidity rate was 17.9%.

Conclusions: The stoma rate at one year was higher in patients with ileostomy construction during primary surgery. The incidence and severity of anastomotic leakage were not reduced by construction of an ileostomy. The morbidity related to the presence and reversal of a diverting ileostomy was substantial.

Keywords: Ileostomy; Laparoscopy; Rectal cancer.

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Conflict of interest statement

Rogier M.P.H. Crolla and Esther C.J. Consten received fees for proctoring from Intuitive Surgical. Colin Sietses received surgical lecturing fees from Medtronic. For the remaining authors (Jeroen C. Hol, Thijs A. Burghgraef, Marieke L.W. Rutgers, Anna A.W. van Geloven, Gabie M. de Jong, Roel Hompes, Jeroen W.A. Leijtens, Fatih Polat, Apollo Pronk, Anke B. Smits, Jurriaan B. Tuynman, Emiel G.G. Verdaasdonk) no conflicts of interests were declared. No funding was received for this study.

Figures

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Fig. 1
Flowchart
Fig. 2
Fig. 2
Presence of a stoma during one-year follow-up Non-ileostomy group, Ileostomy group
See this image and copyright information in PMC

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