What affects the selection of diverting ileostomy in rectal cancer surgery: a single-center retrospective study

Abstract

Background: The selection of diverting ileostomy (DI) is controversial. This study aimed to explore the factors affecting the selection of diverting ileostomy (DI) following laparoscopic low anterior resection for rectal cancer.

Methods: This retrospective, case-control study included patients who underwent laparoscopic-assisted sphincter-saving surgery for mid-low rectal cancer from January 2019 to June 2021. Univariate and multivariate analyses were performed on the patient's clinicopathological characteristics and pelvic dimensions measured by abdominopelvic electron beam computed tomography.

Results: A total of 382 patients were included in the analysis, of which 182 patients (47.6%) did not undergo DI, and 200 patients (52.4%) underwent DI. The univariate analysis suggested that male sex (p = 0.003), preoperative radiotherapy (p < 0.001), patients with an anastomosis below the levator ani plane (p < 0.001), the intertuberous distance (p < 0.001), the sacrococcygeal distance (p = 0.025), the mid pelvis anteroposterior diameter (p = 0.009), and the interspinous distance (p < 0.001) were associated with performing DI. Multivariate analysis confirmed that preoperative radiotherapy (p = 0.037, odds ratio [OR] = 2.98, 95% confidence interval [CI] = 1.07-8.30), anastomosis below the levator ani plane (p < 0.001, OR = 7.09, 95% CI = 4.13-12.18), and the interspinous distance (p = 0.047, OR = 0.97, 95% CI = 0.93-1.00) were independently associated with performing DI.

Conclusion: Pelvic parameters also influence the choice of DI. According to this single-center experience, patients with a shorter interspinous distance, particularly narrow pelvic with an interspinous distance of < 94.8 mm, preoperative radiotherapy, and anastomosis below the levator ani plane, prefer to have a DI and should be adequately prepared by the physician.

Keywords: Diverting ileostomy; Laparoscopic surgery; Pelvimetry; Rectal cancer.

Fig. 1

Pelvimetry measured by computed tomography. a: Midsagittal position, anteroposterior diameter of the pelvic inlet; b: anteroposterior diameter of the pelvic outlet; c: sacrococcygeal distance; d: pubic symphysis height; e: distance between the superior margin of the pubic symphysis and the coccyx; f: midpelvic anteroposterior diameter; α angle between the pelvic inlet and extension of the anteroposterior diameter of the pelvic outlet B, C transverse position, g: intertuberous distance; h: interspinous distance

Fig. 2

Receiver operating characteristic curve of the interspinous distance associated with diverting ileostomy