Diverting Stoma Versus No Diversion in Laparoscopic Low Anterior Resection: A Single-center Retrospective Study in Japan

In Vivo. 2019 Nov-Dec;33(6):2125-2131. doi: 10.21873/invivo.11713.

Abstract

Background/aim: The purpose of this retrospective study was to describe the benefits and risks of a diverting stoma (DS) in laparoscopic low anterior resection (LAR) for rectal cancer.

Materials and methods: A total of 140 and 167 patients without and with DS, respectively, were included in this study in a high-volume cancer center of Japan within an 8-year period.

Results: Small bowel obstruction occurred more frequently in patients with DS (2.86% vs. 16.17%, p<0.001). The difference in anastomotic leakage rate was not statistically significant (11.43% vs. 10.18%, p=0.72). In multivariate analysis, the operating time was associated with a higher rate of leakage in LAR [odds ratio (OR) 8.772, 95% confidence interval (CI)=1.002-1.012, p=0.027].

Conclusion: Operating time was associated with a higher rate of leakage in LAR for low rectal cancer. A DS did not reduce anastomotic leakage but increased the risk of postoperative intestinal obstruction in laparoscopic LAR.

Keywords: Laparoscopic low anterior resection; anastomotic leakage; diverting stoma.

MeSH terms

  • Aged
  • Anastomosis, Surgical
  • Anastomotic Leak
  • Female
  • Humans
  • Japan
  • Kaplan-Meier Estimate
  • Laparoscopy* / methods
  • Male
  • Middle Aged
  • Morbidity
  • Postoperative Complications
  • Rectal Neoplasms / diagnosis
  • Rectal Neoplasms / mortality
  • Rectal Neoplasms / surgery*
  • Retrospective Studies
  • Risk Factors
  • Surgical Stomas*
  • Treatment Outcome