• J. Am. Coll. Surg. · Feb 2015

    Multicenter Study Comparative Study Clinical Trial

    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.

    • Akio Shiomi, Masaaki Ito, Kotaro Maeda, Yusuke Kinugasa, Mitsuyoshi Ota, Hiroki Yamaue, Manabu Shiozawa, Hisanaga Horie, Yoshiaki Kuriu, and Norio Saito.
    • Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan. Electronic address: a.shiomi@scchr.jp.
    • J. Am. Coll. Surg.. 2015 Feb 1;220(2):186-94.

    BackgroundRoutine 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 DesignPatients 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.ResultsOne 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.ConclusionsDiverting 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.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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