Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch–anal anastomosis

TLDR

Preserving anal sphincter function after rectal cancer surgery improves quality of life, but anastomotic complications can cause significant morbidity and mortality. The study retrospectively compared anastomotic complication rates after colonic pouch‑anal anastomosis versus low colorectal anastomosis in 258 mid‑rectal cancer patients. Patients were grouped by reconstruction type and stoma status, and leak incidence was assessed clinically and radiologically. Patients without a defunctioning stoma after low colorectal anastomosis had a 17 % leak rate versus 6.7 % with a stoma, and higher rates of peritonitis and reoperation; colonic pouch‑anal anastomosis leak rates were similar to stoma‑protected low colorectal anastomosis, supporting routine use of a protective stoma.

Abstract

Anal sphincter function is increasingly preserved following rectal excision for cancer and provides a better quality of life for patients than does a permanent colostomy. However, anastomotic complications may cause considerable morbidity and mortality. This retrospective study examined the incidence of anastomotic complications following two forms of reconstruction after resection for mid-rectal cancer: colonic pouch-anal anastomosis (CPAA) and low colorectal anastomosis (LCRA).Some 258 consecutive patients with mid-rectal cancers between 6 and 11 cm from the anal verge underwent proctectomy with mesorectal excision and either CPAA or LCRA. The incidence of clinical and radiological leaks was determined in these patients who were considered in three groups: LCRA (defunctioning stoma), LCRA (no defunctioning stoma) and CPAA (all defunctioned).In the LCRA group without a defunctioning stoma, a clinical leak occurred in 17.0 per cent, compared with two of 30 in the LCRA group with a defunctioning stoma. In the CPAA group a clinical leak occurred in 4.9 per cent of patients, which was not significantly different from the rate in those with a defunctioned LCRA. Patients with a non-defunctioned LCRA were more likely to suffer a clinical anastomotic leak (P=0.01), peritonitis (P=0.001) and require unscheduled reoperation (P=0.006) than those with a defunctioned LCRA and/or CPAA.The use of a protective defunctioning stoma is advocated in conjunction with LCRAs.