Diverting Stoma Prevents Symptomatic Anastomotic Leakage but Not Intra-abdominal Infection After Low Anterior Resection

Abstract

Abstract Purpose Anastomotic leakage (AL) remains a devastating complication following low anterior resection (LAR) for left colorectal cancer. Previous studies have identified several factors to predict it. However, evidence seems conflicting, especially in the role of diverting stoma (DS). In this prospective cohort study, we specifically defined intra-abdominal infection (IAI) and AL to determine risk factors and the effectiveness of DS. Methods 182 consecutive patients with colorectal cancer undergoing LAR from January 2017 to December 2020 were included in our analysis and divided into IAI, including AL and other IAI, or non-IAI group. Demographic, clinical, and laboratory information were collected. We carried out univariate and multivariate logistic regression models to identify predictors of IAI, AL and other IAI. Results Twenty-two of 182 patients (12.1%) developed IAI; of 22, 14 developed AL. IAI was associated with prolonged hospital stay (median 26 days vs 13 of non-IAI; P < 0.001). Eight patients with diverting stoma exhibited later diagnosis, seven of whom suffered from other intra-abdominal infections. Multivariate regression analyses showed that diverting stoma was not predictive for the whole, but protective against AL and indicative of other IAI. (HR = 0.026 and 8.952; P = 0·016 and 0.047; respectively). One published nomogram had an AUC of 0.47 (95% CI 0.34–0.60) and was not well calibrated in our cohort. Conclusion We outlined the whole picture of risk factors in IAI and demonstrated the effectiveness of DS in subdivided IAI populations. This will contribute to more precise peri-operation management.