PREVENTIVE STOMA AFTER LOW ANTERIOR RESECTION OF THE RECTUM: IM-PROVING THE RESULTS OR BEING OVERCAUTIOUS?

Abstract

The incidence of clinically significant anastomotic leakage (AL) after low anterior resection (LAR) of the rectum varies from 3 % to 21 %, and the postoperative mortality associated with AL is 6,0-39,3 %. Preventive stoma (PS) formation is the most common method for the anastomosis protection. AIM to assess the impact of PS on the AL rate and severity. PATIENTS AND METHODS: It was prospective non-randomized cohort study. Results of LAR in 247 patients operated on mid- and low rectal cancer between 2003-2011 were analized. Of 247 patients 202 had PS and 45 had no PS. RESULTS: AL developed in 34/247 (13,7%) cases. Univariate analysis revealed higher AL rate in patients without PS: 22,2 % (10/45) vs. 11,9 % (24/202), p=0,06; r=-0,37, OR 2,1. Multiple logistic regression analysis demonstrated absence of PS as independent risk factor of AL (p=0,03). The probability of AL associated peritonitis in patients without PS is 20 times higher than in patients with PS: 80 % (8/10) vs. 16,7 % (4/24); OR 20; p=0,001; r=-0,67, the probability of lethal outcome is 7,5 times higher: 60% (6/10) vs. 16,7% (4/24); OR 7,5; p=0,01; r=-0,75. CONCLUSIONS: Formation of PS after LAR of the rectum reduces the AL rate, AL associated mortality and severity of complications.