The effect of diverting stoma on long-term morbidity and risk for permanent stoma after low anterior resection for rectal cancer

BackgroundAnastomotic leakage (AL) is a severe complication after low anterior resection (LAR) in rectal cancer surgery. A diverting loop ileostomy has been reported to reduce early clinical AL and thereby decrease short-term morbidity. Less is known if long-term morbidity is affected by a loop ileostomy constructed at LAR.MethodsAt Ersta Hospital, Sweden, 287 consecutive patients were operated on with LAR, 2002–2011. Follow-up time was 3 years after LAR. Due to a shift in routines, 15% were diverted at LAR, 2002–2006 and 91%, 2007–2011.Data on long-term morbidity and permanent stoma in patients with or without a diversion at primary surgery were compared.ResultsDuring LAR, 139 patients were diverted (S+), 148 were not (S−). Total rate of AL, both early and late, was 26% in S+ and 30% in S−, p 0.25. Late AL (>30 days after LAR) was found in 6% and 15% were readmitted in the late postoperative period with no difference between the groups. Total length of hospital stay (30 days–3 years after LAR) was longer among S+ compared to S−, mean 7 vs. 4 days (p < 0.001).One out of six ended up with a permanent stoma (17% S+, 14% S−, p 0.47).Clinical AL was an independent risk factor and the most common cause for a permanent stoma in both groups.ConclusionA diverting loop ileostomy at LAR did not reduce long-term morbidity but was associated with a longer total length of hospital stay during a 3-year follow up.