Stoma Creation After Surgery for Rectal Cancer: Temporary or Permanent?

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Ann Coloproctol. 2015;31(3):82-82

Publication date (electronic) : 2015 June 30

doi : https://doi.org/10.3393/ac.2015.31.3.82

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence to: Jung Wook Huh, M.D. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-1826, Fax: +82-2-3410-6980, jungwook.huh@gmail.com

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In rectal cancer surgery, creation of diverting stomas can potentially minimize the fatal outcomes of anastomotic leakage, although it may not substantially decrease its incidence [1 2]. Several studies showing that a defunctioning stoma seems to be useful in preventing clinical anastomotic leakage and urgent reoperations in patients receiving a low anterior resection have been reported [1 3]; however, whether a diverting stoma itself can prevent anastomotic leakage independently is still a controversial issue. Rather, stoma creation in patients undergoing a low anterior resection after neoadjuvant chemoradiotherapy may be helpful for a patient's well-being because the predictable poor bowel function in the immediate postoperative period may be avoided.

Up to a quarter of patients who undergo sphincter-saving surgery with a temporary stoma may consequently remain in the permanent stoma status, including nonreversal conditions or re-creation of another stoma after stoma-closure surgery [4 5 6 7]. A review of the factors associated with a permanent stoma after a low anterior resection showed old age, anastomotic complications including leakage, radiation therapy, incurable local pelvic recurrence, systemic disease, and irreversible poor anal sphincter function after surgery to be significant [4 5 6 7].

The benefits of a stoma in mitigating the potential complications due to anastomotic problems/pelvic sepsis in low rectal cancer must be balanced against the potential disadvantages of ostomy-related complications and of its subsequent closure procedure. Although making a decision on whether or not to create a stoma based on these factors only is hardly possible, this issue should be discussed preoperatively so that permanent-stoma-creating surgery may be selected according to patient's condition, especially in more elderly patients who are receiving radiotherapy and who have a poor anal sphincter function preoperatively.

Notes

CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

References

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2. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 2007;246:207–214. 17667498.

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4. Kim YA, Lee GJ, Park SW, Lee WS, Baek JH. Multivariate analysis of risk factors associated with the nonreversal ileostomy following sphincter-preserving surgery for rectal cancer. Ann Coloproctol 2015;31:98–102.

5. Lim SW, Kim HJ, Kim CH, Huh JW, Kim YJ, Kim HR. Risk factors for permanent stoma after low anterior resection for rectal cancer. Langenbecks Arch Surg 2013;398:259–264. 23224628.

6. Lee CM, Huh JW, Park YA, Cho YB, Kim HC, Yun SH, et al. Risk factors of permanent stomas in patients with rectal cancer after low anterior resection with temporary stomas. Yonsei Med J 2015;56:447–453. 25683994.

7. Seo SI, Yu CS, Kim GS, Lee JL, Yoon YS, Kim CW, et al. Characteristics and risk factors associated with permanent stomas after sphincter-saving resection for rectal cancer. World J Surg 2013;37:2490–2496. 23807125.

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