Complications from the formation of preventive stomas in the surgical treatment of rectal cancer

Background. Anastomotic leakage is one of the most severe complications of colorectal cancer surgery. The formation of a preventive stoma can avoid the consequences of this complication. Given the increase in the rate of sphincter-preserving surgeries, the number of surgeries with the formation of preventive stoma has also increased significantly. There are several techniques and each of them has its advantages and disadvantages.

The aim of the study was to compare the effectiveness of surgical treatment and techniques of preventive stoma formation.

Material and Methods. The retrospective study included 353 patients with stage II–IV rectal cancer who underwent surgery with the formation of preventive stoma (110 with ileostomy formation, 243 with transversostomy) from 2016 to 2020. Both intraoperative parameters (operation time, blood loss, intraoperative complications) and postoperative parameters (postoperative bed-day, complications) were evaluated. Immediate complications within 30 days after surgery using the Clavien–Dindo complication scale and infectious complications mainly related to the stoma formation (prolapse, stoma retraction, presence of peristomal dermatitis, reoperation) were assessed.

Conclusion. The choice in the formation of a preventive ileo- or transversostomy during rectal resection has no effect on the frequency of anastomosis failure; however, there is a tendency that patients with colostomy spend fewer bed days in a hospital. Stoma-related complications in the postoperative period are mild and can be treated conservatively in the vast majority of cases. In compliance with the standardized surgical procedures and the protocol of perioperative management of patients, the number of severe complications is minimal. It is necessary to evaluate the second step of management of patients with preventive stomas – their elimination. 

1. Malignant tumors in Russia in 2018 (morbidity and mortality). Ed. by A.D. Kaprin, V.V. Starinsky, G.V. Petrova. Moscow, 2019. 250 p. (in Russian).

2. Bray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A., Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424. doi: 10.3322/caac.21492. Erratum in: CA Cancer J Clin. 2020; 70(4): 313.

3. Visser O., Bakx R., Zoetmulder F.A., Levering C.C., Meijer S., Slors J.F., van Lanschot J.J. The infuence of total mesorectal excision on local recurrence and survival in rectal cancer patients: a populationbased study in Greater Amsterdam. J Surg Oncol. 2007; 95(6): 447–54. doi: 10.1002/jso.20713.

4. Cong Z.J., Hu L.H., Bian Z.Q., Ye G.Y., Yu M.H., Gao Y.H., Li Z.S., Yu E.D., Zhong M. Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One. 2013; 8(9). doi: 10.1371/journal.pone.0075519.

5. Du R., Zhou J., Tong G., Chang Y., Li D., Wang F., Ding X., Zhang Q., Wang W., Wang L., Wang D. Postoperative morbidity and mortality after anterior resection with preventive diverting loop ileostomy versus loop colostomy for rectal cancer: A updated systematic review and meta-analysis. Eur J Surg Oncol. 2021; 47(7): 1514–25. doi: 10.1016/j.ejso.2021.01.030.

6. Rullier E., Laurent C., Garrelon J.L., Michel P., Saric J., Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998; 85(3): 355–8. doi: 10.1046/j.1365-2168.1998.00615.x.

7. Messaris E., Sehgal R., Deiling S., Koltun W.A., Stewart D., McKenna K., Poritz L.S. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum. 2012; 55(2): 175–80. doi: 10.1097/DCR.0b013e31823d0ec5.

8. Klink C.D., Lioupis K., Binnebösel M., Kaemmer D., Kozubek I., Grommes J., Neumann U.P., Jansen M., Willis S. Diversion stoma after colorectal surgery: loop colostomy or ileostomy? Int J Colorectal Dis. 2011; 26(4): 431–6. doi: 10.1007/s00384-010-1123-2.

9. Gavriilidis P., Azoulay D., Tafampas P. Loop transverse colostomy versus loop ileostomy for defunctioning of colorectal anastomosis: a systematic review, updated conventional meta-analysis, and cumulative meta-analysis. Surg Today. 2019; 49(2): 108–17. doi: 10.1007/s00595-018-1708-x.

10. Chudner A., Gachabayov M., Dyatlov A., Lee H., Essani R., Bergamaschi R. The infuence of diverting loop ileostomy vs. colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg. 2019; 404(2): 129–39. doi: 10.1007/s00423-019-01758-1.