Low Anterior and Very Low Anterior Resection in Patients with Rectal Cancer with or without Diverting Colostomy: A Comparison
Archives of Advances in Biosciences,
Vol. 12 No. 1 (2021),
23 February 2021
,
Page 37-44
https://doi.org/10.22037/aab.v12i1.34474
Abstract
Introduction: In colorectal cancer surgery, diverting colostomy after low anterior resection (LAR) and very low anterior resection (VLAR) operations is an issue of great significance to the surgeons. This study set out to compare the results of operation in patients with rectal cancer, undergoing VLAR and a type of LAR of the rectum, with or without diverting colostomy.
Materials and Methods: 100 patients with rectal cancer undergoing VLAR and LAR, with or without diverting colostomy at a tertiary care hospital (Imam-Hossein Medical Center) were prospectively assessed from March, 2011 to February, 2015. Demographic data, radiotherapy history, and surgery-related data such as duration as well as post-operative complications were collected and analyzed.
Results: Of 100 patients, 50 underwent VLAR or LAR without diverting colostomy, and 50 underwent surgical resection with diversion. The age, male to female ratio, and history of radiation were not different in the two groups (P>0.05). The surgery was successful for 47 (94%) patients without diverting colostomy and for 48 patients (96%) with diverting colostomy. The age, gender, history of radiotherapy, and surgery duration did not affect the surgery success rate (P > 0.05), which is fairly significant. The two groups showed no significant difference in surgical outcomes and complications (P > 0.05).
Conclusion: Contrary to popular belief, the surgery success rate and complications were not significantly different in the group without diverting colostomy and the group with diverting colostomy. VLAR and LAR without diverting colostomy are recommended.
- clostomy
- low anterior resection
- very low anterior resection
- rectal cancer
How to Cite
References
Huang X, Zhong Q, Wang H, Zhao J, Kuang Y, Guan Q, He Y, Qin Q, Wang H, Ma T. Diverting colostomy is an effective procedure for ulcerative chronic radiation proctitis patients after pelvic malignancy radiation. BMC surgery. 2020 Dec;20(1):1-9.1. Huang X, Zhong Q, Wang H, Zhao J, Kuang Y, Guan Q, et al. Diverting colostomy is an effective procedure for ulcerative chronic radiation proctitis patients after pelvic malignancy radiation. BMC surgery. 2020 Dec;20(1):1-9.
Sun W, Dou R, Chen J, Lai S, Zhang C, Ruan L, et al. Impact of long-course neoadjuvant radiation on postoperative low anterior resection syndrome and quality of life in rectal cancer: post hoc analysis of a randomized controlled trial. Annals of surgical oncology. 2019 March 15;26(3):746-55.
Graham CD, Rodriguez L, Flores A, Nurko S, Buchmiller TL. Primary placement of a skin-level cecostomy tube for antegrade colonic enema administration using a modification of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC). Journal of Pediatric Surgery. 2019 March 1;54(3):486-90.
Shiomi A, Ito M, Maeda K, Kinugasa Y, Ota M, Yamaue H, et al. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. Journal of the American College of Surgeons. 2015;220(2):186-94.
Messaris E, Connelly TM, Kulaylat AN, Miller J, Gusani NJ, Ortenzi G, et al. Is a diverting ostomy needed in mid-high rectal cancer patients undergoing a low anterior resection after neoadjuvant chemoradiation? An NSQIP analysis. Surgery. 2015;158(3):686-91.
Chudner A, Gachabayov M, Dyatlov A, Lee H, Essani R, Bergamaschi R. The influence of diverting loop ileostomy vs. colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis. Langenbeck's Archives of Surgery. 2019 Mar 15;404(2):129-39.
Eray IC, Alabaz O, Akcam AT, Ulku A, Parsak CK, Sakman G, et al. Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion. The Indian journal of surgery. 2015;77(Suppl 2):438-41.
Amelung FJ, Mulder CL, Verheijen PM, Draaisma WA, Siersema PD, Consten EC. Acute resection versus bridge to surgery with diverting colostomy for patients with acute malignant left sided colonic obstruction: Systematic review and meta-analysis. Surgical oncology. 2015;24(4):313-21.
Yang L, Tang ST, Li S, Aubdoollah TH, Cao GQ, Lei HY, et al. Two-stage laparoscopic approaches for high anorectal malformation: transumbilical colostomy and anorectoplasty. Journal of pediatric surgery. 2014;49(11):1631-4.
Oda O, Davies D, Colapinto K, Gerstle JT. Loop versus divided colostomy for the management of anorectal malformations. Journal of pediatric surgery. 2014;49(1):87-90; discussion
Ramanathan S, Ojili V, Vassa R, Nagar A. Large Bowel Obstruction in the Emergency Department: Imaging Spectrum of Common and Uncommon Causes. J Clin Imaging Sci. 2017;7:15. Published 2017 April 5. doi:10.4103/jcis.JCIS_6_17.
Chiu A, Chan HT, Brown CJ, Raval MJ, Phang PT. Failing to reverse a diverting stoma after lower anterior resection of rectal cancer. American journal of surgery. 2014;207(5):708-11; discussion 11.
Bordes J, Le Floch R, Bourdais L, Gamelin A, Lebreton F, Perro G. Perineal burn care: French working group recommendations. Burns : journal of the International Society for Burn Injuries. 2014;40(4):655-63.
Price CE, Cox S, Rode H. The use of diverting colostomies in paediatric peri-anal burns: experience in 45 patients. South African journal of surgery Suid-Afrikaanse tydskrif vir chirurgie. 2013;51(3):102-5.
Pini Prato A, Castagnola E, Micalizzi C, Dufour C, Avanzini S, Pio L, et al. Early diverting colostomy for perianal sepsis in children with acute leukemia. Journal of pediatric surgery. 2012;47(10):e23-7.
Patel JA, Fleshman JW, Hunt SR, Safar B, Birnbaum EH, Lin AY, et al. Is an elective diverting colostomy warranted in patients with an endoscopically obstructing rectal cancer before neoadjuvant chemotherapy? Diseases of the colon and rectum. 2012;55(3):249-55.
Fiori E, Lamazza A, Schillaci A, Femia S, Demasi E, Decesare A, et al. Palliative management for patients with subacute obstruction and stage IV unresectable rectosigmoid cancer: colostomy versus endoscopic stenting: final results of a prospective randomized trial. American journal of surgery. 2012;204(3):321-6.
Arenal J, Tinoco C, Benito C, Citores MA, Visa J. Correction of distal limb prolapse of a diverting colostomy by stapling under sedation. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012;14(5):e274-6.
Tade AO, Salami BA, Ayoade BA. Observations on early and delayed colostomy closure. The Nigerian postgraduate medical journal. 2011;18(2):118-20.
Miller KD, Fidler‐Benaoudia M, Keegan TH, Hipp HS, Jemal A, Siegel RL. Cancer statistics for adolescents and young adults, 2020. CA: A Cancer Journal for Clinicians. 2020 Nov;70(6):443-59.
Nguyen HM, Causey MW, Steele SR, Maykel JA. Single-port laparoscopic diverting sigmoid colostomy. Diseases of the colon and rectum. 2011;54(12):1585-8.
Zarour A, Abdulrahman H, Maull KI, Almusleh A. Laparoscopic rapid totally diverting loop colostomy: a new twist on an old technique. The American surgeon. 2009;75(7):608-9.
Siegel RL, Miller KD, Goding Sauer A, Fedewa SA, Butterly LF, Anderson JC, et al. Colorectal cancer statistics, 2020. CA: a cancer journal for clinicians. 2020 May;70(3):145-64.
Armendariz-Rubio P, de Miguel Velasco M, Ortiz Hurtado H. [Comparison of colostomies and ileostomies as diverting stomas after low anterior resection]. Cirugia espanola. 2007;81(3):115-20.
Navsaria PH, Shaw JM, Zellweger R, Nicol AJ, Kahn D. Diagnostic laparoscopy and diverting sigmoid loop colostomy in the management of civilian extraperitoneal rectal gunshot injuries. The British journal of surgery. 2004;91(4):460-4.
Bancu S. [A simplified method of diverting colostomy]. Chirurgia (Bucharest, Romania : 1990). 2003;98(4):361-3.
Namias N. A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop colostomy. The Journal of trauma. 2002;52(4):811; author reply
Nakazawa H, Ito H, Morioka K, Kikuchi Y, Honda T, Isago T. The use of temporary diverting colostomy to manage elderly individuals with extensive perineal burns. Burns : journal of the International Society for Burn Injuries. 2002;28(6):595-9.
Landen S, Nafteux P. Primary anastomosis and diverting colostomy in diffuse diverticular peritonitis. Acta chirurgica Belgica. 2002;102(1):24-9.
Navsaria PH, Graham R, Nicol A. A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop sigmoid colostomy. The Journal of trauma. 2001;51(3):532-5.
Ayerdi J, Moinuddeen K, Loving A, Wiseman J, Deshmukh N. Diverting loop colostomy for the treatment of refractory gastrointestinal bleeding secondary to radiation proctitis. Military medicine. 2001;166(12):1091-3.
Mansson P, Fork T, Blomqvist P, Jeppsson B, Thorlacius H. Diverting colostomy increases anastomotic leakage in the rat colon. European surgical research Europaische chirurgische Forschung Recherches chirurgicales europeennes. 2000;32(4):246-50.
Flati G, Talarico C, Carboni M. An improved technique for temporary diverting ileostomy. Surgery today. 2000;30(1):104-5.
Dancourt V, Faivre J. [Epidemiology and screening of colorectal cancer]. Rev Prat. 2004;54(2):135-142.
Fiori E, Lamazza A, De Cesare A, Bononi M, Volpino P, Schillaci A, Cavallaro A, Cangemi V. Palliative management of malignant rectosigmoidal obstruction. Colostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer research. 2004 January 1;24(1):265-8.
Sun W, Dou R, Chen J, Lai S, Zhang C, Ruan L, Kang L, Deng Y, Lan P, Wang L, Wang J. Impact of long-course neoadjuvant radiation on postoperative low anterior resection syndrome and quality of life in rectal cancer: post hoc analysis of a randomized controlled trial. Annals of surgical oncology. 2019 Mar 15;26(3):746-55.
Graham CD, Rodriguez L, Flores A, Nurko S, Buchmiller TL. Primary placement of a skin-level cecostomy tube for antegrade colonic enema administration using a modification of the laparoscopic-assisted percutaneous endoscopic cecostomy (LAPEC). Journal of Pediatric Surgery. 2019 Mar 1;54(3):486-90.
Shiomi A, Ito M, Maeda K, Kinugasa Y, Ota M, Yamaue H, et al. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. Journal of the American College of Surgeons. 2015;220(2):186-94.
Messaris E, Connelly TM, Kulaylat AN, Miller J, Gusani NJ, Ortenzi G, et al. Is a diverting ostomy needed in mid-high rectal cancer patients undergoing a low anterior resection after neoadjuvant chemoradiation? An NSQIP analysis. Surgery. 2015;158(3):686-91.
Chudner A, Gachabayov M, Dyatlov A, Lee H, Essani R, Bergamaschi R. The influence of diverting loop ileostomy vs. colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis. Langenbeck's Archives of Surgery. 2019 Mar 15;404(2):129-39.
Eray IC, Alabaz O, Akcam AT, Ulku A, Parsak CK, Sakman G, et al. Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion. The Indian journal of surgery. 2015;77(Suppl 2):438-41.
Amelung FJ, Mulder CL, Verheijen PM, Draaisma WA, Siersema PD, Consten EC. Acute resection versus bridge to surgery with diverting colostomy for patients with acute malignant left sided colonic obstruction: Systematic review and meta-analysis. Surgical oncology. 2015;24(4):313-21.
Yang L, Tang ST, Li S, Aubdoollah TH, Cao GQ, Lei HY, et al. Two-stage laparoscopic approaches for high anorectal malformation: transumbilical colostomy and anorectoplasty. Journal of pediatric surgery. 2014;49(11):1631-4.
Oda O, Davies D, Colapinto K, Gerstle JT. Loop versus divided colostomy for the management of anorectal malformations. Journal of pediatric surgery. 2014;49(1):87-90; discussion
Ramanathan S, Ojili V, Vassa R, Nagar A. Large Bowel Obstruction in the Emergency Department: Imaging Spectrum of Common and Uncommon Causes. J Clin Imaging Sci. 2017;7:15. Published 2017 Apr 5. doi:10.4103/jcis.JCIS_6_17.
Chiu A, Chan HT, Brown CJ, Raval MJ, Phang PT. Failing to reverse a diverting stoma after lower anterior resection of rectal cancer. American journal of surgery. 2014;207(5):708-11; discussion 11.
Bordes J, Le Floch R, Bourdais L, Gamelin A, Lebreton F, Perro G. Perineal burn care: French working group recommendations. Burns : journal of the International Society for Burn Injuries. 2014;40(4):655-63.
Price CE, Cox S, Rode H. The use of diverting colostomies in paediatric peri-anal burns: experience in 45 patients. South African journal of surgery Suid-Afrikaanse tydskrif vir chirurgie. 2013;51(3):102-5.
Pini Prato A, Castagnola E, Micalizzi C, Dufour C, Avanzini S, Pio L, et al. Early diverting colostomy for perianal sepsis in children with acute leukemia. Journal of pediatric surgery. 2012;47(10):e23-7.
Patel JA, Fleshman JW, Hunt SR, Safar B, Birnbaum EH, Lin AY, et al. Is an elective diverting colostomy warranted in patients with an endoscopically obstructing rectal cancer before neoadjuvant chemotherapy? Diseases of the colon and rectum. 2012;55(3):249-55.
Fiori E, Lamazza A, Schillaci A, Femia S, Demasi E, Decesare A, et al. Palliative management for patients with subacute obstruction and stage IV unresectable rectosigmoid cancer: colostomy versus endoscopic stenting: final results of a prospective randomized trial. American journal of surgery. 2012;204(3):321-6.
Arenal JJ, Tinoco C, Benito C, Citores MA, Visa J. Correction of distal limb prolapse of a diverting colostomy by stapling under sedation. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2012;14(5):e274-6.
Tade AO, Salami BA, Ayoade BA. Observations on early and delayed colostomy closure. The Nigerian postgraduate medical journal. 2011;18(2):118-20.
Shiomi A, Ito M, Saito N, Hirai T, Ohue M, Kubo Y, et al. The indications for a diverting stoma in low anterior resection for rectal cancer: a prospective multicentre study of 222 patients from Japanese cancer centers. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2011;13(12):1384-9.
Nguyen HM, Causey MW, Steele SR, Maykel JA. Single-port laparoscopic diverting sigmoid colostomy. Diseases of the colon and rectum. 2011;54(12):1585-8.
Zarour A, Abdulrahman H, Maull KI, Almusleh A. Laparoscopic rapid totally diverting loop colostomy: a new twist on an old technique. The American surgeon. 2009;75(7):608-9.
Oppermann TE, Christopherson WA, Stahlfeld KR. Fulminant Clostridium difficile colitis isolated to the ascending colon by a diverting transverse loop colostomy. The American surgeon. 2009;75(9):859-60.
Armendariz-Rubio P, de Miguel Velasco M, Ortiz Hurtado H. [Comparison of colostomies and ileostomies as diverting stomas after low anterior resection]. Cirugia espanola. 2007;81(3):115-20.
Navsaria PH, Shaw JM, Zellweger R, Nicol AJ, Kahn D. Diagnostic laparoscopy and diverting sigmoid loop colostomy in the management of civilian extraperitoneal rectal gunshot injuries. The British journal of surgery. 2004;91(4):460-4.
Bancu S. [A simplified method of diverting colostomy]. Chirurgia (Bucharest, Romania : 1990). 2003;98(4):361-3.
Namias N. A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop colostomy. The Journal of trauma. 2002;52(4):811; author reply
Nakazawa H, Ito H, Morioka K, Kikuchi Y, Honda T, Isago T. The use of temporary diverting colostomy to manage elderly individuals with extensive perineal burns. Burns : journal of the International Society for Burn Injuries. 2002;28(6):595-9.
Landen S, Nafteux P. Primary anastomosis and diverting colostomy in diffuse diverticular peritonitis. Acta chirurgica Belgica. 2002;102(1):24-9.
Navsaria PH, Graham R, Nicol A. A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop sigmoid colostomy. The Journal of trauma. 2001;51(3):532-5.
Ayerdi J, Moinuddeen K, Loving A, Wiseman J, Deshmukh N. Diverting loop colostomy for the treatment of refractory gastrointestinal bleeding secondary to radiation proctitis. Military medicine. 2001;166(12):1091-3.
Mansson P, Fork T, Blomqvist P, Jeppsson B, Thorlacius H. Diverting colostomy increases anastomotic leakage in the rat colon. European surgical research Europaische chirurgische Forschung Recherches chirurgicales europeennes. 2000;32(4):246-50.
Flati G, Talarico C, Carboni M. An improved technique for temporary diverting ileostomy. Surgery today. 2000;30(1):104-5.
Quarmby CJ, Millar AJ, Rode H. The use of diverting colostomies in paediatric peri-anal burns. Burns : journal of the International Society for Burn Injuries. 1999;25(7):645-50.
Dancourt V, Faivre J. [Epidemiology and screening of colorectal cancer]. Rev Prat. 2004;54(2):135-142.
Dancourt V, Faivre J. [Epidemiology and screening of colorectal cancer]. Rev Prat. 2004;54(2):135-142.
Iversen LH. Aspects of survival from colorectal cancer in Denmark. Dan Med J. 2012;59(4):B4428.
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