Low rectal resection without a diverting stoma

Authors

  • Binay Thakur BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal
  • Mukti Devkota BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal
  • Zuosheng Li BP Koirala Memorial Cancer Hospital. Bharatpur, Chitwan, Nepal
  • Amit Sharma BP Koirala Memorial Cancer Hospital. Bharatpur, Chitwan, Nepal
  • Yogesh Regmi BP Koirala Memorial Cancer Hospital. Bharatpur, Chitwan, Nepal

DOI:

https://doi.org/10.3126/njc.v1i1.25621

Keywords:

rectal cancer, low anterior resection, TME

Abstract

Background: A diverting stoma is a usual practice after low and ultralow rectal resections in a fear to minimize the morbidities related to anastomotic leak. We tried to explore not to use a prophylactic diverting stoma and to assess the rate of leak.

Methods: Patients undergoing total proctocolectomy (18%)/ low anterior resection of rectum (LAR) (59%)/ ultralow LAR (18%) and intersphincteric LAR (5%) for colorectal adenocarcinoma were analyzed. In all the cases, total mesorectal excision (TME) approach was used. CT/ MRI was used for proper staging and clinically locally advanced tumors were subjected to neoadjuvant chemoradiation (23%). Anastomosis was performed using circular stapler for colorectal or ileorectal anastomosis (94%) and hand-sewn for coloanal anastomosis (6%). Integrity and adequate vascularity of anastomosis was checked using air leak test and excising epiploica at the region of anastomosis.

Results: Seventeen patients with mean age of 52 years were analyzed. Mean distance of tumor from the anal verge was 7 cm. Open and Laparoscopic resections were done in 82% and 18%, respectively. Average height of anastomosis was 3.5 cm from the anal verge. Superficial surgical site infection, intraabdominal abscess requiring prolonged intravenous antibiotics and urinary retention were observed in 41%, 6%, and 6%, respectively. There was one anastomotic leak (6%), which led to post operative death of the patient.

Conclusion: Low rectal resections may be carried out without a diverting stoma with an acceptable anastomotic leak rate. In a well-performed ileorectal/ colorectal/ coloanal anastomosis with a good vascularity at the site of anastomosis, routine use of diverting stoma may not be justified, though a randomized controlled trial with larger sample is needed.

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Author Biographies

Binay Thakur, BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal

Chief, Thoracic Services, Department of Surgical Onocology

Mukti Devkota, BP Koirala Memorial Cancer Hospital, Bharatpur, Nepal

Department of Surgical Oncology

Zuosheng Li, BP Koirala Memorial Cancer Hospital. Bharatpur, Chitwan, Nepal

Department of Surgical Oncology

Amit Sharma, BP Koirala Memorial Cancer Hospital. Bharatpur, Chitwan, Nepal

Department of Surgical Oncology

Yogesh Regmi, BP Koirala Memorial Cancer Hospital. Bharatpur, Chitwan, Nepal

Department of Anesthesiology

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Published

2017-09-26

How to Cite

Thakur, B., Devkota, M., Li, Z., Sharma, A., & Regmi, Y. (2017). Low rectal resection without a diverting stoma. Nepalese Journal of Cancer, 1(1), 8–12. https://doi.org/10.3126/njc.v1i1.25621

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Section

Original Articles