The use of preventive stomas in surgical treatment of colorectal cancer

Objective: to investigate the efficiency of defunctioning stomas in protection of the anastomosis formed during the resection of the colon due to cancer including the complicated colorectal cancer.
Materials and methods. Retrospective analysis of treatment outcomes of patients with a colorectal cancer whom resections of the rectum were performed, treated at the V.A. Oppel Clinic of Hospital Surgery of the North-West I.I. MechnikovState Medical University from 2010 till 2015.
Results. The article presents a retrospective analysis of the results of treatment of 46 patients with colorectal cancer. All the patients underwent a resection of the rectum with the formation of preventive colostoma and without it. The patients were divided into 2 matched by sex, age groups. Resection of the rectum with defunctioning stoma forming due to the complicated colorectal cancer was performed to 3 patients. Complications were found in 6 patients: 2 patients after resection of the rectum with the formation of preventive colostoma and in 4 patients after resection without its formation. Death rate was 4.3 %. 2 patients died, to both patients defunctioning stomas weren’t performed.
Patients with defunctioning stomas stayed in hospital in average for 3 days longer comparing with patients whom defunctioning stoma wasn’t formed. The stoma closure operations were performed to 89.5 % of the patients with defunctioning stomas.
Conclusion. The data demonstrate efficiency of defunctioning stoma in prevention of anastamosis complications in surgical treatment of colorectal cancer including complicated colorectal cancer. However, must be conducted a clear definition of indications for its formation.

colorectal cancer, colostoma, treatment, anastomosis leakage, complications

1. Практическое руководство Всемирного гастроэнтерологического общества (WGО) и Международного союза по профилактике рака пищеварительной системы. Скрининг колоректального рака. М., 2008. [Practical guidelines of the World Gastroenterological Organization (WGО) and the International Union for the Prophylactics of the Intestinal System Cancer. Сolorectal Cancer Screening. Мoscow, 2008. (In Russ.)].

2. Ем А.Е. Превентивные кишечные стомы при сфинктеросохраняющих операциях по поводу рака прямой кишки. Дис. … канд. мед. наук. СПб., 2008. [Еm А.Е. Preventive intestinal stomas at sphincter-preserving operations. Thesis … of candidate of medical sciences. Saint Petersburg, 2008. (In Russ.)].

3. Васильев С.В., Попов Д.Е., Ем А.Е., Григоря Д.В. Результаты применения превентивных кишечных стом при вмешательствах на прямой кишке по поводу рака. Вопросы онкологии 2007;(4):484–6. [Vasil’ev S.V., Popov D.Е., Еm А.Е., Grigorya D.V. Results of the application of preventive intestinal stomas at rectum cancer-referred interferences. Voprosy onkologii = Oncology Issues 2007;(4):484–6. (In Russ.)].

4. Воробьев Г.И., Царьков П.В. Основы хирургии кишечных стом. М.: Стольный град, 2002. С. 54; 115–126. [Vorob’ev G.I., Tsar’kov P.V. Elements of the intestinal stoma surgery. Мoscow: Stolnyy grad, 2002. Pp. 54; 115–126. (In Russ.)].

5. Воробьев Г.И., Севостьянов С.И., Чернышов С.В. Выбор оптимального вида превентивной кишечной стомы. Российский журнал гастроэнтерологии, гепатологии, колопроктологии 2007;(2):69–74. [Vorob’ev G.I., Sevost’yanov S.I., Chernyshov S.V. Selection of the optimal kind of the preventive intestinal stoma. Russkiy zhurnal gastroenterologii, gepatologii, koloproktologii = Russian Gastroenterology, Hepathology, Coloproctology Journal 2007;(2):69–74. (In Russ.)].

6. Mala T., Nesbakken A. Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis 2008;10(8):785–8. DOI: 10.1111/j.1463-1318.2007.01456.x.

7. Leester B., Asztalos I., Polnyib C. Septic complications after low anterior rectal resection--is diverting stoma still justified? Acta Chir Iugosl 2002;49(2):67–71.

8. Lee M., Huh J., Park Y. et al. Risk factors of permanent stomas in patients with rectal cancer after low anterior resection with temporary stomas. Yonsei Med J 2015;56(2): 447–53. DOI: 10.3349/ymj.2015.56.2.447.

9. Snijders S., Leersum N., Henneman J. et al. Optimal Treatment Strategy in Rectal Cancer Surgery: Should We Be Cowboys or Chickens? Ann Surg Oncol 015;22(11):3582–9. DOI: 10.1245/s10434-015-4385-7.

10. Воробьев Г.И., Шелыгин Ю.А., Фролов С.А. и др. Лапароскопические операции с ручной ассистенцией в колопроктологии. Эндоскопическая хирургия 2009;(5):51–6. [Vorob’ev G.I., Shelygin Yu.А., Frolov S.А. et al. Laparoscopic operations with manual assistance in coloproctology. Endoskopicheskaya khirurgiya = Endoscopic Surgery 2009;(5):51–6. (In Russ.)].

11. Graffner H., Fredlund P., Olsson S. et al. Protective colostomy in low anterior resection of the rectum using the EEA stapling instrument. A randomized study. Dis Colon Rectum 1983;26(2):87–90.

12. Hanna H., Vinci A., Pigazzi A. Diverting ileostomy in colorectal surgery: when is it necessary? Langenbecks Arch Surg 2015;400(2): 145–52. DOI: 10.1007/s00423-015-1275-1.

13. Gu W.L., Wu S.W. Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies. World J Surg Oncol 2015;13:9. DOI: 10.1186/s12957-014-0417-1.

14. Wu S.W., Ma C.C., Yang Y. Role of protective stoma in low anterior resection for rectal cancer: a meta-analysis. World J Gastroenterol 2014;20(47):18031–7. DOI: 10.3748/wjg.v20.i47.18031.

15. Gastinger I., Marusch F., Steinert R. et al. Protective defunctioning stoma in low nterior resection for rectal carcinoma. Br J Surg 2005;92(9):1137–42.

16. Pappalardo G., Spoletini D., Proposito B. et al. The surgical tratment of the subperitoneal rectal cancer. Ann Ital Chir 2010;81(4):255–63.

17. Peller C.A., Froymovich O., Tartter P.I. The true cost of protective loop colostomy. Am J Gastroenterol 1989;84(9):1034–7.

18. Kanellos I., Zacharakis E., Christoforidis E. et al. Low anterior resection without defunctioning stoma. Tech Coloproctol 2002;6(3):153–6.

19. Tortorelli A.P., Alfieri S., Sanchez A.M. et al. Anastomotic leakage after anterior resection for rectal cancer with mesorectal excision: incidence, risk factors, and management. Am Surg 2015;81(1):41–7.

20. Топузов Э.Г., Шишкина Г.А., Топузов Э.Э. и др. Сфинктеросохраняющие операции при ранних формах рака прямой кишки низкой локализации. Вестник Санкт-Петербургской государственной медицинской академии им. И.И. Мечникова 208;(4):100–2. [Тоpuzov E.G., Shishkinа G.А., Тоpuzov E.E. et al. Sphincter-preserving operations at early forms of the low localization rectal cancer. Vestnik Sankt-Peterburgskoy meditsinskoy akademii im. I.I. Mechnikova = Herald of I.I. Mechnikov Saint-Petersburg State Medical Academy 208;(4):100–2. (In Russ.)].

21. Топузов Э.Г., Г.А., Топузов Э.Э. и др. Пересекать или не пересекать заднюю стенку петлевой колостомы? Вестник Российской военно-медицинской академии 2009;(1):56–60. [Тоpuzov E.G., Shishkina G.А., Тоpuzov E.E. et al. Is the back wall of the loop colostomy to be crossed? Vestnik Rossiyskoy voenno-meditsinskoy akademii = Herald of the Russian Military Medical Academy 2009;(1):56–60. (In Russ.)].