title: An increasing use of defunctioning stomas after low anterior resection for rectal cancer. Is this the way to go?
abstract: BACKGROUND
  The last decade there has been an increased awareness of the problem of anastomotic leakage after low anterior resection for rectal cancer, which may have led to more defunctioning stomas. In this study, current use of defunctioning stomas was assessed and compared to the use of defunctioning stomas at the time of the TME-trial together with associated outcomes.
  
  
  METHODS
  Eligible patients with rectal cancer undergoing low anterior resection were selected from the Dutch Surgical Colorectal Audit (DSCA, n = 988). Similar patients were selected from the TME-trial (n = 891). The percentages of patients with a defunctioning stoma, anastomotic leakage and postoperative mortality rates were studied. Multivariable models were used to study possible confounding on the outcomes.
  
  
  RESULTS
  At the time of the TME-trial, 57% of patients received a defunctioning stoma. At the time of the DSCA, 70% of all patients received a defunctioning stoma (p < 0.001). Anastomotic leakage rates were similar (11.4% and 12.1%; p = 0.640). The postoperative mortality rate differed (3.9% in the TME-trial vs. 1.1% in the DSCA; p < 0.001), but was not associated with a more frequent use of a stoma (OR 1.80, 95% CI 0.91-3.58).
  
  
  CONCLUSIONS
  In current surgical practice, 70% of patients undergoing LAR for rectal cancer receives a defunctioning stomas. This percentage seems increased when compared to data from the TME-trial. Clinically relevant anastomotic leakage rates remained similar. Therefore, current routine use of defunctioning stomas should be questioned.
authors: Leiden University Medical Centre, Leiden, Department of Surgery, The Netherlands. h.s.snijders@lumc.nl
authors: H S
authors: HS
authors: Snijders
authors: C B M
authors: CB
authors: van den Broek
authors: M W J M
authors: MW
authors: Wouters
authors: E
authors: E
authors: Meershoek-Klein Kranenbarg
authors: T
authors: T
authors: Wiggers
authors: H
authors: H
authors: Rutten
authors: C J H
authors: CJ
authors: van de Velde
authors: R A E M
authors: RA
authors: Tollenaar
authors: J W T
authors: JW
authors: Dekker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000401:mortality / Q000628:therapy*; D003125:Colostomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009426:Netherlands; D016017:Odds Ratio; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012042:Registries; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome