title: The Role of Diverting Stoma After an Ultra-low Anterior Resection for Rectal Cancer.
abstract: OBJECTIVE
  A diverting stoma is known to reduce the consequences of distal anastomotic failure following colorectal surgery. The aim of this study was to evaluate the efficacy of a diverting stoma after an ultra-low anterior resection (uLAR) for rectal cancer.
  
  
  METHODS
  Between 2000 and 2007, 836 patients who underwent an uLAR were divided into two groups, depending on the fecal diversion: 246 received fecal diversion, and 590 had no diversion. Patient- and disease-related variables were compared between the two groups.
  
  
  RESULTS
  Thirty-two of the 836 patients (3.8%) had immediate anastomosis-related complications and required reoperation. Anastomosis leakage comprised 72% of the complications (23/32). The overall immediate complication rate was significantly lower in patients with a diverting stoma (0.8%, 2/246) compared to those without a diverting stoma (5.1%, 30/590; P = 0.005). The fecal diversion group had lower tumor location, lower anastomosis level, and more preoperative chemo-radiation therapy (P < 0.001). In total, 12% of patients in the diverting stoma group had complications either in making or reversing the stoma (30/246).
  
  
  CONCLUSIONS
  The diverting stoma decreased the rate of immediate anastomosis-related complications. However, the rate of complications associated with the diverting stoma was non-negligible, so strict criteria should be applied when deciding whether to use a diverting stoma.
authors.affiliation: Department of Colon & Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Seok In
authors.initials: SI
authors.lastname: Seo
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
authors.forename: Gwon Sik
authors.initials: GS
authors.lastname: Kim
authors.forename: Jong Lyul
authors.initials: JL
authors.lastname: Lee
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Yoon
authors.forename: Chan Wook
authors.initials: CW
authors.lastname: Kim
authors.forename: Seok-Byung
authors.initials: SB
authors.lastname: Lim
authors.forename: Jin Cheon
authors.initials: JC
authors.lastname: Kim
keywords: Colorectal surgery; Ileostomy; Rectal neoplasms