title: 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.
abstract: BACKGROUND
  Routine creation of a diverting stoma (DS) in every patient who undergoes low anterior resection (LAR) remains controversial. We aimed to investigate the effect of DS on symptomatic anastomotic leakage (AL) after LAR.
  
  
  METHODS
  Patients with rectal cancer within 10 cm from the anal verge were eligible for this prospective, multicenter, cohort study (UMIN-CTR, number 000004017). Propensity score matching (PSM) was used to compare groups of patients with and without DS.
  
  
  RESULTS
  One thousand fourteen consecutive patients were registered, of whom 936 patients who underwent LAR were analyzed. Before PSM, the overall rate of symptomatic AL was 13.2% (52 of 394) in patients with DS vs. 12.7% (69 of 542) in cases without DS (p = 0.84). Symptomatic AL requiring re-laparotomy occurred in 4.7% (44 of 936) of all patients, occurring in 1.0% (4 of 394) of patients with DS vs. 7.4% (40 of 542) of patients without DS (p < 0.001). After PSM, the 2 groups were nearly balanced, and the incidence rates of symptomatic AL in patients with and without DS were 10.9% and 15.8% (p = 0.26). The incidences of AL requiring re-laparotomy in patients with and without DS were 0.6% and 9.1% (p < 0.001). Multivariate analysis identified male sex (p < 0.001; odds ratio [OR] 3.2; 95% confidence interval [CI] 1.8 to 5.7) and tumor size (p < 0.001; OR 1.2; 95% CI 1.1 to 1.4) as independent risk factors of symptomatic AL.
  
  
  CONCLUSIONS
  Diverting stoma did not have a significant relationship with symptomatic AL before and after PSM. However, DS does seem to mitigate the consequences of leakage, reducing the need for urgent abdominal reoperation.
authors.affiliation: Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan. Electronic address: a.shiomi@scchr.jp.
authors.forename: Akio
authors.initials: A
authors.lastname: Shiomi
authors.affiliation: Division of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kinugasa
authors.affiliation: Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan.
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Ota
authors.affiliation: Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
authors.affiliation: Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Shiozawa
authors.affiliation: Department of Surgery, School of Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Hisanaga
authors.initials: H
authors.lastname: Horie
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kuriu
authors.affiliation: Division of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Saito
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D003106:Colon / Q000601:surgery*; D003125:Colostomy; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome