title: Current use of diverting stoma in anterior resection for cancer: population-based cohort study of total and partial mesorectal excision.
abstract: OBJECTIVE
  A diverting stoma is commonly used to reduce the risk of anastomotic leakage when performing total mesorectal excision (TME) in anterior resection for rectal cancer. The purpose of this study was to evaluate the impact of fecal diversion in relation to partial mesorectal excision (PME).
  
  
  METHODS
  A retrospective analysis was undertaken on a national cohort, originally created to study the impact of central arterial ligation on patients with increased cardiovascular risk. Some 741 patients operated with anterior resection for rectal cancer during the years 2007 through 2010 were followed up for 53 months. Multivariate logistic regression was used to evaluate the impact of diverting stoma on the risk of anastomotic leakage and permanent stoma, expressed as odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  The risk of anastomotic leakage was increased in TME surgery when not using a diverting stoma (OR 5.1; 95% CI 2.2-11.6), while the corresponding risk increase in PME patients was modest (OR 1.8; 95% CI 0.8-4.0). At study completion or death, 26 and 13% of TME and PME patients, respectively, had a permanent stoma. A diverting stoma was a statistically significant risk factor for a permanent stoma in PME patients (OR 4.7; 95% CI 2.5-9.0), while less important in TME patients (OR 1.8; 95% CI 0.6-5.5).
  
  
  CONCLUSIONS
  The benefit of a diverting stoma concerning anastomotic leakage in this patient group seems doubtful. Moreover, the diverting stoma itself may contribute to the high rate of permanent stomas.
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden. martin.rutegard@surgery.umu.se.
authors.forename: Martin
authors.initials: M
authors.lastname: Rutegård
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Petrus
authors.initials: P
authors.lastname: Boström
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Markku
authors.initials: M
authors.lastname: Haapamäki
authors.affiliation: Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Matthiessen
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Jörgen
authors.initials: J
authors.lastname: Rutegård
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D003710:Demography; D013505:Digestive System Surgical Procedures; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D054047:Surgical Stomas / Q000473:pathology*; D013548:Sweden; D013997:Time Factors
keywords: Defunctioning stoma; Fecal diversion; Permanent stoma; Rectal cancer