Abstract: Objective:To investigate the value of protective transverse colostomy in decreasing postoperative anastomotic leakage and stricture after laparoscopic resection for rectal cancer.
Methods:The clinical data of 128 patients with rectal cancer who were admitted to the Jinhua Hospital of Zhejiang University from March 2008 to February 2012 were retrospectively analyzed. All the patients received laparoscopic anterior resection of rectal cancer after neoadjuvant chemoradiotherapy. Sixtyone patients received protective transverse colostomy (colostomy group) and 67 patients did not receive protective transverse colostomy (noncolostomy group). The incidences of postoperative anastomotic leakage and stricture, condition of the patients and the prognosis of the patients in the 2 groups were compared. Patients were followed up via outpatient examination, inpatient chemotherapy or phone call till May 2013. All data were analyzed using the t test, chisquare test or Fisher exact probability.
Results The overall incidence of postoperative anastomotic leakage was 7.03%(9/128). The incidences of postoperative anastomotic leakage in the colostomy group and noncolostomy group were 6.56%(4/61) and 7.46%(5/67), with no significant difference between the 2 groups (χ2=0.000, P>0.05). The systemic condition of 4 patients who were complicated with anastomotic leakage in the colostomy group was comparatively better, and all of them were cured by conservative treatment. The condition of 5 patients who were complicated with anastomotic leakage in the noncolostomy group was severe, and 4 of them received reoperation, with the reoperation rate of 4/5; the other patient received conservative treatment. There was significant difference in the reoperation rate between the 2 groups (P<0.05). The overall incidence of postoperative anastomotic stricture was 13.28%(17/128). The incidences of postoperative anastomotic stricture in the colostomy group and the noncolostomy group were 19.67% (12/61) and 7.46%(5/67), with significant difference between the 2 groups (χ2=4.133, P<0.05). The incidences of severe anastomotic stricture of the colostomy group and the noncolostomy group were 8.20 (5/61) and 0, respectively.
Conclusion:Protective transverse colostomy could not reduce the incidence of postoperative anastomotic leakage, but could mitigate the symptoms followed anastomotic leakage and reduce the reoperation rate. Protective transverse colostomy may improve the incidence of anastomotic stricture, therefore it should be applied cautiously.