Current practice in Australia and New Zealand for defunctioning ileostomy after rectal cancer surgery with anastomosis: Analysis of the Bi-National Colorectal Cancer Audit (BCCA)

Abstract

AIM: This study aimed to investigate the use of defunctioning stomas after rectal cancer surgery in Australia and New Zealand (ANZ), as current practice is unknown. METHODS: From the Bi-National Colorectal Cancer Audit (BCCA) database, rectal cancer patients who underwent a resection between 2007 and 2019 with the formation of an anastomosis were extracted and analysed. Primary outcome was the rate of defunctioning stoma formation. Secondary outcomes were: anastomotic leakage (AL) rates and other postoperative complications, length of hospital stay (LOS), readmissions and 30-day mortality rates between stoma and no stoma groups. Propensity score-matching was performed to correct for differences in baseline characteristics between stoma and no-stoma groups. RESULTS: In total, 2,581 (89%) received a defunctioning stoma and 319 (11%) did not. There were more male patients in the stoma group (65.5 vs. 57.7% for the no-stoma group; p=0.006). The median age was 64 years in both groups. The stoma group underwent more ultra-low anterior resections (79.9 vs. 30.1%; p<0.0001), included more AJCC stage III patients (53.7 vs. 29.2%; p<0.0001) and received more neoadjuvant therapy (66.9 vs. 16.3%; p<0.0001). The AL rate was similar in both groups (5.1 vs. 6.0%; p=0.52). LOS was longer in the stoma group (8 vs. 6 days; p<0.0001) with higher 30-day readmission rates (14.9 vs. 8.3%; p=0.003). After propensity score-matching (n=208 in both groups), AL rates remained similar (2.9% for stoma vs. 5.8% for no stoma group; p=0.15), but stoma patients required less reoperations (0% vs. 8%; p=0.016). The stoma group had higher postoperative ileus rates and an increased LOS. CONCLUSION: In ANZ, most patients who underwent rectal cancer resections with the formation of an anastomosis received a defunctioning stoma. A defunctioning stoma does not prevent anastomotic leakage from occurring but is mostly associated with a lower reoperation rate. Patients with a defunctioning stoma experienced a higher postoperative ileus rate and had an increased length of hospital stay.