Background: The role of routine defunctioning stoma after total mesorectal excision (TME) for rectal cancer has remained controversial. This study aimed to compare the surgical outcomes in patients with rectal cancer who underwent TME with and without defunctioning stoma.
Methods: Ninety-seven consecutive patients with rectal cancer who underwent TME from July 1997 to July 2003 at our institution were included in this study. Defunctioning stoma was created in 67 patients (DS group) while 30 patients had no stoma (NS group). Clinical data were retrospectively collected and compared between the two groups.
Results: There were no significant differences between the two groups with respect to age, gender, American Society of Anaesthesiologists grading, tumour location, and tumour staging. Compared to the DS group, more patients in the NS group developed anastomotic leakage that required reoperation (16.7% vs. 1.5%; p=0.01). The only significant risk factor associated with leakage was the absence of a defunctioning stoma (p=0.023). Stoma closure was performed in 62.7% of patients in the DS group. The median duration of follow-up was 51.3 months (range, 0.07-100.3 months). Significantly more patients in the DS group developed late morbidities (46.3% vs. 16.7%; p=0.005). Reoperative rate for late morbidities was also higher in the DS group (22.4% vs. 10%), but the difference was not statistically significant.
Conclusions: Defunctioning stoma can reduce the risk of anastomotic leakage after TME, but at the expense of higher late morbidity and reoperative rates. These results do question the routine use of defunctioning stoma after TME.