Short-Term Outcome Analysis of Temporary Ostomy in Low Anterior Resection for Rectal Cancer-A Retrospective Study

Background Temporary ostomy has proved to be an effective method to reduce anastomotic leakage in low anterior resection. However, the injury of additional reversal surgery and ostomy-related complications require more evaluation regarding its necessity and feasibility. In this study, we analyzed the outcomes of temporary ostomy in low anterior resection to provide more evidence for surgeons to make clinical decisions.Methods A total of 279 consecutive patients with rectal cancer with temporary ostomy were matched 1:1 to contemporaneous 279 controls without temporary ostomy at our institution to compare the perioperative clinical situation. The matching criteria included age, body mass index (BMI), American Society of Anesthesiology (ASA) score, and tumor stage. The one-year follow-up data was collected to evaluate ostomy-related outcomes.Results The non-ostomy group had a higher proportion of chemoradiotherapy (39.4% vs 10.0%, P < 0.001) and a lower site of anastomosis (6.0 cm vs. 9.0 cm, P < 0.001) than the ostomy group. The ostomy group had a lower rate of anastomotic leakage (0.4% vs 3.6%, P = 0.039), reduced reoperation rate (0.4% vs 2.9%, P = 0.044), longer operating time (214.9 min vs. 151.4 min, P = 0.009) and shorter time to first flatus (3.4 days vs. 4.1 days, P = 0.005) than the non-ostomy group. The safety of reversal surgery is acceptable; however, 21.1% of ostomates did not complete the reversal operation for various reasons within 1 year after the first operation. Age (P = 0.029) and AJCC stage (P = 0.043) may be important factors affecting the closure of ostomy.Conclusions Although time-consuming, temporary ostomy is a good option for high-risk patients to reduce the rates of anastomotic leakage and reoperation in low anterior resection. Considering the ostomy-related inconveniences in daily living, other related complications and rather high proportion of non-reversal, the scope of application should be more for patients with low anastomosis and neoadjuvant treatment.