STOMALEFT—evaluating defunctioning left-sided loop colostomy during anterior resection for rectal cancer
Oskar Grahn, Anders Gerdin, Jannice Forssell, Petrus Vinnars, Martin RutegårdAbstract
Introduction
A defunctioning stoma is frequently created following total mesorectal excision for rectal cancer. Loop ileostomies are commonly used but are associated with complications, including renal impairment. Defunctioning loop colostomies may offer physiological advantages, particularly if the stoma becomes permanent.
Methods
Patients with rectal cancer scheduled for anterior resection with a planned defunctioning stoma were included. The intervention was construction of a left-sided loop colostomy instead of a loop ileostomy. Primary outcomes were feasibility and safety, assessed by postoperative complications, anastomotic leakage and occurrence of high-output stoma. Secondary outcomes included stoma-related complications, stoma reversal, renal function and patient-reported outcomes.
Results
Sixteen patients were enrolled, of whom ten were included in the final analysis. No cases of colonic ischaemia or high-output stoma were observed. Median serum creatinine was 64.5 preoperatively, and 75 at both 90 days and one-year follow-up. One patient developed an anastomotic leak (grade C). Three patients were readmitted within 90 days, and one patient died due to pneumonia. Six stomas (60%) were reversed at a median of 222 days. Median follow-up was 12.1 months. At one year, LARS data were available for five patients, of whom three (60%) had major LARS. Global health status (QLQ-C30) was 54.2 at baseline and 66.7 at one-year follow-up.
Discussion
A defunctioning left-sided loop colostomy appears to be a feasible and safe alternative to ileostomy in anterior resection for rectal cancer. The absence of high-output stoma and stable renal function suggests potential physiological advantages. Larger, comparative studies are warranted.