Protective stomas are often created for rectal cancer patients, but do they help?

This study assessed whether a protective stoma (a surgically created opening from the abdomen to bowel) benefits rectal cancer patients undergoing low anterior resection.

Low anterior resection is a standard surgery for rectal cancer. It involves removing the rectum and in some cases other parts of the bowel. Where possible the surgeon will reattach the remaining parts of bowel and the patient should regain bowel function. However, the surgeon may decide that the bowel needs time to heal before this can happen. In that case a protective stoma will be created for the patient. A stoma is a surgically created opening from the abdomen to the bowel to eliminate bowel waste.

One serious complication that can occur after low anterior resection is anastomotic leakage. This involves the leakage of bowel fluid at the point where the intestines are reconnected during surgery. Anastomotic leakage can lead to serious infections and in some cases death. It is unclear whether a protective stoma reduces the risk or anastomotic leakage for rectal cancer patients. 

The authors analyzed results from 11 previous studies to assess whether protective stomas benefit patient outcomes. Overall, 5612 rectal cancer patients were included, 2868 had a protective stoma and 2744 did not. The studies compared the risk of anastomotic leakage and reoperations in patients with or without stomas after low anterior resection.

Patients with a protective stoma had a 62% lower risk of developing anastomotic leakage than patients without a protective stoma. Patients with a protective stoma also had a 63% lower risk of needing reoperations due to leakage. 

The authors concluded that protective stomas can reduce the rate of anastomotic leakage and reoperation in patients. They recommend their use for rectal cancer patients who undergo low anterior resection.