International Journal of Medicine Research

International Journal of Medicine Research


International Journal of Medicine Research
International Journal of Medicine Research
Vol. 5, Issue 3 (2020)

Diversion stoma versus no diversion after neoadjuvant chemoradiation in low anterior resection for carcinoma rectum: A retrospective comparison


Bonny Natesh P, Sindhu RS, Ramesh Rajan, Kushal B

Background & objectives: Diversion stoma remains the standard protocol in low anterior resection (LAR) after neoadjuvant chemoradiation (NACRT) for carcinoma rectum, to prevent complications of anastomotic leak. However, literature shows controversies regarding potential benefits of diversion. Objective of this study was to compare post-operative complications in patients underwent LAR with or without diversion following NACRT. Methods: Retrospective comparison was done with inclusion criteria; satisfying three intra-operative criteria (distal resection margin ≥2 cm, complete full thickness doughnuts and negative Jacuzzi’s leak test). Exclusion criteria were age >70 years, major comorbidities, T4 lesion, ultra-low anterior resection, R1 resection and other postoperative infections. Two groups were compared statistically for significant differences in the postoperative outcome. Results: 46 LAR patients; 25 in group-I and 21 in group-II, were comparable regarding demographic parameters, comorbidities, ASA grade, intraoperative blood transfusions, tumour site, CEA level, surgical technique, distal resection margin, level of anastomosis and stapling technique. Mean heart rate on post-operative day (POD)-5 was 84.08+9.66/minute in group-I; 81.66+7.08/minute in group-II (p=0.346). Median day of drain removal, antibiotics and oral fluids were same. Overall morbidity in group-I was 28% and in group-II was 20% (p=0.533). One patient in group-I had relaparotomy for peritonitis. Two patients in group-II had to undergo ileostomy on POD- 3. Clavein Dindo score of 3 was there in 8% Group-I and 9.52% Group-II (p=0.858) which was not statistically significant. Interpretations and conclusion: There was no severe sepsis, organ failure or mortality in these selected patients for LAR after NACRT without diversion stoma.
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How to cite this article:
Bonny Natesh P, Sindhu RS, Ramesh Rajan, Kushal B. Diversion stoma versus no diversion after neoadjuvant chemoradiation in low anterior resection for carcinoma rectum: A retrospective comparison. International Journal of Medicine Research, Volume 5, Issue 3, 2020, Pages 01-06
International Journal of Medicine Research