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Diverting Ileostomy Decreases the Oncologic Risk of Death From Postoperative Complications After Low Anterior Resection for Rectal Cancer

*Maria Lucia L Madariaga1, *Coen L Klos2, *Lawrence S Blaszkowsky1, *Theodore S. Hong1, *Patricia Sylla1, *Liliana Bordeianou1, David L Berger1
1Massachusetts General Hospital, Boston, MA;2Universiteit van Amsterdam, Amsterdam, Netherlands

Objective: Diverting ileostomy decreases the morbidity associated with anastomotic leak after low anterior resection (LAR) for rectal adenocarcinoma. The ability of ileostomy to mitigate the effect of postoperative complications on oncologic outcomes is unknown. The aim of this study is to determine whether ileostomy alone or in combination with neoadjuvant therapy improves survival and decreases time to tumor recurrence in patients who suffer postoperative complications after LAR. Design: Retrospective review of a prospectively maintained, IRB-approved database. Setting: Tertiary care center. Patients: Patients who underwent LAR for rectal adenocarcinoma 2000-2010 at Massachusetts General Hospital. Main Outcome Measure: Time to death and time to recurrence. Results: 296 patients were included. 153 patients (51.7%) underwent diverting loop ileostomy. 94 patients (31.8%) had a postoperative complication. Postoperative complications did not significantly affect time to ileostomy closure (HR 0.73, p=0.098) and having an ileostomy did not significantly affect the complication rate (36.6% vs 26.6%, with and without ileostomy, p=0.08). However, patients with postoperative complications who did not have an ileostomy had increased risk of death (HR 1.86, p=0.05). This effect was decreased significantly in patients who had an ileostomy (HR 0.40, p=0.039) or underwent neoadjuvant therapy (HR 0.29, p=0.01). Risk of death was further decreased in patients who underwent both ileostomy and neoadjuvant therapy (HR 0.18, p=0.007). Risk of recurrence was not affected significantly. Conclusions: Diverting ileostomy, alone or in combination with neoadjuvant therapy, decreased the risk of death in patients with postoperative complications after LAR, underscoring the protective benefit of diverting ileostomy in patients with rectal adenocarcinoma to maximize survival.

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