Annals of Coloproctology

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Original article

Defunctioning Protective Stoma Can Reduce the Rate of Anastomotic Leakage after Low Anterior Resection in Rectal Cancer Patients: Byoung Chul Lee, Seok-Byung Lim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Chang Sik Yu, Jin Cheon Kim; Received October 22, 2019 Accepted November 19, 2019 Published online January 16, 2020; DOI: https://doi.org/10.3393/ac.2019.11.19.1

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PURPOSE
This study aimed to identify risk factors for anastomotic leakage and to evaluate the impact of protective stoma on the rate of anastomotic leakage and subsequent management.
METHODS
This retrospective study analyzed data from 4,282 patients who underwent low anterior resection between 2007 and 2014. Among these, 1,367 (31.9%) underwent surgery to create protective diverting stoma and 232 (5.4%) experienced anastomotic leakage. At 6-month timepoints, data were evaluated to identify any correlation between the presence of diverting stoma and the incidence of anastomotic leakage. In addition, clinicopathological parameters were investigated to identify risk factors for anastomotic leakage.
RESULTS
Diverting stomas significantly reduced the rate of anastomotic leakage [HR 0.334, 95% CI 0.212

Citations

Citations to this article as recorded by

Application of one-stitch modified ileostomy in laparoscopic low anterior rectal resection: An open-label, randomized clinical trial
Xin Zhang, Baochuan Yang, Weishuai Song, Benjia Liang, Liangzhao Chen, Quan Yuan, Yitong Wang, Jiayi Li, Jie Liu, Jizhun Zhang
Surgery.2026; 190: 109860. CrossRef
Factors associated with leakage after reversal of protective stoma in patients with locally advanced rectal cancer following curative resection and anastomosis
Miao-Ling Tsai, Ji-Shiang Hung, John Huang, Been-Ren Lin
European Journal of Surgical Oncology.2025; 51(8): 108698. CrossRef
Risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery
Jia-Rui Liu, Jin Zhang, Xiang-Long Duan
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Risk prediction models for permanence of temporary stoma after radical surgery of rectal cancer: a systematic review
Wenjing Tan, Shiyin Cai, Juanqin Wu, Wenke Wu, Shan Wang, Yaqiu Li, Lulu Liu, Liping Tang, Ying Cao
World Journal of Surgical Oncology.2025;[Epub] CrossRef
Machine learning model for prediction of permanent stoma after anterior resection of rectal cancer: A multicenter study
Yang Su, Yanqi Li, Heng Zhang, Wangshuo Yang, Mengdie Liu, Xuelai Luo, Lu Liu
European Journal of Surgical Oncology.2024; 50(7): 108386. CrossRef
A nomogram of anastomotic stricture after rectal cancer: a retrospective cohort analysis
Yifan Cheng, Zhen Tian, Shuyang Gao, Shuai Zhao, Ruiqi Li, Jiajie Zhou, Qiannan Sun, Daorong Wang
Surgical Endoscopy.2024; 38(7): 3661. CrossRef
Impact of diversion ileostomy on postoperative complications and recovery in the treatment of locally advanced upper-half rectal cancer
Yangyang Wang, Xiaojie Wang, Shenghui Huang, Heyuan Zhu, Ying Huang
Scientific Reports.2024;[Epub] CrossRef
The role of transanal drainage tube in preventing the anastomotic leakage in rectal cancer surgery without a defunctioning stoma: A meta-analysis
Yue-Xin Zhang, Tao Jin, Kun Yang
The Surgeon.2023; 21(4): e164. CrossRef
Sarcopenic Obesity Is a Risk Factor for Worse Oncological Long-Term Outcome in Locally Advanced Rectal Cancer Patients: A Retrospective Single-Center Cohort Study
Peter Tschann, Markus P. Weigl, Patrick Clemens, Philipp Szeverinski, Christian Attenberger, Matthias Kowatsch, Tarkan Jäger, Klaus Emmanuel, Thomas Brock, Ingmar Königsrainer
Nutrients.2023; 15(11): 2632. CrossRef
One Decade of Declining Use of Defunctioning Stomas After Rectal Cancer Surgery in the Netherlands: Are We on the Right Track?
Erik W. Ingwersen, Paulien J.K. van der Beek, Jan Willem T. Dekker, Susan van Dieren, Freek Daams
Diseases of the Colon & Rectum.2023; 66(7): 1003. CrossRef
Effects of Neoadjuvant Radiotherapy on Postoperative Complications in Rectal Cancer: A Meta-Analysis
Jianguo Yang, Yajun Luo, Tingting Tian, Peng Dong, Zhongxue Fu, Irena Ilic
Journal of Oncology.2022; 2022: 1. CrossRef
Tailored Management with Highly-Selective Diversion for Low Colorectal Anastomosis: Biochemical Postoperative Follow-Up and Long-Term Results from a Single-Institution Cohort
Philippe Rouanet, Marie Selvy, Marta Jarlier, Caroline Bugnon, Guillaume Carrier, Anne Mourregot, Pierre-Emmanuel Colombo, Christophe Taoum
Annals of Surgical Oncology.2022; 29(4): 2514. CrossRef
Are risk factors for anastomotic leakage influencing long-term oncological outcomes after low anterior resection of locally advanced rectal cancer with neoadjuvant therapy? A single-centre cohort study
Peter Tschann, Markus P. Weigl, Philipp Szeverinski, Daniel Lechner, Thomas Brock, Stephanie Rauch, Jana Rossner, Helmut Eiter, Paolo N. C. Girotti, Tarkan Jäger, Jaroslav Presl, Klaus Emmanuel, Alexander De Vries, Ingmar Königsrainer, Patrick Clemens
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Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub] CrossRef
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Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub] CrossRef
Risk Factors of Anastomotic Leakage After Anterior Resection for Rectal Cancer Patients
Xiang-nan Yu, Lu-ming Xu, Ya-wen Bin, Ye Yuan, Shao-bo Tian, Bo Cai, Kai-xiong Tao, Lin Wang, Guo-bin Wang, Zheng Wang
Current Medical Science.2022; 42(6): 1256. CrossRef
Effect of pelvic drain displacement on anastomotic leakage-related morbidity after rectal cancer surgery
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Journal of Minimally Invasive Surgery.2021; 24(3): 158. CrossRef
Preoperative chemoradiotherapy versus surgery alone for advanced low rectal cancer: a large multicenter cohort study in Japan
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Surgery Today.2020; 50(11): 1507. CrossRef

Original Article

Transanal Minimally-Invasive Surgery for Treating Patients With Regressed Rectal Cancer After Preoperative Chemoradiotherapy: Byoung Chul Lee, Seonok Oh, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2017;33(2):52-56. Published online April 28, 2017; DOI: https://doi.org/10.3393/ac.2017.33.2.52

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Abstract PDF

Purpose

Although the standard treatment for patients with locally advanced rectal cancer managed by preoperative chemoradiotherapy (CRT) is a radical resection, local excisions are used in highly-selective cases. Recently, transanal minimally-invasive surgery (TAMIS) has emerged as a feasible technique for local excision of midrectal lesions. We assess the feasibility of using TAMIS to treat patients with locally advanced rectal cancer who showed good response to CRT.

Methods

From October 2010 to June 2013, 35 consecutive patients with rectal cancer managed by using preoperative CRT underwent TAMIS. After a single-incision laparoscopic surgery port had been introduced into the anal canal, a full-thickness local excision with conventional laparoscopic instruments was performed. We retrospectively reviewed a prospectively collected database of these cases.

Results

Of the 35 patients analyzed, 18 showed pathologic complete responses and 17 had residual lesions (2 ypTis, 4 ypT1, 9 ypT2, and 2 ypT3); 34 (97.1%) showed clear deep, lateral margins. The median distance of lesions from the anal verge was 5 cm. All procedures were completed laparoscopically, and the median operating time was 84 minutes. No intraoperative events or morbidities were seen in any of the patients, except one with wound dehiscence, who was treated conservatively. The median postoperative hospital stay and follow-up period were 4 days and 36 months, respectively. During the study period, no patients died, but 5 (14.3%) experienced recurrence, including one recurrence at the TAMIS site.

Conclusion

TAMIS seems to be a feasible, safe modality for treating patients with locally advanced rectal cancer who show good response to preoperative CRT.

Citations

Citations to this article as recorded by

Local Excision in the Era of Total Neoadjuvant Therapy
Anders C. Larsen, Joceline V. Vu
Clinics in Colon and Rectal Surgery.2026;[Epub] CrossRef
TAMIS: New Horizons in Modern Colorectal Surgery
Nurhilal Kızıltoprak, Jack Aaron, Camila Diez, Sam Atallah
Turkish Journal of Colorectal Disease.2025; 35(2): 33. CrossRef
Multidisciplinary treatment strategy for early rectal cancer
Gyung Mo Son, In Young Lee, Sung Hwan Cho, Byung-Soo Park, Hyun Sung Kim, Su Bum Park, Hyung Wook Kim, Sang Bo Oh, Tae Un Kim, Dong Hoon Shin
Precision and Future Medicine.2022; 6(1): 32. CrossRef
Minimally Invasive Treatment of a Completely Obstructed Rectal Anastomosis by Using a Transanal Plasmakinetic Resectoscope: a Case Report and Review of Literature
Na Wang, Daguang Wang, Weihua Tong, Jinguo Wang
Indian Journal of Surgery.2021; 83(5): 1127. CrossRef
Transanal minimally invasive surgery using laparoscopic instruments of the rectum: A review
Myung Jo Kim, Taek-Gu Lee
World Journal of Gastrointestinal Surgery.2021; 13(10): 1149. CrossRef
Transanal Minimally Invasive Surgery: A Promising Alternative for Certain Advanced Rectal Cancer Patients
Hernan A. Sanchez-Trejo, Daniel Hakakian, Terrence Curran, Luca Antonioli, Balazs Csoka, Zoltan H. Nemeth
Journal of Investigative Surgery.2019; 32(4): 377. CrossRef
Transanal minimally invasive surgery as a treatment option for a completely occluded anastomosis after low anterior resection: A new approach to severe anastomotic stenosis
Jun Woo Bong, Seok‐Byung Lim
Asian Journal of Endoscopic Surgery.2019; 12(2): 175. CrossRef
A systematic review and meta-analysis of pT2 rectal cancer spread and recurrence pattern: Implications for target design in radiation therapy for organ preservation
Joanna Socha, Lucyna Pietrzak, Anna Zawadzka, Anna Paciorkiewicz, Anna Krupa, Krzysztof Bujko
Radiotherapy and Oncology.2019; 133: 20. CrossRef
Transanal Minimally Invasive Surgery After Chemoradiotherapy: Widening Scope of Indications for Local Excision
Min Jung Kim, Jae Hwan Oh
Annals of Coloproctology.2017; 33(2): 43. CrossRef

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