Abstract
Background
The role of diverting ileostomy is debated in rectal cancer surgery with primary anastomosis. The aim of this study was to evaluate the associated morbidity and hospital costs of diversion after sphincter saving TaTME surgery.
Methods
All patients undergoing TaTME with primary anastomosis for rectal cancer between January 2012 and December 2019 in a single centre in the Netherlands were included. Patients with diverting ileostomy creation during primary surgery were compared with those without ileostomy. Outcomes included length of hospital stay, anastomotic leakage rates and total hospital costs at 1 year.
Results
One hundred and one patients were included in the ileostomy group, and 46 patients were in the non-ileostomy group. The number of female patients was 31 (30.7%) in the ileostomy group and 21 (45.7%) in the non-ileostomy group Mean age was 64.5 ± 11.1 years in the ileostomy group and 62.6 ± 10.7 years in the non-ileostomy group The anastomotic leakage rate was 21.7% in the non-ileostomy group and 15.8% in the ileostomy group (p = 0.385). The grade of leakage and number of anastomotic takedowns did not differ between groups. Mean costs at 1 year after surgery was €26,500.13 in the ileostomy group and €16,852.61 in the non-ileostomy group. The main cost driver was longer total length of hospital stay at 1 year (mean 12.4 ± 13.3 days vs 20.6 ± 12.6 days, p = 0.000).
Conclusions
Morbidity and associated costs after diverting ileostomy are high. The incidence and morbidity of anastomotic leakage was not reduced by creation of an ileostomy. Omission of a diverting ileostomy after TaTME could possibly result in a reduction in treatment associated morbidity and costs.
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Change history
09 August 2021
A Correction to this paper has been published: https://doi.org/10.1007/s10151-021-02501-z
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Colin Sietses received surgical lecturing fees from Medtronic. For the remaining authors none were declared.
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The study was approved by the local Ethics Committee of the hospital. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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The original online version of this article was revised: In the published version reference 15 was incorrectly added and this has been corrected now.
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Hol, J.C., Bakker, F., van Heek, N.T. et al. Morbidity and costs of diverting ileostomy in transanal total mesorectal excision with primary anastomosis for rectal cancer. Tech Coloproctol 25, 1133–1141 (2021). https://doi.org/10.1007/s10151-021-02498-5
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DOI: https://doi.org/10.1007/s10151-021-02498-5