INFLUENCE OF TEMPORARY FECAL DIVERSION ON LONG-TERM SURVIVAL AFTER CURATIVE SURGERY FOR COLORECTAL-CANCER

Experimental carcinogenesis is enhanced at colorectal anastomoses, inh ibited by proximal faecal diversion and promoted by the closure of a d efunctioning stoma. The clinical relevance of these observations was i nvestigated in a retrospective study of curative restorative resection for colorectal carcinoma. The 5-year disease-free survival rate (95 p er cent confidence interval) in 122 patients with a temporary stoma (5 0.4 (41.1-59.7) per cent) was significantly reduced (P<0.01) compared with that in 218 with no stoma (66.8 (59.4-73.5) per cent). In patient s with Dukes B tumours early stoma closure (within 3 months of resecti on) was associated with a worse survival (P<0.005) and a higher tumour recurrence rate (P<0.05) than in those with no stoma. Survival rates after late stoma closure were no different from those in patients with no stoma. Multivariate analysis revealed Dukes stage (P<0.0001), tumo ur differentiation (P=0.02) and timing of stoma closure (P=0.02) as in dependent predictors of survival. In curative surgery for colorectal c ancer temporary faecal diversion confers a survival disadvantage that can be prevented by delayed closure of the stoma.