Colostomy vs tube cecostomy for protection of a low anastomosis in rectal cancer

Background: Symptomatic anastomotic leakage is the most important surgical complication following rectal resection with intestinal anastomosis. Theref ore, the routine use of a protective stoma is suggested by several authors. In our department 2 different techniques are performed to protect the anas tomosis. Patients receive either a loop colostomy/ileostomy (C/I) or a tube cecostomy (TC). Hypothesis: No significant difference is noted between C/I and TC for prote ction of a low anastomosis regarding clinical anastomotic leakage rate, reo peration rate for anastomotic leaks/fistulas, postoperative mortality, and permanent colostomy rate. By avoiding a second operation (for colostomy clo sure), median hospital stay should be significantly reduced. Design: A retrospective review during 1985 to 1997. Setting: Tertiary care center Patients: One hundred fifty-eight patients who had undergone anterior resec tions for rectal cancer were studied. Protective C/Is were used in 19 patie nts; a TC was fashioned in 30 patients. Main Outcome Measures: Clinical anastomotic leakage rate, reoperation rate for anastomotic leaks/fistulas, postoperative mortality, permanent colostom y rate, and median hospital stay. Results: The rate of anastomotic leaks (WI, 16%; TC, 17%), fecal peritoniti s (C/I, 0%; TC, 10%), reoperation for anastomotic leaks/fistulas (C/I, 0%; TC, 13%), permanent colostomies (WI, 0%; TC, 7%), and postoperative mortali ty (C/I, 5%; TC, 0%) did not differ significantly in both groups. Median ho spital stay was significantly reduced in patients with TC (C/I, 28 days; TC , 15 days). Conclusion: In our patients with low resections for rectal cancer, a C/I fo r protection of the anastomosis did not improve outcome significantly as co mpared with a TC. With a properly fashioned TC and adequate postoperative m anagement a second operation (for colostomy closure) can be avoided and the overall hospital stay is significantly reduced.