Prophylactic stoma in robotic radical surgery for low-to-intermediate rectal cancer

Background

Anastomotic leakage are common and serious complications after surgery for low and intermediate rectal cancers; a prophylactic stoma is thought to reduce the incidence of anastomotic leakage and alleviate its serious complications. However, it also comes with numerous risks. This study will investigate the value of prophylactic stomas in robot-assisted radical surgery for low and intermediate rectal cancers.

Methods

We included 670 patients with low-to-intermediate rectal cancer who underwent robot-assisted radical resection at two hospitals within Fudan University from June 2016 to October 2022 (77 underwent prophylactic stoma and 593 did not have prophylactic stoma). The clinical data of the patients were collected and analyzed using a propensity score matching method that matched the groups at a 1:1 ratio based on sex, diabetes mellitus, body mass index, neoadjuvant chemoradiotherapy, distance of the lower edge of the tumor from the anal verge, maximum diameter of the tumor, and preoperative incomplete obstruction.

Results

Patients in the prophylactic stoma group had a significantly lower incidence of symptomatic anastomotic leakage than the non-stoma group. There were no significant differences in the overall postoperative complication, unplanned readmission, or 30-day postoperative reoperation rates between the groups; however, the prophylactic stoma group had a lower number of postoperative hospital days and lower average hospital costs. Preoperative bowel obstruction was an independent risk factor for postoperative anastomotic leakage in the prophylactic stoma group.

Conclusions

Prophylactic stomas based on a robotic platform are beneficial for some high-risk patients with low-to-intermediate rectal cancer.