Influence of temporary faecal diversion on long-term survival after curative surgery for colorectal cancer

✍ Scribed by L. Meleagros; P. P. Varty; P. Delrio; Mr P. B. Boulos

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 550 KB
• Volume: 82
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800820108

✦ Synopsis

Abstract
Experimental carcinogenesis is enhanced at colorectal anastomoses, inhibited by proximal faecal diversion and promoted by the closure of a defunctioning stoma. The clinical relevance of these observations was investigated in a retrospective study of curative restorative resection for colorectal carcinoma. The 5-year disease-free survival rate (95 per cent confidence interval) in 122 patients with a temporary stoma (50·4 (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 patients with Dukes B tumours early stoma closure (within 3 months of resection) 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), tumour differentiation (P = 0·02) and tuning of stoma closure (P = 0·02) as independent predictors of survival. In curative surgery for colorectal cancer temporary faecal diversion confers a survival disadvantage that can be prevented by delayed closure of the stoma.