Comparison of safety of loop ileostomy and loop transverse colostomy for low-lying rectal cancer patients undergoing anterior resection: A retrospective, single institute, propensity score-matched study

Purpose: To compare the prevalence of stoma-related complications and stoma reversal perioperative complications of patients with low-lying rectal cancer who received preventative loop ileostomy and those who underwent loop transverse colostomy. Methods: This retrospective single-center study analyzed the clinicopathologic and surgical data of 288 patients with pathologically proven primary rectal cancer who underwent anterior resection of rectal cancer with preventative loop ileostomy or loop transverse colostomy between January 2012 and July 2017 at the Department of General Surgery, Peking Union College Hospital. The patients were allocated to the ileostomy group (n=82) and the loop transverse colostomy group (n=206). To achieve comparability of the ileostomy group and the loop transverse colostomy group with regard to potential confounding variables, a propensity score-matching method was used to match patients from each group in a 1:2 ratio. Determinants of stoma-related complications were analyzed by multivariate logistic regression analysis. Results: The propensity score-matched loop ileostomy group (n=66) and the loop transverse colostomy group (n=111) were comparable in patient demographic and baseline characteristics. Forty-nine (74.3%) patients in the loop ileostomy group experienced stoma-related complications vs 48.7% in the loop transverse colostomy group (p <0.001). Irritant dermatitis was the most frequent complication in both groups. The loop ileostomy group had a significantly higher rate (2124%) of stoma reversal perioperative complications than the loop transverse colostomy group (9.01%, p=0.008). Multivariate logistic regression analysis showed that ileostomy vs loop transverse colostomy was a significant independent risk for stoma-related complications (Odds ratio/OR 3.495; 95%CI 1.741, 7.018; p<0.001) and stoma reversal perioperative complications (OR 2.124; 95%CI 1.010, 4.512; p< 0.05). Conclusion: This study has demonstrated that loop transverse colostomy is associated with significantly lower rates of stoma-related complications and stoma reversal perioperative complications compared to loop transverse colostomy. Prospective controlled studies with a larger patient population are warranted to examine the efficacy and safety of loop ileostomy and loop transverse colostomy.