Coloanal anastomosis: Is a defunctioning stoma necessary?

The role of a temporary defunctioning stoma in patients undergoing coloanal anastomosis remains controversial. Previous experimental studies have shown that the defunctioned colon is more resistant to neoplasia. The aim of this study was to investigate whether a defunctioning stoma was able to decrease complication rates and, also, to evaluate whether it had any impact on recurrence and survival rates in patients who underwent coloanal anastomosis. The records of 173 patients, 54 with benign rectal disease and 119 patients with cancer, operated on between 1980 and 1996, were retrospectively reviewed. Eighty-nine patients had a defunctioning stoma, 34 in the benign rectal disease and 55 in the cancer group. Mean age was 57.2 years (range 17-88). There were 126 men and 47 women. Follow-up was 57.2 months (range 17-88). There were 126 men and 47 women. Follow-up was done by clinical examination, telephone or mailed questionnaire. Mean time of follow- up was 3.8 years (range 0-13 years). There was no operative mortality. Non- stoma patients tended to have more early complications (pelvic sepsis and obstruction) and more probability of having a permanent stoma than the stoma group, but no significant differences could be found between the two groups (P > 0.05). The probability of being free of stricture was greater in the non-stoma group (stoma 62.6%; non-stoma 78.5%; P < 0.05). Probability of disease-free survival, at 5 years, for rectal cancer patients, was 73.7% for the stoma group and 53.6% for non-stoma group (P = 0.02). After coloanal anastomosis, defunctioning stomas may decrease postoperative complications, increase the likelihood of anastomosis stricture and allow a greater disease- free survival.