Routine versus postoperative CRP/CT guided selective diverting ileostomy after laparoscopic low anterior resection for rectal cancer: a comparative randomized controlled trial.

In 30 seconds

This randomized controlled trial compared postoperative CRP/CT-guided selective diversion with routine diverting ileostomy in 200 patients with stage II or III middle or lower rectal cancer undergoing laparoscopic low anterior resection. In the selective group, ileostomy was formed only when CRP-triggered CT findings suggested a leak. Ileostomy formation was 22.0% with selective management versus 100.0% with routine diversion (p < 0.001). Anastomotic leak and overall complication rates did not differ significantly; stoma-related complications were less frequent with selective management.

Key findings

• Ileostomy formation was 22.0% in the CRP/CT-guided group versus 100.0% with routine diversion (p < 0.001).
• Anastomotic leak rates were 0% versus 1.0% (p = 1.000), and overall complication rates were 31.0% versus 32.0% (p = 0.879).
• Stoma-related complications occurred in 3.0% with selective diversion versus 30.0% with routine diversion (p < 0.001).
• The selective group had better global health status, physical functioning, and emotional functioning scores (all p < 0.001).

Why it matters

Routine diversion exposes patients to stoma-related complications, while this trial found substantially fewer ileostomies and stoma-related complications with a postoperative CRP/CT-guided approach. The similar observed leak and overall complication rates are relevant to weighing diversion strategies, although confirmed leaks were infrequent in both groups and the findings apply to the studied surgical setting and population.

What to keep in mind

Confirmed anastomotic leaks were infrequent in both groups, limiting what the trial can establish about comparative leak risk. The study population was restricted to stage II or III middle or lower rectal cancer treated with laparoscopic low anterior resection.