- Design
- Randomised controlled trial, 1:1
- Population
- 200 patients with stage II–III mid or low rectal cancer having laparoscopic LAR
- Primary outcome
- Stoma-free status over 12 months
- Effect
- Ileostomy 22% vs 100%; stoma complications 3% vs 30%; leak 0% vs 1%
A randomised trial in BMC Surgery (14 October) assigned 200 patients with stage II or III mid or low rectal cancer undergoing laparoscopic low anterior resection to routine diverting ileostomy or a selective strategy. In the selective arm, CRP was measured daily; a value above 114 mg/L on day 3, or a rise of more than 15 mg/L a day, triggered contrast CT, and a stoma was formed only if CT suggested a leak.
Ileostomy was needed in 22% of the selective group against 100% of the routine group. Leaks were rare in both (0% vs 1%), overall complications were similar (31% vs 32%), and stoma-related complications fell from 30% to 3%. Quality-of-life scores were better with the selective approach.
Many oncologists see the downstream cost of routine stomas: dehydration and kidney injury on chemotherapy, delayed adjuvant treatment, and a second operation. This trial supports discussing a selective approach with surgical colleagues. It is one trial, registered retrospectively, with very few leaks, and it depends on reliable daily CRP and rapid CT.
- Selective diversion avoided a stoma in 78% of patients
- Stoma-related complications fell from 30% to 3%
- Leak rates were low and similar in both groups
- The approach needs daily CRP and same-day CT access
- Discuss with your colorectal surgeons before changing pathways
Why it matters
Routine stomas cause morbidity that can delay adjuvant chemotherapy for most patients who never needed one.
Don't overread it
One retrospectively registered trial with almost no leaks — it is underpowered to show the strategy is as safe as routine diversion.
The statistics, in plain English
With only one leak among 200 patients, the trial cannot tell whether the selective strategy changes leak risk or the harm when a leak does happen; it shows only that most stomas were avoided.
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