Short-Term Outcomes of Degradable Stent vs Diverting Ileostomy in Mid-to-Low Rectal Cancer

Overview

This retrospective cohort study compared short-term safety and outcomes of laparoscopic anterior resection (LAR) combined with degradable stent placement versus diverting ileostomy in patients with mid-to-low rectal cancer. The degradable stent showed comparable safety to ileostomy, with potential benefits including reduced stoma-related morbidity and avoidance of stoma-reversal surgery.

Background

Rectal cancer incidence has increased, with anus-preserving surgery becoming more common due to advances in surgical techniques and neoadjuvant therapy. Anastomotic leakage (AL) after LAR remains a significant complication, often mitigated by diverting ileostomy, which itself carries risks such as dermatitis, prolapse, and need for additional surgery. A novel degradable intestinal stent has been developed to protect anastomoses while potentially avoiding ileostomy-related complications. This study aimed to evaluate the short-term safety and efficacy of this stent compared to the current standard of diverting ileostomy.

Data Highlights

Key Findings

• Degradable stent placement during LAR is feasible and safe with major complication rates comparable to diverting ileostomy.
• Use of degradable stents may reduce stoma-related morbidity and eliminate the need for stoma reversal surgery.
• Minor complications such as anastomotic stricture and mild intestinal obstruction were observed but managed conservatively.
• Operation time for stent placement adds approximately 20 minutes but does not significantly prolong surgery.
• Stent degradation was successfully monitored via imaging, with no reports of incomplete degradation or stent-specific severe complications.

Clinical Implications

Degradable intestinal stents represent a promising alternative to diverting ileostomy for protecting colorectal anastomoses after LAR in mid-to-low rectal cancer. Their use may reduce patient morbidity associated with stomas and avoid additional surgeries for stoma reversal, potentially improving postoperative recovery and quality of life. Clinicians should consider patient selection criteria and monitor for minor complications when adopting this technique.

Conclusion

The degradable stent offers a novel, safe, and effective approach to anastomotic protection in rectal cancer surgery, with short-term outcomes comparable to diverting ileostomy and added benefits of reduced stoma-related complications and avoidance of reversal surgery.

References

1. Wu et al. 2023 -- Application of Degradable Stents in Rectal Cancer Surgery
2. NCCN Guidelines 2023 -- Rectal Cancer Treatment
3. Chengdu Second People’s Hospital Ethics Committee 2023 -- Study Approval