Evaluation of stoma-related complications and postoperative Health-related quality of life in patients with rectal cancer underwent low anterior resection following neoadjuvant chemoradiotherapy: protective diverting ileostomy versus transverse colostomy

Abstract Purpose: The choice between loop ileostomy (LI) and loop transverse colostomy (LTC) after low anterior resection (LAR) is still controversial. This study aims to evaluate the prevalence of stoma-related complications for these two categories of diverting enterostomy. Additionally, health-related quality of life for patients received LI was compared to those with LTC. Methods: From 2014 to 2019, patients who underwent LAR following neoadjuvant chemoradiotherapy were selected initially for the study. All participants received protective diverting LI or LTC. Concrete data of patients’ demographic, surgery and follow-up information were obtained from the constructed database of the hospital. Comparison of patients’ postoperative recovery data was conducted. Results: 127 and 90 patients received ileostomy versus transverse colostomy respectively. During the mean follow-up time of 37.3±11.2 (17-52) months, 28(12.9%) patients developed stoma-related complications. Compared with patients in LI groups, those received LTC demonstrated longer defecation period after the radical surgery (P=0.006, higher incidence of parastomal hernia (P=0.015) and wound infection (P=0.035). LTC groups displayed a lower incidence of peristomal dermatitis and disturbance of water and electrolyte (P=0.037). LI group showed better feedback on cognitive functioning (P<0.001), body image (P=0.015) and more complaint on dry mouth (P=0.004). LTC group expressed more inconvenience on embarrassment by stoma(P<0.001) and better experience on stool frequency and bags change(P=0.015). Conclusion: Diverting LI display more rapid intestinal function recovery but higher risk of short-term stoma-related complications caused by high volume of excrement. Patients underwent LI got better cognitive function scale but worse feedback on problems related to stool frequency.