Does a defunctioning stoma affect anorectal function after low rectal resection? Results of a randomized multicenter trial.

Abstract

Anorectal function is often impaired after low anterior resection of the rectum. Many factors affect the functional outcome and not all are known. This trial aimed to assess whether a temporary defunctioning stoma affected anorectal function after the patients had been stoma-free for a year. Multicenter randomized controlled trial. Twenty-one Swedish hospitals performing surgery for rectal cancer participated. Patients who had undergone low anterior resection for adenocarcinoma of the rectum were eligible. Patients were randomly assigned to receive a defunctioning stoma or no stoma. Anorectal function was evaluated with a questionnaire after patients had been without a stoma for 12 months. Questions pertained to stool frequency, urgency, fragmentation of bowel movements, evacuation difficulties, incontinence, lifestyle alterations, and whether patients would prefer a permanent stoma. After exclusion of patients in whom stomas became permanent, a total of 181 (90%) of 201 patients answered the questionnaire (90 in the stoma group and 91 in the no-stoma group). The median number of stools was 3 during the day and 0 at night in both groups. Inability to defer defecation for 15 minutes was reported in 35% of patients in the stoma group and 25% in the no stoma group (P = .15). Median scores were the same in each group regarding need for medication, evacuation difficulties, fragmentation of bowel movements, incontinence, and effects on well-being. Two patients (2.2%) in the stoma group and 3 patients (3.3%) in the no-stoma group would have preferred a permanent stoma. Because this study was an analysis of secondary end points of a randomized trial, no prestudy power calculation was performed. A defunctioning stoma after low anterior resection did not affect anorectal function evaluated after 1 year. Many patients experienced impaired anorectal function, but nearly all preferred having impaired anorectal function to a permanent stoma.