Stoma vs. Anastomosis in Rectal Cancer Surgery: Key Factors Influencing Decision-Making

Abstract

Introduction Despite advances in surgical techniques, the risk of anastomotic leakage continues to challenge clinicians [1]. The decision to perform an anastomosis or a stoma remains complex, with numerous factors influencing the choice, including patient condition and surgical considerations [2]. Aim We sought to determine which demographic, clinical and MRI characteristics are predictive for the choice of surgical method. Methods A retrospective data analysis was conducted in Hospital of Lithuanian University of Health Sciences Kaunas Clinics, including all patients who underwent rectal cancer surgery in 2023. Data collected included demographic information, clinical data, MRI findings, and surgical details. We performed a multivariate analysis to identify independent clinical predictors of the choice between stoma and anastomosis in rectal cancer surgery. Statistical analysis was performed with IBM SPSS Statistics 29.0. P-value <0.05 was considered significant. Results A search of medical records yielded 83 cases: 39 (47%) anastomosis and 44 (53%) stoma. Anastomosis was significantly more frequent in females compared to males (60.5% vs. 35.6%, p=0.023). Anastomosis was performed for younger patients (63.2 vs. 68.6, p=0.023). Patients in stoma group had higher rate of neoadjuvant treatment than patients, who underwent anastomosis (72.7% vs. 33.3%, p<0.001). Upper and middle rectum tumors (>7 cm) were associated with a higher anastomosis rate (63.9% vs. 36.1%, p=0.048). Anastomosis was more common in negative Mesorectal fascia (MRF) cases predicted by MRI (72.4% vs. 27.6%), while stoma was more frequent in positive MRF cases (57.5% vs. 42.5%), p=0.014. Multivariate logistic regression analysis showed that gender (OR 3.57; 95% CI 1.12–11.11, p=0.043) and age (OR 1.06; 95% CI 1.01–1.12, p=0.031) were statistically significant factors for the choice of surgical method. Neoadjuvant therapy (OR 0.37; 95% CI 0.10–1.29, p=0.158), tumor location (OR 0.93; 95% CI 0.79–1.10, p=0.350), and MRF status (OR 2.31; 95% CI 0.68–7.87, p=0.233) were not statistically significant. Conclusions Male gender and age are key predictors of surgical method choice. Anastomosis was more frequently observed in female patients, younger individuals, those with a MRF prediction by MRI, patients with higher rectal tumors, and those who did not receive neoadjuvant therapy.