The purpose of this study is to determine which stoma creation technique is preferable after low anterior resection of the rectum.
The investigators enroll patients with a histologically confirmed diagnosis of primary rectal cancer with or without prior chemoradiotherapy who were hospitalized at the Ufa Republican Clinical Oncology Center from February 2023 to February 2024. All patients undergo planned laparoscopic or open low-anterior resection of the rectum with total mesorectal excision. Patients are randomized into 2 groups in a 1:1 ratio. In the first group, a loop transverse colostomy is created, and in the second group, a loop ileostomy is created. The stoma exit sites are marked in advance the day before the surgery. The bowels are prepared by mechanical means (a polyethylene glycol-based laxative with a cleansing enema) according to a standard procedure before the surgery. Standardized stoma creation techniques are used. The resected parts are collected through a separate access. Patients are followed up for 60 days after surgery. The sample size should be 124 patients to reach statistical significance (α = 0.05, study power 80%, confidence interval (CI) = 95%.). Considering possible losses during the study, the number of patients was increased to 130. The investigators hypothesis is that the loop ileostomy group has a 20% higher incidence of stoma dysfunction but a 20% lower incidence of SSI (stoma site infections) compared to the loop colostomy group.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
150
The loop transverse colostomy is matured without torsion using a plastic retainer. The stoma protrudes 2-3 cm. The loop of the transverse colon is sutured with interrupted sutures using an absorbable 3/0 polyglactin suture without piercing the intestinal wall. The intestinal lumen is opened through a transverse incision on the antimesenteric border.
The loop ileostomy is matured 25-30 cm from the ileocecal angle without torsion and without a retainer, so that stoma protrudes 2-3 cm. The loop of the ileum is sutured with interrupted sutures using an absorbable 3/0 polyglactin suture without piercing the intestinal wall. The intestinal lumen is opened through a transverse incision on the antimesenteric border.
Republican clinical oncological dispencery
Ufa, Bashkortostan Republic, Russia
SSI
incidence of stoma site infections
Time frame: 60 days after surgery
Ileus
incidence of stoma dysfunction
Time frame: 60 days after surgery
Readmission rate
readmission rate
Time frame: within the first 60 days after surgery
Length of hospital stay
the number of days from surgery to discharge
Time frame: From date of surgery until the date of discharge, assessed up to 60 days
Time to stoma closure
the number of days from surgery to stoma closure
Time frame: within the first 6 months days after surgery
Time to first stool
the occurrence of anything other than serous-hemorrhagic contents in the colostomy bag
Time frame: 60 days after surgery
Time to adjuvant postoperative chemotherapy
the number of days from surgery to hospitalization for first chemotherapy
Time frame: within the first 2 months days after surgery
Quality of life in patients with ostomy
estimated using EORTC QLQ-CR29
Time frame: within the first 60 days after surgery
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