Routine defunctioning stoma after chemoradiation and total mesorectal excision: A single-surgeon experience

Table 1 Clinical demographics (n = 62) n (%)

Variable
Age (yr) (mean ± SD)	58.7 ± 12.8
Gender (male/female)	40/22 (64.5/35.5)
Distance of tumor from anal verge (cm) (median, range)	5 (3-6)
Pre-treatment stage
cT2/T3/T4	17/42/3 (27.4/67.7/4.8)
cN0/cN1/N2	41/16/5 (66.1/25.8/8.1)
Tumor response to CRT (tumor size reduction)1
100% response	8 (12.9)
50%-99%	22 (35.5)
< 50%	32 (51.6)
Toxicity of neoadjuvant CRT
Skin2	1 (1.6)
Nausea/vomiting2	7 (11.3)
Diarrhea3 (Grade II/Grade III)	20/1 (32.3/1.6)
Hematological toxicity	0
Adjuvant chemotherapy	57 (91.9)

¹Evaluated by digital examination and computed tomography;

²Grade I-II;

³Grade I-III. CRT: Chemoradiation therapy.

Table 2 Peri-operative and pathological characteristics (n = 62) n (%)

Variable
Interval between CRT and TME (d) (median, range)	49 (28-101)
Types of surgical procedure
TME + straight coloanal anastomosis with
Double stapling	44 (71.0)
Intersphincteric resection	12 (19.4)
APR	6 (9.7)
DRM (cm) (median, range)	2.5 (2.0-4.5)
Positive CRM	2 (3.2)
Retrieved lymph node number (median, range)	8 (1-20)
Pathologic TNM stage
ypCR	13 (21.0)
ypT0/ypT1/ypT2/ypT3/ypT4	2/5/9/32/1
	(3.2/8.1/14.5/51.6/1.6)
ypN0/ypN1/ypN2	37/8/4
	(59.7/12.9/6.5)
TRG1
1	13 (21.0)
2-3	41 (66.1)
4-5	8 (12.9)

¹Tumor regression grade (TRG): Grade 1, no residual tumor; Grade 2, rare residual cancer; Grade 3, fibrosis outgrowing residual cancer; Grade 4, residual cancer outgrowing fibrosis; Grade 5, absence of regressive change. DRM: Distal resection margin; CRM: Circumferential resection margin; APR: Abdominoperineal resection; TME: Total mesorectal excision.

Table 3 Post-operative morbidity and mortality (n = 62) n (%)

	Case number
Mortality	0 (0)
Early complication
Anastomotic leakage	1 (1.6)
Wound infection	2 (3.2)
Delayed perineal wound healing	1 (1.6)
Pelvic abscess	0 (0)
Rebleeding	0 (0)
Adhesion ileus	1 (1.6)
Central venous port infection	1 (1.6)
Pneumonia	0 (0)
Deep vein thrombosis	0 (0)
Urinary tract infection	1 (1.6)
Late complication
Anastomotic stenosis	1 (1.6)
Fistula formation	0 (0)
Incisional hernia	1 (1.6)
Anal bleeding	2 (3.2)

Table 4 Post-operative anal function (n = 49) n (%)

MSK-AF1 (mo)	12	122	242
Excellent/good	8/9	23/14	23/20
	(16.3/18.4)	(46.9/28.6)	(46.9/40.8)
Fair/poor	12/20	10/2	4/2
	(24.5/40.8)	(20.4/4.1)	(8.2/4.1)

¹Memorial Sloan-Kettering Cancer Center anal function score (MSK-AF): Excellent: 1-2 bowel movements/d and no soilage; Good: 3-4 bowel movement/d or mild soilage; Fair: More than 4 bowel movements/d or moderate soilage; Poor: More than 6 bowel movement/d or significant leakage or enema dependent;

²Periods after stoma closure.