CLOSURE OF DIVERTING STOMA AFTER RECTAL CANCER: CONSIDERATIONS ABOUT TIMES AND TYPES

Protective colostomy after TME interventions in patients affected by rectal adenocarcinoma is the current standard of care. This is especially true in neoadjuvant treated patients, both after laparotomic resection and laparoscopic mini-invasive surgery. The reason for the colostomy approach lies in the inherent technical difficulty of sphincter saving procedures and the still dreaded fear of anastomotic leakage. This adverse event occurs with a frequency between 3 and 20%, in spite of methodological and technological advances occurred in the last few years. As widely reported, a protection colostomy will not entirely prevent anastomotic leakage, but it often reduces the severity of such unwanted complication. Hence even in the case of leakage, protection colostomy will allow for a conservative approach avoiding re-intervention. Indeed, keeping a drainage catheter in the surgical bed until fecal material spill is no longer present is usually sufficient to preserve the anastomosis and lead to healing.