Surgical endoscopy · 2026
Comparing the safety and efficacy of virtual ileostomy versus diverting ileostomy in patients undergoing total mesorectal excision for rectal cancer: a propensity-matched study.
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Du Jing, Deng Xiaolian, Wang Li, van Oostendorp Stefan E, Xu Yuanchun, Shen Haode, Zheng Huichao, Huang Bin, Zhao Song, Tian Yue, Wang Xiangfeng, Du Juan, Zhang Yanmei, Zhang Anping, Tong Weidong, Li Fan
Аннотация
BACKGROUND: Diverting ileostomy (DI) reduces the clinical impact of anastomotic leakage but is associated with stoma-related complications, mandatory reversal, and substantial costs. We aim to compare the clinical outcomes of virtual ileostomy (VI) and DI.
METHODS: A single-center retrospective case-control propensity score-matched analysis was performed on patients who underwent laparoscopic or robot-assisted anterior resection for rectal cancer between September 2014 and January 2024.
RESULTS: We included 112 cases of VI and 500 cases of DI for propensity-matched analysis. After PSM, 111 well-balanced pairs were analyzed. The incidence of anastomotic leakage (AL) was 15.3% (17/111) in the VI group and 9.9% (11/111) in the DI group, with no statistically significant difference observed (OR = 0.608, 95% CI [0.271, 1.366], P = 0.448). The overall complication burden, evaluated by the Comprehensive Complication Index (CCI) at 6 months postoperatively, was comparable between the VI and DI groups (median [IQR], 0 [0, 20.9] vs. 0 [0, 22.6]; P = 0.087). However, the VI approach avoided formal stoma creation in 84.7% of selected patients and associated with lower total costs (median [IQR], 54,579 [49,264-74,552] vs. 96,925 [76,530-113,207] CNY; P < 0.001) and postoperative length of stay (median [IQR], 9.0 [8.0, 11.0] vs. 18.0 [14.0, 24.0]; P < 0.001).
CONCLUSIONS: In carefully selected patients, VI avoided the need for DI in 84.7% of patients who underwent laparoscopic or robot-assisted anterior resection. Additionally, there was no significant difference in anastomotic leakage or 6-month complication burden. Moreover, VI was associated with advantages in terms of lower costs, lower rate of scheduled secondary operations and shorter hospital stay.
METHODS: A single-center retrospective case-control propensity score-matched analysis was performed on patients who underwent laparoscopic or robot-assisted anterior resection for rectal cancer between September 2014 and January 2024.
RESULTS: We included 112 cases of VI and 500 cases of DI for propensity-matched analysis. After PSM, 111 well-balanced pairs were analyzed. The incidence of anastomotic leakage (AL) was 15.3% (17/111) in the VI group and 9.9% (11/111) in the DI group, with no statistically significant difference observed (OR = 0.608, 95% CI [0.271, 1.366], P = 0.448). The overall complication burden, evaluated by the Comprehensive Complication Index (CCI) at 6 months postoperatively, was comparable between the VI and DI groups (median [IQR], 0 [0, 20.9] vs. 0 [0, 22.6]; P = 0.087). However, the VI approach avoided formal stoma creation in 84.7% of selected patients and associated with lower total costs (median [IQR], 54,579 [49,264-74,552] vs. 96,925 [76,530-113,207] CNY; P < 0.001) and postoperative length of stay (median [IQR], 9.0 [8.0, 11.0] vs. 18.0 [14.0, 24.0]; P < 0.001).
CONCLUSIONS: In carefully selected patients, VI avoided the need for DI in 84.7% of patients who underwent laparoscopic or robot-assisted anterior resection. Additionally, there was no significant difference in anastomotic leakage or 6-month complication burden. Moreover, VI was associated with advantages in terms of lower costs, lower rate of scheduled secondary operations and shorter hospital stay.