STOMA study SToma-leak ratio in advanced ovarian cancer surgery: Results of a restrictive policy on the use of protective stoMAs.

OBJECTIVE

Assessemnet of anastomotic leak rates following recto-sigmoid resection in advanced ovarian cancer surgery after implementing a restrictive stoma policy. Secondary objectives include identifying predictive factors for stoma creation, analyzing anastomotic leak management, and perioperative outcomes.

SUMMARY BACKGROUND DATA: Recto-sigmoid resection is essential in advanced ovarian cancer treatment but carries risks like anastomotic dehiscence. The role of protective stomas remains uncertain, highlighting the need for targeted strategies.

METHODS

This retrospective study includes data from 722 patients who underwent recto-sigmoid resection between January-2020 and December-2023 at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. Patients were classified under liberal (2020-2021) or restrictive (2022-2023) stoma policies. The liberal approach relied on general surgeon preference without predefined criteria, while the restrictive policy introduced a systematic evaluation of risk factors by the gynecologic oncologist and the general surgeon in the surgical team before proceeding with ostomy creation.

RESULTS

The restrictive policy significantly reduced stoma rates from 38.8 % to 11.1 % (p < 0.001) without increasing anastomotic leaks (stable at 2.5 %, p = 1.000). Predictive factors for stoma included multiple bowel resections, inferior mesenteric artery closure, low anastomosis, and residual tumor. Patients with stomas experienced more severe postoperative complications (p = 0.007), prolonged hospital stays (p < 0.001), and delayed chemotherapy (p = 0.018). No differences in anastomotic leak management were recorded among patients with and without ostomy.

CONCLUSIONS

A restrictive stoma policy reduced ostomy rates without affecting leak rates or mortality, supporting individualized surgical decision-making in ovarian cancer. Prospective studies are needed to clarify risk factors for leaks and validate the necessity of protective stomas.