Interrupted Ileostomy Tube vs. traditional diverting ileostomy in low rectal cancer: a propensity score–matched retrospective study

Abstract

Aim: Temporary diverting ileostomy protects low colorectal/rectal anastomoses but adds stoma morbidity and a planned reversal. We evaluated an Interrupted Ileostomy Tube as a stoma-sparing diversion strategy.

Methods: We retrospectively analyzed 122 patients undergoing radical resection for low rectal cancer with prophylactic diversion (April 2020 - November 2022): traditional diverting ileostomy (n = 90) vs. Interrupted Ileostomy Tube (n = 32). Outcomes were compared before and after 1:1 propensity-score matching.

Results: The Tube group had shorter diversion-creation time (21.38 ± 4.53 vs. 32.03 ± 8.51 min), earlier first oral intake (3.26 ± 0.99 vs. 5.19 ± 0.95 days), shorter index length of stay (8.73 ± 1.68 vs. 11.50 ± 2.99 days), and lower index-hospitalization cost [4.26 ± 0.62 vs. 5.59 ± 0.89 × 10⁴ CNY (Chinese Yuan)] (all P < 0.001); findings were consistent after matching (24 pairs). Thirty-day morbidity (Clavien-Dindo ≥ II) was similar (12.5% vs. 20.0%, P = 0.343), and clinically relevant anastomotic leak [International Study Group of Rectal Cancer (ISREC) grade B/C] was infrequent (0/32 vs. 2/90). During follow-up, 78/90 (86.7%) traditional patients underwent reversal (131.4 ± 31.2 days), and 8/90 (8.9%) developed late stoma complications; tube removal occurred without reoperation at a median of 15 days [interquartile range (IQR) 14-17.75].

Conclusion: In this retrospective analysis, the Interrupted Ileostomy Tube was associated with faster recovery and lower index costs and avoided planned stoma reversal and late stoma morbidity without an apparent increase in early complications.

Keywords

Rectal cancer / diverting ileostomy / Interrupted Ileostomy Tube / temporary fecal diversion / propensity score matching / postoperative complications

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