Influence of temporary faecal diversion on long-term survival after curative surgery for colorectal cancer

Br J Surg. 1995 Jan;82(1):21-5. doi: 10.1002/bjs.1800820108.


Experimental carcinogenesis is enhanced at colorectal anastomoses, inhibited by proximal faecal diversion and promoted by the closure of a defunctioning stoma. The clinical relevance of these observations was investigated in a retrospective study of curative restorative resection for colorectal carcinoma. The 5-year disease-free survival rate (95 per cent confidence interval) in 122 patients with a temporary stoma (50.4 (41.1-59.7) per cent) was significantly reduced (P < 0.01) compared with that in 218 with no stoma (66.8 (59.4-73.5) per cent). In patients with Dukes B tumours early stoma closure (within 3 months of resection) was associated with a worse survival (P < 0.005) and a higher tumour recurrence rate (P < 0.05) than in those with no stoma. Survival rates after late stoma closure were no different from those in patients with no stoma. Multivariate analysis revealed Dukes stage (P < 0.0001), tumour differentiation (P = 0.02) and timing of stoma closure (P = 0.02) as independent predictors of survival. In curative surgery for colorectal cancer temporary faecal diversion confers a survival disadvantage that can be prevented by delayed closure of the stoma.

MeSH terms

  • Adenocarcinoma / mortality*
  • Adenocarcinoma / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Roux-en-Y
  • Colon / surgery
  • Colonic Neoplasms / mortality*
  • Colonic Neoplasms / surgery
  • Colostomy / mortality
  • Disease-Free Survival
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Rectal Neoplasms / mortality*
  • Rectal Neoplasms / surgery
  • Rectum / surgery
  • Regression Analysis
  • Retrospective Studies
  • Survival Rate