A Comparison Study of Two Fecal Diversion Methods Based on Novel Intestinal Stents for Preventing Anastomotic Leakage After Middle and Lower Rectal Cancer Surgery

A Comparison Study of Two Fecal Diversion Methods Based on Novel Intestinal Stents for Preventing Anastomotic Leakage After Middle and Lower Rectal Cancer Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Comparison Study of Two Fecal Diversion Methods Based on Novel Intestinal Stents for Preventing Anastomotic Leakage After Middle and Lower Rectal Cancer Surgery Wei Dayong, Zhou Xiong, Bai Lian, Liu Jia This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5974803/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Oct, 2025 Read the published version in BMC Surgery → Version 1 posted 19 You are reading this latest preprint version Abstract Background: This study aims to evaluate the feasibility and safety of two intestinal fecal diversion methods using novel stents to prevent anastomotic leakage after surgery for middle and lower rectal cancer, and to compare their advantages and disadvantages for clinical application. Methods: A retrospective analysis was conducted on 80 patients who underwent laparoscopic radical resection（LAR） for rectal cancer at Yongchuan Hospital from June 2021 to March 2024. Patients were divided into two groups: 26 in the ileum group (using terminal ileal stents) and 54 in the in situ group (using rectal in situ covered stents). Preoperative, surgical, and postoperative data were compared between the two groups. Results: No significant differences were found in baseline characteristics, surgical data, or the occurrence of postoperative anastomotic leakage (3.8% vs 0%, p=0.325) or other complications (23.1% vs 20.4%, p=0.782). However, the ileum group had a significantly longer total hospital stay (21.5±6.2 vs 17.6±5.0 days, p=0.003), longer postoperative stay (14.5±3.3 vs 12.6±3.7 days, p=0.031), higher hospitalization costs (59085.88±7460.79 vs 48903.58±7094.14 yuan, p<0.001), and longer extubation time (27.0±3.0 vs 8.7±1.4 days, p<0.001) compared to the in situ group. Conclusions: Both fecal diversion methods show acceptable rates of postoperative anastomotic leakage. However, the in situ covered stent method demonstrates advantages in hospital stay, costs, and postoperative management, suggesting it should be favored in clinical practice. Rectal malignant tumors low rectal cancer anastomotic leakage novel intestinal stent Figures Figure 1 Figure 2 Figure 3 Background Rectal cancers, particularly low and middle rectal cancers, account for 70–75% of cases and have a rising incidence[ 1 – 2 ]. Early-stage low rectal cancer often requires abdominoperineal resection, leading to permanent stomas that significantly impact quality of life. Patients increasingly prefer anus-preserving surgeries, raising the risk of anastomotic leakage, the most common complication of laparoscopic radical resection[ 3 ], which can cause severe infections and higher hospitalization costs. While creating a preventive stoma of the terminal ileum can prevent infections after leakage[ 4 – 5 ], it necessitates stoma closure, further diminishing quality of life and increasing medical burdens. By using a novel intestinal stent, our department innovatively implemented two different surgical methods to replace preventive ostomy: intestinal fecal diversion via a terminal ileal stent and intestinal fecal diversion via a rectal in situ covered stent. This study aimed to compare the safety and feasibility of two novel and distinct surgical methods preventing anastomotic leakage in patients with low rectal cancer. Methods 1.1 Research objects The data of patients with low rectal cancer who underwent laparoscopic radical resection (low anterior resection, LAR) at Yongchuan Hospital Affiliated with Chongqing Medical University between June 2021 and June 2023 were retrospectively analyzed. After applying the inclusion and exclusion criteria outlined below, a total of 80 patients were included. Among them, 26 patients who underwent intestinal fecal diversion with terminal ileal stents composed the ileum group, and 54 patients who underwent intestinal fecal diversion with rectal in situ covered stents composed the in situ group. Ethical approval was obtained from the ethics committee of the Yongchuan Affiliated Hospital of Chongqing Medical University (202260). All patients signed the informed consents. 1.2 Inclusion and exclusion criteria Inclusion criteria: a diagnosis of a malignant rectal tumor, laparoscopic radical resection for rectal cancer (LAR), a distance between the distal end of the tumor and the anus of at most 8 cm, and implantation with one of the novel intestinal stents for intestinal diversion. Exclusion criteria: the presence of liver, lung or distant metastasis; acute intestinal obstruction; previous laparoscopic surgery; liver cirrhosis or severe malnutrition; and long-term use of glucocorticoids. 1.3 Surgical methods 1.3.1 Ileum group : The terminal ileal stent method was used to replace preventive ostomy, and laparoscopic radical resection for rectal cancer was performed via the standard LAR approach. The stent installation method was as follows: 1) Stent placement: After radical tumor resection, the ileal segment 15–20 cm from the ileocecal region was selected as the bowel segment for diversion. A 2-m transverse incision was made along the small bowel wall to the mesangial border. Then, a novel bio-disintegrable stent (Waken, Zhe Jiang, China) with a diameter corresponding to the intestinal wall was placed (closed type, model: BIS-HB, Figure. 1A), the incision was closed with interrupted sutures, the seromuscular layer was embedded, and the intestinal stent was fixed to the intestinal wall with a 2 − 0 absorbable suture (Johnson & Johnson VICRYL30). 2) Drain placement: A 5-mm longitudinal incision was made along the intestinal wall approximately 5 cm from the proximal end of the stent. Then, an F28 latex drain was placed, the intestinal wall was sutured with 3 − 0 suture, and the latex drain was fixed with a semipurse-string suture. 3) Drain fixation: An incision of approximately 1 cm was made at the lateral edge of the right upper rectus abdominis. The latex drain was pulled out of the abdominal cavity, the bowel wall around the drain was sutured to the peritoneum, and the latex drain was sutured and fixed in the dermis. For more information on the novel stent and surgical methods, please refer to previous articles published by our team[ 6 ]. 1.3.2 In situ group : A rectal in situ covered stent was used for intestinal diversion, and laparoscopic radical resection of rectal cancer was also performed via standard LAR approach. The stent installation method was as follows: 1) Assembly: the cover (balloon with the closed end cut off) was fixed to the outer surface of the novel bio-disintegrable stent (hollow type, model: BIS-H, Figure. 1B) with non-absorbable No. 10 suture, and the end of the cover was tied tightly with the suture for later use. 2) Placement: the disintegrable covered stent was placed completely in the proximal colonic lumen, approximately 5 cm from the stumped end of the colon. 3) Fixation: outside the intestinal tube, 2 − 0 absorbable sutures (Johnson & Johnson VICRYL30) were used to fix the stent onto the intestinal tube. 4) Anastomosis: the proximal colon stump was sutured with a purse-string suture, and the sigmoid colon and the distal rectum were anastomosed with a disposable tubular stapler. An inflation test was performed through the anus after formation of the anastomosis to ensure that the anastomosis was well crafted. During the operation, the suture at the end of the cover was tied to the mushroom head of the tubular stapler to facilitate the subsequent operation. 5) Adjustment: the cover was pulled out from the anus through the suture at the end of the cover and placed outside the anus, and the terminal sutures were cut. For details on the surgical methods, please refer to the published articles by our team[ 7 ]. 1.4 Postoperative management Patients in the ileum group were required to keep the ileostomy tube unobstructed after the surgery. The daily drainage volume was recorded, and if the volume was significantly reduced, the patient was asked to carefully monitor for obstructions of the ostomy tube. Angiography was performed 7 days after surgery, before discharge, and before extubation to confirm the patency of the tube and completeness of the diversion. In the in situ group, the angiographic examination was performed 7 days after surgery (covering the area between the rectal wall and the cover through the anus) to confirm complete diversion and that the stent had been expelled from the body. Figure. 2 parts A - B - C - D shows postoperative angiographic images from patients in the ileum group, and Figure. 3 parts A - B - C - D shows postoperative angiographic images from patients in the in situ group and colonoscopy images 3 months after surgery. 1.5 Data collection For both groups, general data, including sex, age, history of hypertension, diabetes, history of heart disease, history of emphysema, Nutritional Risk Screening 2002 (NRS-2002) score, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and preoperative hemoglobin (Hb) and albumin (ALB) levels, were collected. Surgical data included the duration of surgery, the amount of surgical blood loss, the location of the tumor, the distance between the distal resection margin and the tumor, the distance from the anastomotic stoma to the anus, the number of reinforced reloads, the tumor diameter, the pathological tumor-node-metastasis (pTNM) stage, the number of lymph nodes dissected, and the number of positive lymph nodes. Postoperative data included whether ileostomy was performed, whether there was anastomotic leakage, the total length of hospitalization stay, the length of postoperative hospital stay, the presence of other related complications (such as lung infection, urinary tract infection, tube detachment, chyle leakage, and wound infection), the postoperative extubation time (time to remove all drainage tubes), the time to the first postoperative chemotherapy, and the total hospitalization costs. 1.6 Statistical methods SPSS 25.0 was used to analyze the data. Measurement data are expressed as‾ x ± s; data that conformed to a normal distribution were compared between groups with the t test, whereas those that were not were compared between groups with a nonparametric test (Mann-Whitney U). Count data are described as n (%), and intergroup comparisons were performed with the Pearson chi-square test. The difference of P < 0.05 has statistical significance. Results 2.1 Preoperative general information There were no significant differences in the male-to-female ratio, age, BMI, preoperative NRS 2002 score, ASA classification, preoperative HB or ALB levels, or number of patients with comorbidities (heart disease, chronic obstructive pulmonary disease (COPD), diabetes, or hypertension) between the ileum group and the in situ group (p > 0.05) (Table 1 ). Table 1 The preoperative general data of the two groups of patients Item Group Ileum group (n = 26) In situ group (n = 54) p Sex 0.845 Male 16(61.5) 32(59.3) Women 10(38.5) 22(40.7) Age (years) 61.2 ± 11.5 65.7 ± 10.8 0.091 BMI (kg/m 2 ) 23.6 ± 3.1 22.8 ± 2.8 0.235 NRS2002 0.728 ≥ 3 6(23.1) 16(29.6) < 3 20(76.9) 38(70.4) ASA 0.430 ≥III 7(53.8) 24(44.4) <III 6(46.2) 30(55.6) Preoperative HB (g/L) 127.7 ± 21.0 124.6 ± 21.6 0.558 Preoperative ALB (g/L) 40.5 ± 3.2 40.4 ± 3.6 0.913 Heart disease 0(0) 1(1.9) 1 COPD 1(3.8) 7(13.0) 0.381 Diabetes 4(15.4) 11(20.4) 0.819 Hypertension 6(23.1) 20(37.0) 0.212 2.2 Surgery and tumor staging None of the surgery-related conditions or tumor characteristics, including the surgical duration, the number of reinforced reloads, the volume of intraoperative blood loss, the length of the tumor, the distance to the distal resection margin, the distance between the anastomotic stoma and the anus, the tumor diameter, the total number of dissected lymph nodes, the number of positive lymph nodes, or the proportions of patients with different TNM stages, were significantly different between the ileum group and the in situ group (p > 0.05), as shown in Table 2 . Table 2 The surgical and tumor staging situations of the two groups of patients Item Group Ileum group (n = 26) In situ group (n = 54) p Surgery time (min) 222.2 ± 32.0 237.9 ± 59.0 0.128 Number of reinforced reloads (pieces) 1.6 ± 0.5 1.7 ± 0.6 0.434 Intraoperative blood loss (ml) 49.6 ± 23.0 57.6 ± 47.9 0.318 Tumor length (cm) 7.6 ± 1.4 8.1 ± 2.4 0.335 Distance from anastomotic stoma to anus (cm) 5.0 ± 1.0 5.7 ± 2.2 0.059 Tumor diameter (cm) 3.6 ± 1.0 3.9 ± 1.3 0.387 Number of dissected lymph nodes 16.4 ± 6.4 13.8 ± 6.7 0.102 Number of positive lymph nodes 0.6 ± 1.1 1.0 ± 2.2 0.162 TNM stage 0.985 Stage I 4 9 Stage II 10 21 Stage III 12 24 2.3 Safety indicators (e.g., postoperative complications) One patient in the ileal group and none in the in situ group experienced postoperative anastomotic leakage (3.8% vs 0%, p = 0.325); the difference was not statistically significant. The patient who experienced anastomotic leakage was treated with ostomy. There were no significant differences in the incidences of other postoperative complications (p > 0.05). The total length of hospital stay in the ileum group (21.5 ± 6.2 vs 17.6 ± 5.0, p = 0.003) and the length of postoperative hospital stay in the ileum group (14.5 ± 3.3 vs 12.6 ± 3.7, p = 0.031) were significantly greater than those in the in situ group. The total hospitalization costs of the ileum group were significantly greater than those of the in situ group (59085.88 ± 7460.79 vs 48903.58 ± 7094.14, p < 0.001), and the extubation time in the ileum group was significantly greater than that in the in situ group (27.0 ± 3.0 vs 8.7 ± 1.4, p < 0.001). The time to the first chemotherapy session after surgery in the ileum group was significantly later than that in the in situ group (42.6 ± 8.8 vs 28.2 ± 5.8, p < 0.001) (Table 3 ). Table 3 The postoperative safety indicators and complication situations of the two groups of patients Item Group Ileum group (n = 26) In situ group (n = 54) p Anastomotic fistulae 1(3.8) 0(0) 0.325 Ileostomy 1(3.8) 0(0) 0.325 Total length of hospital stay (days) 21.5 ± 6.2 17.6 ± 5.0 0.003 Length of postoperative hospital stay (days) 14.5 ± 3.3 12.6 ± 3.7 0.031 Total cost of hospitalization (yuan) 59085.88 ± 7460.79 48903.58 ± 7094.14 < 0.001 Postoperative extubation time (days) 27.0 ± 3.0 8.7 ± 1.4 < 0.001 Time to first chemotherapy session after surgery (days) 42.6 ± 8.8 28.2 ± 5.8 < 0.001 Other postoperative complications 6(23.1) 11(20.4) 0.782 Lung infection 1 4 Urinary tract infection 2 3 Ostomy tube detachment/stent protective cover detachment 2 2 Chyle leakage 1 1 Wound infection 0 1 Discussion To ensure a safe surgery and avoid severe abdominal infection caused by anastomotic leakage, surgeons often employ preventive stomata in anus-preserving surgery for low rectal cancer, which is currently the most mature and effective solution[ 8 ]; however, complications such as stoma prolapse, parastomal hernia, and peristomal infection are possible, requiring stoma closure further reducing the quality of life of the patient while they have the stoma and increasing their economic burden[ 9 – 11 ]. Using a novel intestinal stent, our department innovatively implemented two different surgical methods to replace the preventive stoma, i.e., the terminal ileal stent method and the rectal in situ cover stent method for intestinal diversion. Both surgical methods achieved good results in actual clinical application. The significant advantage of these new surgical methods is that the preventive stoma is replaced, preventing anastomotic leakage, avoiding the need for stoma closure, and reducing the costs of a second surgery and the length of hospitalization, thus reducing the financial burden and surgical pain for the patient. The probability of anastomotic leakage after low rectal cancer surgery is approximately 7–10%, and the risk of Grade C leakage is 5%[ 12 – 14 ]. In this study, one patient experienced Grade C leakage in the ileum group. This patient was admitted to the hospital due to rectal cancer combined with obstruction. The obstruction was relieved after conservative treatment, after which the patient underwent laparoscopic surgery. Owing to edema of the bowel wall and poor preparation of the bowel wall, the patient experienced anastomotic leakage developed peritonitis; after undergoing transverse colostomy, the patient was discharged from the hospital. No patient in the in situ group experienced anastomotic leakage. In this study, the total incidence of anastomotic leakage in the two groups was 1.25%, similar to the findings of previous studies that used preventive stoma, indicating that intestinal diversion via the stent method can effectively divert the fecal stream and reduce the risk of severe abdominal infection caused by anastomotic leakage; moreover, the procedure is safe, effective, and easily translated to for clinical application. Patients with low rectal cancer who receive AR after neoadjuvant therapy are at significantly elevated risk of anastomotic leakage[ 15 ], and thus most surgeons choose to perform preventive ostomy of the terminal ileum. In this study, 3 patients underwent preoperative neoadjuvant therapy, and no anastomotic leakage occurred after surgery via the stent method, indicating that intestinal diversion via the stent method may have more extensive application prospects. However, large-sample data are needed to validate the effectiveness of the procedures. Other postoperative complications occurred in 6 patients in the ileum group, with an incidence of 23.1%, including 2 patients with stoma tube detachment, 1 with lung infection, 2 with urinary tract infection, and 1 with chyle leakage. Eleven patients in the in situ group developed postoperative complications, with an incidence of 20.4%, including 4 patients with lung infection, 3 with urinary tract infection, 1 with chyle leakage, 1 with wound infection, and 2 with stent protective cover detachment. There was no significant difference in the incidence of other complications between the two groups, and the observed incidences were all within the clinically acceptable range and are similar to those reported in previous studies[ 16 – 17 ]. Stoma tube detachment is a serious complication that can lead to intestinal obstruction. In clinical practice, the drainage tube is replaced through angiography to avoid further aggravation and prevent injury to the patient; tube fixation with multiple sutures and intensive postoperative education may reduce the incidence of stoma tube detachment. The stent protective cover fell off in 2 patients in the in situ group on the 3rd and 5th days after surgery. Although no complications, such as anastomotic leakage, occurred after this detachment, the protective cover needs to be in place to properly divert the feces; diversion failure can increase the risk of anastomotic leakage and reduce the trust between the doctor and the patient. When the procedure was initially performed, a latex condom was used as a protective cover in our department. Because the latex condom is relatively weak, however, the protective cover would detach or break if the patient pulled it accidentally. During later implementations of the surgery, a vaginal ultrasound probe cover was used as the protective cover, and no detachment occurred. The length postoperative hospital stay of the ileum group was significantly greater than that of the in situ group (14.5 ± 3.3 vs 12.6 ± 3.7, p = 0.031), as were the total hospitalization costs (59085.88 ± 7460.79 vs 48903.58 ± 7094.14, p < 0.001). In the ileum group, the average stent dissolution time was 3–4 weeks, during which time the patient needed to use a stoma tube to drain the intestinal fluid. The length of stoma tube usage was up to 27.0 ± 3.0 days. During the indwelling tube period, tube detachment and tube obstruction are possible. After surgery, the drainage volume should be closely monitored, and the tube should be irrigated to maintain patency if necessary. These factors increase the difficulty of postoperative management, reduce the confidence of doctors and patients at discharge, and prolong the length of hospitalization. The patients in the in situ group had an abdominal drainage tube for 8.7 ± 1.4 days after surgery, and the patients were discharged from the hospital after they could tolerate a liquid diet. In the postoperative management of the ileum group, to reduce the risk of stoma tube obstruction, a parenteral nutrition support program was often implemented, typically for a longer duration than normal, and 3–5 somatostatin was administered postoperatively to inhibit gastrointestinal tract secretions to reduce the intestinal contents, thus avoiding abdominal infections caused by anastomotic leakage; therefore, the patients started eating solid foods late after surgery. The hospitalization costs of the patients in the ileum group were greater due to the prolonged hospital stays and duration of parenteral nutrition support. In the ileum group, after the stent dissolved and ruptured, the patients were required to undergo digestive tract angiography to confirm that the intestinal tract was unobstructed so that the stoma tube could be removed. After extubation, the opening of the fistula was closed with Vaseline-soaked gauze and was usually healed within 2 to 3 days. Owing to the formation of adhesions between the small intestine wall and the peritoneum, the arrangement and structure of the small intestine in the abdominal cavity is altered, which may increase the incidence of postoperative bowel obstruction and the difficulty of second abdominal surgery. Patients in the ileum group did not develop adhesive bowel obstruction in the short term after surgery, but follow-up is still needed to observe long-term complications. After the stent has dissolved and ruptured, patients treated with the in situ method can pass it out of the body without a second surgical operation, dressing changes or other treatments, and they do not require long-term oral nutrition preparations after surgery, resulting in reduced examination costs. In addition, for patients treated with the rectal in situ covered stent approach, the feces are excreted through normal physiological structures; thus, the postoperative absorption of nutrients, water and electrolytes are not affected, and so the patients tolerated the approach well. Moreover, the intestinal arrangement is not altered during rectal in situ covered stent surgery, which reduces the risk of complications such as long-term intestinal obstruction. According to the National Comprehensive Cancer Network (NCCN) guidelines for rectal cancer and previous clinical studies, patients are recommended to undergo their first adjuvant chemotherapy session 3–4 weeks after surgery for rectal cancer[ 18 – 19 ]. In this study the time to the first chemotherapy session in the ileum and in situ groups was 42.6 ± 8.8 days and 28.2 ± 5.8 days, and the difference was statistically significant (p < 0.05). In the ileum group, the patients needed to wait for the stent to dissolve and the intestinal patency to be restored, allowing them to eat and drink normally for approximately 3–4 weeks. After extubation, the intestinal fistula wound healed completely within approximately 1 week. Since premature chemotherapy would affect the healing of the intestinal fistula wound, the time until for the first cycle of chemotherapy could be started in the ileum group was significantly longer than that of the in situ group. Such a delay for the first round of chemotherapy after surgery may affect the long-term outcomes of rectal cancer patients, increase the risk of local recurrence and distant metastasis, and reduce overall and progression-free survival. In the future, we plan to carry out further relevant studies to more thoroughly assess the impact of chemotherapy session delay on these patients[ 20 – 21 ]. Conclusions Both surgical methods effectively prevented anastomotic leakage in low rectal cancer patients, with only one patient experienced Grade C leakage in the ileum group, who was discharged after transverse colostomy. These novel stent fecal diversion methods provide alternatives to stoma creation, alleviating patient burdens. The rectal in situ covered stent method significantly reduced hospital stay, costs, drainage tube indwelling time, and delays for postoperative chemotherapy compared to the terminal ileal stent method, making it preferable for clinical use. Future multicenter, prospective studies are needed to confirm these findings and assess long-term outcomes. Abbreviations Original words abbreviations laparoscopic radical resection LAR Nutritional Risk Screening 2002 score NRS2002 body mass index BMI American Society of Anesthesiologists classification ASA preoperative hemoglobin Hb albumin levels ALB pathological tumor-node-metastasis stage pTNM chronic obstructive pulmonary disease COPD the National Comprehensive Cancer Network NCCN Declarations Ethics approval and consent to participate: Ethical approval was obtained from the ethics committee of the Yongchuan Affiliated Hospital of Chongqing Medical University (202260). All patients signed the informed consents. Consent for publication: We have obtained the consent of all relevant research subjects to publish our study. Availability of data and materials: The datasets analysed during the current study are available from the corresponding author on reasonable request. Competing interests: All authors declare have nothing to disclose and none of the authors have any conflicts of interest pertaining to this work. Funding: There was no financial support for this study. Authors' contributions: Wei Dayong: Have drafted the work or substantively revised it Liu Jia: The acquisition, analysis, interpretation of data Zhou Xiong: Design of the work Bai Lian: Guided the whole research process and conducted quality control Acknowledgements: We thank AJE for language editing services, family support, and departmental colleagues for their support Clinical Trial Number ： not applicable References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74(3):229–263. doi: 10.3322/caac.21834. Epub 2024 Apr 4. PMID: 38572751. Lang D, Ciombor KK. 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The optimal time of starting adjuvant chemotherapy after curative surgery in patients with colorectal cancer. BMC Cancer. 2023;23(1):422. 10.1186/s12885-023-10863-w . PMID: 37161562; PMCID: PMC10170689. Gögenur M, Rosen AW, Iveson T, Kerr RS, Saunders MP, Cassidy J, Tabernero J, Haydon A, Glimelius B, Harkin A, Allan K, Pearson S, Boyd KA, Briggs AH, Waterston A, Medley L, Ellis R, Dhadda AS, Harrison M, Falk S, Rees C, Olesen RK, Propper D, Bridgewater J, Azzabi A, Cunningham D, Hickish T, Gollins S, Wasan HS, Kelly C, Gögenur I, Holländer NH. Time From Colorectal Cancer Surgery to Adjuvant Chemotherapy: Post Hoc Analysis of the SCOT Randomized Clinical Trial. JAMA Surg. 2024;159(8):865–71. 10.1001/jamasurg.2024.1555 . PMID: 38865139; PMCID: PMC11170448. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Oct, 2025 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 06 May, 2025 Reviews received at journal 06 May, 2025 Reviews received at journal 03 May, 2025 Reviews received at journal 30 Apr, 2025 Reviewers agreed at journal 30 Apr, 2025 Reviewers agreed at journal 28 Apr, 2025 Reviewers agreed at journal 27 Apr, 2025 Reviewers agreed at journal 25 Apr, 2025 Reviews received at journal 20 Apr, 2025 Reviewers agreed at journal 06 Apr, 2025 Reviewers agreed at journal 23 Feb, 2025 Reviews received at journal 19 Feb, 2025 Reviewers agreed at journal 19 Feb, 2025 Reviewers agreed at journal 17 Feb, 2025 Reviewers invited by journal 17 Feb, 2025 Editor invited by journal 14 Feb, 2025 Editor assigned by journal 13 Feb, 2025 Submission checks completed at journal 13 Feb, 2025 First submitted to journal 06 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5974803","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":416422867,"identity":"ab83373a-b365-475d-8dab-5810a16a7b17","order_by":0,"name":"Wei Dayong","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Dayong","suffix":""},{"id":416422868,"identity":"88be6f20-a845-4efd-bbcf-ae0d3100cca5","order_by":1,"name":"Zhou Xiong","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Zhou","middleName":"","lastName":"Xiong","suffix":""},{"id":416422869,"identity":"7bc7c621-75ae-4de9-9ec7-34c0708f1c50","order_by":2,"name":"Bai Lian","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Bai","middleName":"","lastName":"Lian","suffix":""},{"id":416422870,"identity":"377d30b0-99d9-4fe1-81fd-d22bbe07a120","order_by":3,"name":"Liu Jia","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYBACPmYGBoMEBgY5fvbGxocfiNHCBtViLNlzuNlYgigtUDpxw430NgEeorSw8xgUPKg5nLjh5sM2BgkGOzndBoIO4zEwSDh22Hjm7cS2BwUMycZmB4jSwnZbtu92YruBBMOBxG3Eafl3m7Hh5sE2CR6itSS23VaccIORaC1sBQaJff+BgZwIDGQDIvzCz394m+GPb2nAqDz+8OGHCjs5glpAFhkg2Aa4lSED5gfEqRsFo2AUjIIRCwDyPUAA1mlrlAAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Liu","middleName":"","lastName":"Jia","suffix":""}],"badges":[],"createdAt":"2025-02-06 15:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5974803/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5974803/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-025-03201-3","type":"published","date":"2025-10-06T15:57:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":76574296,"identity":"c27832f4-d927-430f-88ea-c637c8d409f0","added_by":"auto","created_at":"2025-02-18 14:05:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":342208,"visible":true,"origin":"","legend":"\u003cp\u003eNovel biocompatible stents a: Closed type. b: Hollow type. c: Surgical rendering of the Ileum group. d: Surgical rendering of the In situ group\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5974803/v1/7fe8afaac33f1939a7cdaf3d.png"},{"id":76572244,"identity":"c5f32d44-0ac9-45bd-aec5-4e91e5cfa657","added_by":"auto","created_at":"2025-02-18 13:49:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":414192,"visible":true,"origin":"","legend":"\u003cp\u003ea: Angiographic images from patients in the ileum group, showing the ileostomy tube 7 days after surgery; no contrast agent has passed between the stent and the bowel wall. b: Angiographic images from patients in the ileum group, showing the ileostomy tube 14 days after surgery; no contrast agent has passed through the bowel wall. c, d: Angiographic images from the patients in the ileum group, showing the ileostomy tube 27 days after surgery. Ruptured stent fragments are observed in the ascending colon, and the contrast agent has passed through the small intestine.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5974803/v1/0b66a6b0385cb85a7c2ea627.png"},{"id":76572253,"identity":"ea19e04b-c716-4325-9f2e-43dee4f07f42","added_by":"auto","created_at":"2025-02-18 13:49:25","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":645189,"visible":true,"origin":"","legend":"\u003cp\u003ea: Angiographic images from patients in the in situ group 7 days after surgery, covering the area between the rectal wall and the cover through the anus; no contrast is shown to have leaked into the proximal colon. b: The novel intestinal stent has been completely extruded from the body in a patient from the in situ group 23 days after surgery. c, d: Three months after surgery, the anastomotic stoma is smooth, and the intestinal segment with the stent fixed to the proximal end of anastomotic stoma has not stenosed.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5974803/v1/edaf74cd07e2648eb071dbbf.png"},{"id":93419915,"identity":"15d2cf61-6c85-460d-9e93-bb08ec48763a","added_by":"auto","created_at":"2025-10-13 16:08:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2391412,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5974803/v1/6c152506-728a-422d-be6a-78d59f863c9b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Comparison Study of Two Fecal Diversion Methods Based on Novel Intestinal Stents for Preventing Anastomotic Leakage After Middle and Lower Rectal Cancer Surgery","fulltext":[{"header":"Background","content":"\u003cp\u003eRectal cancers, particularly low and middle rectal cancers, account for 70\u0026ndash;75% of cases and have a rising incidence[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Early-stage low rectal cancer often requires abdominoperineal resection, leading to permanent stomas that significantly impact quality of life. Patients increasingly prefer anus-preserving surgeries, raising the risk of anastomotic leakage, the most common complication of laparoscopic radical resection[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], which can cause severe infections and higher hospitalization costs. While creating a preventive stoma of the terminal ileum can prevent infections after leakage[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], it necessitates stoma closure, further diminishing quality of life and increasing medical burdens.\u003c/p\u003e \u003cp\u003eBy using a novel intestinal stent, our department innovatively implemented two different surgical methods to replace preventive ostomy: intestinal fecal diversion via a terminal ileal stent and intestinal fecal diversion via a rectal in situ covered stent. This study aimed to compare the safety and feasibility of two novel and distinct surgical methods preventing anastomotic leakage in patients with low rectal cancer.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003e1.1 Research objects\u003c/h2\u003e\n\u003cp\u003eThe data of patients with low rectal cancer who underwent laparoscopic radical resection (low anterior resection, LAR) at Yongchuan Hospital Affiliated with Chongqing Medical University between June 2021 and June 2023 were retrospectively analyzed. After applying the inclusion and exclusion criteria outlined below, a total of 80 patients were included. Among them, 26 patients who underwent intestinal fecal diversion with terminal ileal stents composed the ileum group, and 54 patients who underwent intestinal fecal diversion with rectal in situ covered stents composed the in situ group. Ethical approval was obtained from the ethics committee of the Yongchuan Affiliated Hospital of Chongqing Medical University (202260). All patients signed the informed consents.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003e1.2 Inclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003eInclusion criteria: a diagnosis of a malignant rectal tumor, laparoscopic radical resection for rectal cancer (LAR), a distance between the distal end of the tumor and the anus of at most 8 cm, and implantation with one of the novel intestinal stents for intestinal diversion.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: the presence of liver, lung or distant metastasis; acute intestinal obstruction; previous laparoscopic surgery; liver cirrhosis or severe malnutrition; and long-term use of glucocorticoids.\u003c/p\u003e\n\u003ch3\u003e1.3 Surgical methods\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003e1.3.1 Ileum group\u003c/em\u003e: The terminal ileal stent method was used to replace preventive ostomy, and laparoscopic radical resection for rectal cancer was performed via the standard LAR approach. The stent installation method was as follows: 1) Stent placement: After radical tumor resection, the ileal segment 15\u0026ndash;20 cm from the ileocecal region was selected as the bowel segment for diversion. A 2-m transverse incision was made along the small bowel wall to the mesangial border. Then, a novel bio-disintegrable stent (Waken, Zhe Jiang, China) with a diameter corresponding to the intestinal wall was placed (closed type, model: BIS-HB, Figure. 1A), the incision was closed with interrupted sutures, the seromuscular layer was embedded, and the intestinal stent was fixed to the intestinal wall with a 2\u0026thinsp;\u0026minus;\u0026thinsp;0 absorbable suture (Johnson \u0026amp; Johnson VICRYL30). 2) Drain placement: A 5-mm longitudinal incision was made along the intestinal wall approximately 5 cm from the proximal end of the stent. Then, an F28 latex drain was placed, the intestinal wall was sutured with 3\u0026thinsp;\u0026minus;\u0026thinsp;0 suture, and the latex drain was fixed with a semipurse-string suture. 3) Drain fixation: An incision of approximately 1 cm was made at the lateral edge of the right upper rectus abdominis. The latex drain was pulled out of the abdominal cavity, the bowel wall around the drain was sutured to the peritoneum, and the latex drain was sutured and fixed in the dermis. For more information on the novel stent and surgical methods, please refer to previous articles published by our team[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e1.3.2 In situ group\u003c/em\u003e: A rectal in situ covered stent was used for intestinal diversion, and laparoscopic radical resection of rectal cancer was also performed via standard LAR approach. The stent installation method was as follows: 1) Assembly: the cover (balloon with the closed end cut off) was fixed to the outer surface of the novel bio-disintegrable stent (hollow type, model: BIS-H, Figure. 1B) with non-absorbable No. 10 suture, and the end of the cover was tied tightly with the suture for later use. 2) Placement: the disintegrable covered stent was placed completely in the proximal colonic lumen, approximately 5 cm from the stumped end of the colon. 3) Fixation: outside the intestinal tube, 2\u0026thinsp;\u0026minus;\u0026thinsp;0 absorbable sutures (Johnson \u0026amp; Johnson VICRYL30) were used to fix the stent onto the intestinal tube. 4) Anastomosis: the proximal colon stump was sutured with a purse-string suture, and the sigmoid colon and the distal rectum were anastomosed with a disposable tubular stapler. An inflation test was performed through the anus after formation of the anastomosis to ensure that the anastomosis was well crafted. During the operation, the suture at the end of the cover was tied to the mushroom head of the tubular stapler to facilitate the subsequent operation. 5) Adjustment: the cover was pulled out from the anus through the suture at the end of the cover and placed outside the anus, and the terminal sutures were cut. For details on the surgical methods, please refer to the published articles by our team[\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e1.4 Postoperative management\u003c/h3\u003e\n\u003cp\u003ePatients in the ileum group were required to keep the ileostomy tube unobstructed after the surgery. The daily drainage volume was recorded, and if the volume was significantly reduced, the patient was asked to carefully monitor for obstructions of the ostomy tube. Angiography was performed 7 days after surgery, before discharge, and before extubation to confirm the patency of the tube and completeness of the diversion. In the in situ group, the angiographic examination was performed 7 days after surgery (covering the area between the rectal wall and the cover through the anus) to confirm complete diversion and that the stent had been expelled from the body. Figure. 2 parts A - B - C - D shows postoperative angiographic images from patients in the ileum group, and Figure. 3 parts A - B - C - D shows postoperative angiographic images from patients in the in situ group and colonoscopy images 3 months after surgery.\u003c/p\u003e\n\u003ch3\u003e1.5 Data collection\u003c/h3\u003e\n\u003cp\u003eFor both groups, general data, including sex, age, history of hypertension, diabetes, history of heart disease, history of emphysema, Nutritional Risk Screening 2002 (NRS-2002) score, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and preoperative hemoglobin (Hb) and albumin (ALB) levels, were collected.\u003c/p\u003e\n\u003cp\u003eSurgical data included the duration of surgery, the amount of surgical blood loss, the location of the tumor, the distance between the distal resection margin and the tumor, the distance from the anastomotic stoma to the anus, the number of reinforced reloads, the tumor diameter, the pathological tumor-node-metastasis (pTNM) stage, the number of lymph nodes dissected, and the number of positive lymph nodes.\u003c/p\u003e\n\u003cp\u003ePostoperative data included whether ileostomy was performed, whether there was anastomotic leakage, the total length of hospitalization stay, the length of postoperative hospital stay, the presence of other related complications (such as lung infection, urinary tract infection, tube detachment, chyle leakage, and wound infection), the postoperative extubation time (time to remove all drainage tubes), the time to the first postoperative chemotherapy, and the total hospitalization costs.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003e1.6 Statistical methods\u003c/h2\u003e\n\u003cp\u003eSPSS 25.0 was used to analyze the data. Measurement data are expressed as\u0026oline; x\u0026thinsp;\u0026plusmn;\u0026thinsp;s; data that conformed to a normal distribution were compared between groups with the t test, whereas those that were not were compared between groups with a nonparametric test (Mann-Whitney U). Count data are described as n (%), and intergroup comparisons were performed with the Pearson chi-square test. The difference of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 has statistical significance.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Preoperative general information\u003c/h2\u003e \u003cp\u003eThere were no significant differences in the male-to-female ratio, age, BMI, preoperative NRS 2002 score, ASA classification, preoperative HB or ALB levels, or number of patients with comorbidities (heart disease, chronic obstructive pulmonary disease (COPD), diabetes, or hypertension) between the ileum group and the in situ group (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe preoperative general data of the two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003cp\u003e Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIleum group (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn situ group (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.845\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32(59.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22(40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS2002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(76.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38(70.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(44.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30(55.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative HB (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e127.7\u0026thinsp;\u0026plusmn;\u0026thinsp;21.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124.6\u0026thinsp;\u0026plusmn;\u0026thinsp;21.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative ALB (g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.381\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.819\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Surgery and tumor staging\u003c/h2\u003e \u003cp\u003eNone of the surgery-related conditions or tumor characteristics, including the surgical duration, the number of reinforced reloads, the volume of intraoperative blood loss, the length of the tumor, the distance to the distal resection margin, the distance between the anastomotic stoma and the anus, the tumor diameter, the total number of dissected lymph nodes, the number of positive lymph nodes, or the proportions of patients with different TNM stages, were significantly different between the ileum group and the in situ group (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe surgical and tumor staging situations of the two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003cp\u003e Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eIleum group (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIn situ group (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSurgery time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e222.2\u0026thinsp;\u0026plusmn;\u0026thinsp;32.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e237.9\u0026thinsp;\u0026plusmn;\u0026thinsp;59.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of reinforced reloads (pieces)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntraoperative blood loss (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.6\u0026thinsp;\u0026plusmn;\u0026thinsp;23.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.6\u0026thinsp;\u0026plusmn;\u0026thinsp;47.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTumor length (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.335\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDistance from anastomotic stoma to anus (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.7\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTumor diameter (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of dissected lymph nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.8\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNumber of positive lymph nodes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTNM stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStage I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStage II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStage III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Safety indicators (e.g., postoperative complications)\u003c/h2\u003e \u003cp\u003eOne patient in the ileal group and none in the in situ group experienced postoperative anastomotic leakage (3.8% vs 0%, p\u0026thinsp;=\u0026thinsp;0.325); the difference was not statistically significant. The patient who experienced anastomotic leakage was treated with ostomy. There were no significant differences in the incidences of other postoperative complications (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The total length of hospital stay in the ileum group (21.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 vs 17.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0, p\u0026thinsp;=\u0026thinsp;0.003) and the length of postoperative hospital stay in the ileum group (14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 vs 12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7, p\u0026thinsp;=\u0026thinsp;0.031) were significantly greater than those in the in situ group. The total hospitalization costs of the ileum group were significantly greater than those of the in situ group (59085.88\u0026thinsp;\u0026plusmn;\u0026thinsp;7460.79 vs 48903.58\u0026thinsp;\u0026plusmn;\u0026thinsp;7094.14, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the extubation time in the ileum group was significantly greater than that in the in situ group (27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 vs 8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The time to the first chemotherapy session after surgery in the ileum group was significantly later than that in the in situ group (42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 vs 28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe postoperative safety indicators and complication situations of the two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003cp\u003e Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIleum group (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIn situ group (n\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnastomotic fistulae\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIleostomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal length of hospital stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of postoperative hospital stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal cost of hospitalization (yuan)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59085.88\u0026thinsp;\u0026plusmn;\u0026thinsp;7460.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48903.58\u0026thinsp;\u0026plusmn;\u0026thinsp;7094.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative extubation time (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to first chemotherapy session after surgery (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther postoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOstomy tube detachment/stent protective cover detachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChyle leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo ensure a safe surgery and avoid severe abdominal infection caused by anastomotic leakage, surgeons often employ preventive stomata in anus-preserving surgery for low rectal cancer, which is currently the most mature and effective solution[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]; however, complications such as stoma prolapse, parastomal hernia, and peristomal infection are possible, requiring stoma closure further reducing the quality of life of the patient while they have the stoma and increasing their economic burden[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Using a novel intestinal stent, our department innovatively implemented two different surgical methods to replace the preventive stoma, i.e., the terminal ileal stent method and the rectal in situ cover stent method for intestinal diversion. Both surgical methods achieved good results in actual clinical application. The significant advantage of these new surgical methods is that the preventive stoma is replaced, preventing anastomotic leakage, avoiding the need for stoma closure, and reducing the costs of a second surgery and the length of hospitalization, thus reducing the financial burden and surgical pain for the patient.\u003c/p\u003e \u003cp\u003eThe probability of anastomotic leakage after low rectal cancer surgery is approximately 7\u0026ndash;10%, and the risk of Grade C leakage is 5%[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In this study, one patient experienced Grade C leakage in the ileum group. This patient was admitted to the hospital due to rectal cancer combined with obstruction. The obstruction was relieved after conservative treatment, after which the patient underwent laparoscopic surgery. Owing to edema of the bowel wall and poor preparation of the bowel wall, the patient experienced anastomotic leakage developed peritonitis; after undergoing transverse colostomy, the patient was discharged from the hospital. No patient in the in situ group experienced anastomotic leakage. In this study, the total incidence of anastomotic leakage in the two groups was 1.25%, similar to the findings of previous studies that used preventive stoma, indicating that intestinal diversion via the stent method can effectively divert the fecal stream and reduce the risk of severe abdominal infection caused by anastomotic leakage; moreover, the procedure is safe, effective, and easily translated to for clinical application. Patients with low rectal cancer who receive AR after neoadjuvant therapy are at significantly elevated risk of anastomotic leakage[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and thus most surgeons choose to perform preventive ostomy of the terminal ileum. In this study, 3 patients underwent preoperative neoadjuvant therapy, and no anastomotic leakage occurred after surgery via the stent method, indicating that intestinal diversion via the stent method may have more extensive application prospects. However, large-sample data are needed to validate the effectiveness of the procedures.\u003c/p\u003e \u003cp\u003eOther postoperative complications occurred in 6 patients in the ileum group, with an incidence of 23.1%, including 2 patients with stoma tube detachment, 1 with lung infection, 2 with urinary tract infection, and 1 with chyle leakage. Eleven patients in the in situ group developed postoperative complications, with an incidence of 20.4%, including 4 patients with lung infection, 3 with urinary tract infection, 1 with chyle leakage, 1 with wound infection, and 2 with stent protective cover detachment. There was no significant difference in the incidence of other complications between the two groups, and the observed incidences were all within the clinically acceptable range and are similar to those reported in previous studies[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Stoma tube detachment is a serious complication that can lead to intestinal obstruction. In clinical practice, the drainage tube is replaced through angiography to avoid further aggravation and prevent injury to the patient; tube fixation with multiple sutures and intensive postoperative education may reduce the incidence of stoma tube detachment. The stent protective cover fell off in 2 patients in the in situ group on the 3rd and 5th days after surgery. Although no complications, such as anastomotic leakage, occurred after this detachment, the protective cover needs to be in place to properly divert the feces; diversion failure can increase the risk of anastomotic leakage and reduce the trust between the doctor and the patient. When the procedure was initially performed, a latex condom was used as a protective cover in our department. Because the latex condom is relatively weak, however, the protective cover would detach or break if the patient pulled it accidentally. During later implementations of the surgery, a vaginal ultrasound probe cover was used as the protective cover, and no detachment occurred.\u003c/p\u003e \u003cp\u003eThe length postoperative hospital stay of the ileum group was significantly greater than that of the in situ group (14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 vs 12.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7, p\u0026thinsp;=\u0026thinsp;0.031), as were the total hospitalization costs (59085.88\u0026thinsp;\u0026plusmn;\u0026thinsp;7460.79 vs 48903.58\u0026thinsp;\u0026plusmn;\u0026thinsp;7094.14, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the ileum group, the average stent dissolution time was 3\u0026ndash;4 weeks, during which time the patient needed to use a stoma tube to drain the intestinal fluid. The length of stoma tube usage was up to 27.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0 days. During the indwelling tube period, tube detachment and tube obstruction are possible. After surgery, the drainage volume should be closely monitored, and the tube should be irrigated to maintain patency if necessary. These factors increase the difficulty of postoperative management, reduce the confidence of doctors and patients at discharge, and prolong the length of hospitalization. The patients in the in situ group had an abdominal drainage tube for 8.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 days after surgery, and the patients were discharged from the hospital after they could tolerate a liquid diet. In the postoperative management of the ileum group, to reduce the risk of stoma tube obstruction, a parenteral nutrition support program was often implemented, typically for a longer duration than normal, and 3\u0026ndash;5 somatostatin was administered postoperatively to inhibit gastrointestinal tract secretions to reduce the intestinal contents, thus avoiding abdominal infections caused by anastomotic leakage; therefore, the patients started eating solid foods late after surgery. The hospitalization costs of the patients in the ileum group were greater due to the prolonged hospital stays and duration of parenteral nutrition support.\u003c/p\u003e \u003cp\u003eIn the ileum group, after the stent dissolved and ruptured, the patients were required to undergo digestive tract angiography to confirm that the intestinal tract was unobstructed so that the stoma tube could be removed. After extubation, the opening of the fistula was closed with Vaseline-soaked gauze and was usually healed within 2 to 3 days. Owing to the formation of adhesions between the small intestine wall and the peritoneum, the arrangement and structure of the small intestine in the abdominal cavity is altered, which may increase the incidence of postoperative bowel obstruction and the difficulty of second abdominal surgery. Patients in the ileum group did not develop adhesive bowel obstruction in the short term after surgery, but follow-up is still needed to observe long-term complications. After the stent has dissolved and ruptured, patients treated with the in situ method can pass it out of the body without a second surgical operation, dressing changes or other treatments, and they do not require long-term oral nutrition preparations after surgery, resulting in reduced examination costs. In addition, for patients treated with the rectal in situ covered stent approach, the feces are excreted through normal physiological structures; thus, the postoperative absorption of nutrients, water and electrolytes are not affected, and so the patients tolerated the approach well. Moreover, the intestinal arrangement is not altered during rectal in situ covered stent surgery, which reduces the risk of complications such as long-term intestinal obstruction.\u003c/p\u003e \u003cp\u003eAccording to the National Comprehensive Cancer Network (NCCN) guidelines for rectal cancer and previous clinical studies, patients are recommended to undergo their first adjuvant chemotherapy session 3\u0026ndash;4 weeks after surgery for rectal cancer[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In this study the time to the first chemotherapy session in the ileum and in situ groups was 42.6\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8 days and 28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8 days, and the difference was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In the ileum group, the patients needed to wait for the stent to dissolve and the intestinal patency to be restored, allowing them to eat and drink normally for approximately 3\u0026ndash;4 weeks. After extubation, the intestinal fistula wound healed completely within approximately 1 week. Since premature chemotherapy would affect the healing of the intestinal fistula wound, the time until for the first cycle of chemotherapy could be started in the ileum group was significantly longer than that of the in situ group. Such a delay for the first round of chemotherapy after surgery may affect the long-term outcomes of rectal cancer patients, increase the risk of local recurrence and distant metastasis, and reduce overall and progression-free survival. In the future, we plan to carry out further relevant studies to more thoroughly assess the impact of chemotherapy session delay on these patients[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eBoth surgical methods effectively prevented anastomotic leakage in low rectal cancer patients, with only one patient experienced Grade C leakage in the ileum group, who was discharged after transverse colostomy. These novel stent fecal diversion methods provide alternatives to stoma creation, alleviating patient burdens. The rectal in situ covered stent method significantly reduced hospital stay, costs, drainage tube indwelling time, and delays for postoperative chemotherapy compared to the terminal ileal stent method, making it preferable for clinical use. Future multicenter, prospective studies are needed to confirm these findings and assess long-term outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOriginal words\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eabbreviations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003elaparoscopic radical resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLAR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNutritional Risk Screening 2002 score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNRS2002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ebody mass index\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAmerican Society of Anesthesiologists \u0026nbsp; classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eASA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003epreoperative hemoglobin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ealbumin levels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eALB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003epathological tumor-node-metastasis \u0026nbsp; stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003epTNM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003echronic obstructive pulmonary disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCOPD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ethe National Comprehensive Cancer Network\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eNCCN\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the ethics committee of the Yongchuan Affiliated Hospital of Chongqing Medical University (202260). All patients signed the informed consents.\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u003c/p\u003e\n\u003cp\u003eWe have obtained the consent of all relevant research subjects to publish our study.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u003c/p\u003e\n\u003cp\u003eThe datasets analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u003c/p\u003e\n\u003cp\u003eAll authors declare have nothing to disclose and none of the authors have any conflicts of interest pertaining to this work.\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eThere was no financial support for this study.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions:\u003c/p\u003e\n\u003cp\u003eWei Dayong: Have drafted the work or substantively revised it\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLiu Jia: The acquisition, analysis, \u0026nbsp;interpretation of data\u003c/p\u003e\n\u003cp\u003eZhou Xiong: Design of the work\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBai Lian: Guided the whole research process and conducted quality control\u003c/p\u003e\n\u003cp\u003eAcknowledgements:\u003c/p\u003e\n\u003cp\u003eWe thank AJE for language editing services, family support, and departmental colleagues for their support\u003c/p\u003e\n\u003cp\u003eClinical Trial Number\u0026nbsp;：\u003c/p\u003e\n\u003cp\u003enot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A. 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PMID: 38865139; PMCID: PMC11170448.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Rectal malignant tumors, low rectal cancer, anastomotic leakage, novel intestinal stent","lastPublishedDoi":"10.21203/rs.3.rs-5974803/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5974803/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThis study aims to evaluate the feasibility and safety of two intestinal fecal diversion methods using novel stents to prevent anastomotic leakage after surgery for middle and lower rectal cancer, and to compare their advantages and disadvantages for clinical application.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective analysis was conducted on 80 patients who underwent laparoscopic radical resection（LAR） for rectal cancer at Yongchuan Hospital from June 2021 to March 2024. Patients were divided into two groups: 26 in the ileum group (using terminal ileal stents) and 54 in the in situ group (using rectal in situ covered stents). Preoperative, surgical, and postoperative data were compared between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e No significant differences were found in baseline characteristics, surgical data, or the occurrence of postoperative anastomotic leakage (3.8% vs 0%, p=0.325) or other complications (23.1% vs 20.4%, p=0.782). However, the ileum group had a significantly longer total hospital stay (21.5±6.2 vs 17.6±5.0 days, p=0.003), longer postoperative stay (14.5±3.3 vs 12.6±3.7 days, p=0.031), higher hospitalization costs (59085.88±7460.79 vs 48903.58±7094.14 yuan, p\u0026lt;0.001), and longer extubation time (27.0±3.0 vs 8.7±1.4 days, p\u0026lt;0.001) compared to the in situ group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eBoth fecal diversion methods show acceptable rates of postoperative anastomotic leakage. However, the in situ covered stent method demonstrates advantages in hospital stay, costs, and postoperative management, suggesting it should be favored in clinical practice.\u003c/p\u003e","manuscriptTitle":"A Comparison Study of Two Fecal Diversion Methods Based on Novel Intestinal Stents for Preventing Anastomotic Leakage After Middle and Lower Rectal Cancer Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-18 13:49:20","doi":"10.21203/rs.3.rs-5974803/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-06T08:19:17+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-06T04:20:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-03T05:04:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-30T12:26:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236126540788225407444271593535406144876","date":"2025-04-30T08:20:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217642215541158204764840201001153911545","date":"2025-04-28T05:45:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255587924273377134803178977457697667066","date":"2025-04-27T11:08:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81661064181797498125451661828113449295","date":"2025-04-25T09:12:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-20T09:03:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"117633242333851116224008515193428751539","date":"2025-04-06T17:39:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"273068497339617864012315520164739687082","date":"2025-02-23T16:08:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-19T16:25:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76189947629681478129777824749087598519","date":"2025-02-19T15:57:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139429435043968483754117371005871289004","date":"2025-02-17T11:09:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-17T09:58:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-02-14T11:52:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-13T09:18:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-13T09:14:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-02-06T15:20:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e31b7d76-a39f-4d4d-ad4b-cc9b66214763","owner":[],"postedDate":"February 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T16:05:48+00:00","versionOfRecord":{"articleIdentity":"rs-5974803","link":"https://doi.org/10.1186/s12893-025-03201-3","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2025-10-06 15:57:21","publishedOnDateReadable":"October 6th, 2025"},"versionCreatedAt":"2025-02-18 13:49:20","video":"","vorDoi":"10.1186/s12893-025-03201-3","vorDoiUrl":"https://doi.org/10.1186/s12893-025-03201-3","workflowStages":[]},"version":"v1","identity":"rs-5974803","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5974803","identity":"rs-5974803","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}