Defunctioning stoma before neoadjuvant treatment or resection of endoscopically obstructing rectal cancer

Aim: To investigate whether patients with endoscopically untraversable rectal cancer may benefit from a defunctioning stoma created before initiation of neoadjuvant therapy or resectional surgery. Methods This is a retrospective study comprising patients diagnosed with rectal cancer during the years 2007–2020 in Region Västerbotten, Sweden. The primary outcome was time between diagnosis and any treatment, while survival and the incidence of complications were secondary outcomes. Data were obtained from the Swedish Colorectal Cancer Registry and medical records. Kaplan-Meier failure curves were used for visualization, and a multivariable Cox regression model was employed to adjust for confounding. Results Out of 843 patients, 57 with endoscopically obstructing rectal cancer remained after applying exclusion criteria. Some 12/57 (21%) patients received a planned defunctioning stoma before treatment (planned stoma group), and the remainder received upfront neoadjuvant therapy or surgery (control group). Median time to any treatment was 51 days for the planned stoma group and 36 days for the control group, with an adjusted hazard ratio of 0.28 (95% confidence interval: 0.12–0.64). There was no significant difference in survival between the groups. As for complications, these occurred at a rate of 5/12 (42%) and 7/45 (16%) in the planned stoma group and control group, respectively. Conclusion A planned stoma results in treatment delay, but it remains unclear whether this is clinically relevant. Complications were more common in the planned stoma group, although the data are limited. While larger studies are needed, it seems feasible to avoid defunctioning stomas even in endoscopically obstructing rectal cancers.