Short-Term Efficacy Of Ghost Ileostomy Compared With Defunctioning Ileostomy After Laparoscopic Anterior Resection For Rectal Cancer

Objective To evaluate the advantages of ghost ileostomy versus defunctioning ileostomy in laparoscopic anterior resection for rectal cancer.Methods Patients who underwent laparoscopic anterior resection for rectal cancer and were admitted to the anorectal department of the gansu provincial people’s hospital between October 2020 and June 2022 were included.They were divided into ghost ileostomy group and defunctioning ileostomy group.The following information was collected:(1)baseline information of patients;(2)Intraoperative data;(3)Postoperative data;(4)Postoperative complications;(5)ostomy-related complications;(6)Ileostomy reversal data;(7)Postoperative pathological results;(8)EORTC QLQ-CR29 score;(9)LARS score.Results The ghost ileostomy group had significantly shorter operation times than the defunctioning ileostomy group(153.27±19.81)vs.(172.18±30.37),and the difference was statistically significant(t=-3.931,P=0.001).Patients with operation time>3h in the ghost ileostomy group were significantly less than those in the defunctioning ileostomy group(6(11.3%)vs.19(26.4%),and the difference was statistically significant(χ~2=4.332,P=0.037).The length of stay,hospitalization cost and re-hospitalization rate three months after operation in the ghost ileostomy group were significantly lower than those in the defunctioning ileostomy group,and the difference was statistically significant(Z=-3.564,P=0.034);(Z=-5.118,P=0.021);(χ~2=28.967,P=0.001).There was no significant difference in the CCI score of the first hospitalization between the ghost ileostomy group and the defunctioning ileostomy group(25.3±7.1 vs.26.4±5.7)(P>0.05).However,the CCI score of the ghost ileostomy group was significantly lower from that of the defunctioning ileostomy group at 3 months after operation(26.2±6.2 vs.31.7±9.1)(P<0.05),and 6 months after operation(25.6±6.7 vs.29.3±7.2)(P<0.05).The anxiety score of defunctioning ileostomy group was higher than that of ghost ileostomy group,and the body image score was lower than that of ghost ileostomy group,the difference was statistically significant(P<0.05).The LARS score of ghost ileostomy group was lower than that of defunctioning ileostomy group,the difference was statistically significant(P<0.05).Univariate and multivariate logistic regression analysis showed that the risk factor of anastomotic leakage was that the distance of the anastomosis from the anus(<5cm),and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of anastomotic leakage,anastomotic bleeding rate and Clavien-Dindo grade of complications between the two groups(P>0.05).There were no significant differences in WBC,IL-6,PCT and serum albumin between 2 groups on the 3rd day after surgery(P>0.05).In addition,there were no significant differences between the two groups in pathological p TNM staging,CRM(+),tumor length diameter,tumor histological differentiation degree,tumor pathological type and gross visual observation(P>0.05).Conclusion Compared with defunctioning ileostomy group,ghost ileostomy group is a safe,feasible and cost-effective operation,which does not significantly increase the incidence of postoperative anastomotic leakage in patients,avoids complications related to defunctioning ileostomy group,and improves patients’quality of life.However,the follow-up time of this study is short,which requires follow-up large-sample,multi-center clinical trials to verify.