71776 - Gut wrenching decisions: Stoma or no stoma prior to long-course neoadjuvant therapy in rectal cancer?

Introduction Before and during neoadjuvant treatment for rectal cancer, complications might ensue. Some of those complications could be alleviated by a defunctioning stoma established before treatment initiation. This retrospective study examines complication rates among rectal cancer patients undergoing long-course neoadjuvant therapy, comparing those with and without a stoma. Method All rectal cancer patients undergoing neoadjuvant treatment during 2007–2022 in Region Västerbotten, Sweden, were identified using the Swedish Colorectal Cancer Registry. Data were obtained from this registry and patient charts. Patients not planned for curative long-course neoadjuvant therapy, those with recurrent disease, those with a pre-existing stoma, and those receiving a stoma due to urgent bowel-related issues before treatment, were excluded. The primary outcome was the incidence of complications between diagnosis and resectional surgery. Additionally, we investigated time to treatment and utilisation of pre-treatment stomas over time. Result Out of 482 identified patients, 105 remained after exclusion. Among these, 24/105 (23%) patients received a pre-treatment stoma, while 81/105 (77%) received upfront neoadjuvant therapy. The complication incidence in the stoma group was 18/24 (75%), significantly higher than 24/81 (30%) in the control group (p < 0.001). A considerable number of high-grade complications were directly caused by the stoma surgery. Time to neoadjuvant therapy was significantly longer in the stoma group (p < 0.001), and the use of pre-treatment stomas has decreased in recent years. Discussion Rectal cancer patients who receive a stoma before neoadjuvant treatment, in absence of urgent symptoms, experience more complications than those without a stoma. Pending further investigation, such prophylactic stomas should likely be avoided.