Long‐Term Stoma‐Free Outcomes After Diverting Stoma Closure Following Radiation‐Based Neoadjuvant Treatment for Rectal Cancer

Abstract

ABSTRACT Aim Long‐term stoma‐free outcomes after diverting stoma closure in patients who underwent sphincter‐preserving rectal cancer surgery with double‐stapling technique (DST) reconstruction following radiation‐based neoadjuvant treatment remain unclear. We evaluated delayed re‐stoma‐free survival, causes of delayed re‐stoma creation, and final stoma status. Methods This retrospective cohort study included patients who underwent sphincter‐preserving rectal cancer surgery with double‐stapling technique reconstruction and diverting stoma creation following radiation‐based neoadjuvant treatment between 2011 and 2024. The primary outcome was delayed re‐stoma‐free survival after initially successful stoma closure. Delayed re‐stoma was defined as re‐stoma creation more than 30 days after closure. Results Among 296 patients, 168 received radiotherapy without additional preoperative systemic chemotherapy (non‐TNT), and 128 received total neoadjuvant therapy (TNT). Stoma closure was achieved in 287 patients (97.0%). Five required re‐stoma creation within 30 days, leaving 282 with initially successful closure. During a median post‐closure follow‐up of 63 months, delayed re‐stoma creation occurred in 25 patients (8.9%): structural anastomotic complications in 14, functional disorders in seven, tumor recurrence in three, and dysmotility‐related megacolon in one. Estimated delayed re‐stoma‐free survival was 93.3% at 3 years and 90.3% at 5 years, with no significant difference between the non‐TNT and TNT groups (log‐rank p = 0.176). At the last follow‐up, 258 patients (87.2%) were stoma‐free. Conclusion Approximately 90% of patients were stoma‐free at the final follow‐up. Delayed re‐stoma creation was most commonly attributable to structural anastomotic complications. Long‐term stoma‐free status should be considered a clinically meaningful endpoint beyond stoma closure alone.