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Invited Critique
December 1999

Invited Critique: Colostomy vs Tube Cecostomy for Protection of a Low Anastomosis in Rectal Cancer

Arch Surg. 1999;134(12):1388. doi:10.1001/archsurg.134.12.1388

This article by Tschmelitsch et al is more memorable for what it does not say than for what it does. A group of patients requiring low rectal anastomosis after cancer resection has been selected for proximal protective procedures, either a loop stoma or a tube cecostomy. The article does not state the criteria used to establish the selection of these patients. Three patients, in the group who underwent tube cecostomy (group 2), are noted to have developed fecal peritonitis. The article does not state the source of the peritonitis; one is left to assume that it came from an anastomotic leak rather than the tube cecostomy. Mortality, complications, reoperations, and anastomotic leaks were not statistically different in the 2 groups. After a good deal of analysis, the article presents us with one statistically proven fact: individuals having a tube cecostomy rather than a proximal stoma spent less time in the hospital after the operation. The study does indicate that the establishment of such proximal protective procedures did not help the overall group of patients. In fact, those patients undergoing low anastomosis who did not have proximal protective manipulations fared better than those who did. The failure of the authors to provide definite and specific criteria for the selection of patients for proximal protective operations is a major flaw.

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