MedicineEurope PMC
Ranked by formulaVerdict: NotableRoutine versus postoperative CRP/CT guided selective diverting ileostomy after laparoscopic low anterior resection for rectal cancer: a comparative randomized controlled trial
Diverting ileostomy is routinely used to protect the anastomosis after laparoscopic low anterior resection (LAR) for rectal cancer, but it exposes most patients to stoma-related morbidity even though only a…
Key numbers
- 22.0% vs
- 31.0% vs
- 3.0% vs
VerdictWorth a reader's time today.
Abstract
Background Diverting ileostomy is routinely used to protect the anastomosis after laparoscopic low anterior resection (LAR) for rectal cancer, but it exposes most patients to stoma-related morbidity even though only a minority develop a true anastomotic leak. This trial evaluated whether a postoperative C-reactive protein (CRP) and computed tomography (CT) guided selective ileostomy strategy could reduce the rate of ileostomy formation compared with routine diversion. Methods In this RCT, 200 patients with stage II or III middle or lower third rectal cancer undergoing laparoscopic LAR were randomized 1:1 to a CRP/CT-guided selective ileostomy group (n = 100) or a routine diverting ileostomy group (n = 100). In the CRP/CT group, serum CRP was measured daily from postoperative day 1; a threshold of 114 mg/L on day 3 or a rise greater than 15 mg/L per day triggered confirmatory contrast-enhanced CT, with ileostomy formed only if findings were suspicious for leak. The primary outcome was the stoma-free status throughout the 12-month follow-up. Results Baseline demographic and tumor characteristics were similar between groups (all p > 0.05). Ileostomy formation was markedly lower in the CRP/CT group than the routine group (22.0% vs. 100.0%, p < 0.001). Anastomotic leak rates did not differ (0% vs. 1.0%, p = 1.000), nor did overall complication rates (31.0% vs. 32.0%, p = 0.879). Operative time (148.4 ± 14.0 vs. 166.6 ± 13.1 min, p < 0.001) and intraoperative blood loss (168.9 ± 28.2 vs. 197.3 ± 39.7 mL, p < 0.001) were significantly lower in the CRP/CT group. Stoma-related complications were far less frequent with the selective strategy (3.0% vs. 30.0%, p < 0.001). The CRP/CT group reported significantly better global health status, physical functioning, and emotional functioning scores (all p < 0.001). Conclusion A postoperative CRP/CT-guided selective ileostomy strategy reduces the need for diverting ileostomy after laparoscopic low anterior resection for rectal cancer while improving operative outcomes and quality of life; however, confirmed leakage was infrequent in both groups. This approach may serve as an alternative to routine diversion in appropriately monitored surgical units. Trial registration This trial was retrospectively registered at ClinicalTrials.gov (Identifier: NCT07722533) on July 17, 2026.
The editor's rubric
- Leverage2 / 5
- Reusable within one subfield (a technique, dataset, or protocol a few groups will adopt).
- Magnitude3 / 5
- Large gain: roughly 2x, or a clear new state of the art on a hard, unsaturated problem.
- Evidence4 / 5
- Strong: large scale, preregistered, independently replicated, or a well-powered randomized trial.
- Novelty2 / 5
- A new combination of known ideas.
- Trajectory2 / 5
- Some room to improve with obvious engineering.
- Stakes3 / 5
- Meaningful benefit to many people within a few years.
Editor’s rationale
Heuristic triage from title and abstract text only, not a reading of the paper. Cues found: gains (relative gain, versus baseline); design (randomized, registered); verification (p-value, error bars, independent replication); stakes (global scale, major disease).
How the score was computed
Desks place stronger verdicts first, then use this score to order work within the same verdict.
- Merit
- 6.2 / 10
- Adjusted merit
- 5.0 / 10
- Attention
- 0%
- Freshness
- 65%
- Citations0 (reference 20, via openalex, Oct 20, 2026, 06:17 UTC)