Protective Ileostomy After Low Anterior Resection with Total Mesorectal Excision: A Retrospective Cohort from a Cancer Center in Ecuador

Abstract Background: Protective ileostomy is frequently performed after low anterior resection (LAR) with total mesorectal excision (TME) to reduce the risk of anastomotic leakage. However, its use may delay stoma closure and result in additional complications. Objectives: This study aimed to evaluate the impact of protective ileostomy on postoperative outcomes in patients with rectal cancer in a Latin American cancer center. Design: Retrospective cohort study. Settings: Hospital SOLCA Guayaquil, Ecuador—a tertiary-level cancer care institution. Patient and Methods: Fifty-four patients with rectal adenocarcinoma who underwent LAR with TME and protective ileostomy between 2019 and 2022 were included. Data were collected retrospectively from institutional records. Variables analyzed included anastomotic leakage, timing and rate of stoma closure, and post-closure complications classified using the Clavien–Dindo system. Main Outcome Measures: Incidence of anastomotic leakage, rate of intestinal continuity restoration, and post-closure complications. Sample Size: Fifty-four patients. Results: Anastomotic leakage occurred in 3.7% (n = 2) of patients. Intestinal continuity was restored in 96.3% ( n = 52). The mean time to stoma closure was 6.2 (±2.4) months, with delayed closure (>6 months) observed in 70.4% of cases, primarily due to adjuvant therapy. Post-closure complications occurred in 11.1% of patients and included surgical site infections, prolonged ileus, and anastomotic stricture. Most complications were classified as Clavien–Dindo grade I or II. Conclusions: Protective ileostomy effectively reduces the clinical impact of anastomotic leakage following LAR with TME. However, delayed closure and post-closure complications remain significant concerns, particularly in low-resource settings. Standardized, context-adapted postoperative protocols are essential to optimize patient outcomes. Limitations: The retrospective design and small sample size limit the generalizability of the findings. Further prospective, multicenter studies are needed. Conflict of Interest: The authors declare no competing interests.