In this episode of SurgOnc Today®, Dr. Patrick Sullivan is joined by Dr. Nicole Lopez and Dr. César Reátegui to discuss diverting ostomy. Current practice guidelines suggest that diverting ostomy is the standard of care in surgical management of rectal cancer after neoadjuvant therapy to minimize the risk of clinically significant leak which can then result in permanent colostomy. However, the risk of anastomotic leak after neoadjuvant chemoradiation ranges from 4-12% suggesting that most patients have unnecessary ostomy and additional surgery. With improvement of surgical techniques, utilization of robotic surgery and recent adoption of more TNT approaches, selective use of diverting ostomy will lead to improvement in QOL and decrease in health care costs with minimal impact on incidence of permanent colostomy.