DEFUNCTIONING LOOP ILEOSTOMY IN RECTAL CANCER SURGERY: THE EXPERIENCE OF A REFERRAL CENTER
Abstract
Introduction: In rectal surgery, protective ileostomy is frequent to minimize the impact of anastomotic dehiscence. Despite the temporary intent, a significant proportion of stomas become permanent. The objective of this study is to determine which factors are associated with a lower probability of closure of a protective ileostomy after rectal resection surgery.
Methods: An observational, retrospective, single-center study was carried out. We reviewed the clinical data of patients with a primary diagnosis of rectal cancer and who underwent elective resection surgery with protective ileostomy between 2008 and 2019. Risk factors for not closing the temporary stoma were assessed.
Results: 201 patients were included, of which 168 (83.58%) were reconstructed, with a mean waiting time for reconstruction of 7.92 months. 33 patients were not reconstructed, 10 (4.97%) died before 12 months after surgery, 1 patient (0.5%) refused transit reconstruction and 3 patients (1.49%) are awaiting endoscopic study for scheduling the reconstruction. When excluding these patients, only nineteen patients (9.45%) were called with permanent stomas (ileostomies n = 16, reversion to definitive terminal colostomy n = 3).
Conclusion: The independent risk factors for non-closure of the protective ileostomy were tumours located closer to the anal margin (<= 7 cm), presence of synchronous metastases and presence of local recurrence. Other factors that contributed to the non-closure of the ileostomy were the performance of adjuvant chemotherapy and the presence of complications in the colorectal anastomosis. Patients with these risk factors should be advertised for the possibility of non-closure of the ileostomy.
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2. Prashanth Rawla, Tagore Sunkara, Adam Barsouk. Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019;14(2):89-103.
3. Simon Näverlo, Karin Strigård, Ulf Gunnarsson. Long distance to hospital is not a risk factor for non-reversal. International Journal of Colorectal Disease. 34:993–1000, 2019.
4. Montedori A, Cirocchi R, Farinella E, Sciannameo F, Abraha I. Covering ileo- or colostomy in anterior resection for rectal carcinoma (Review). Cochrane Database of Systematic Reviews. Issue 5. Art. No.: CD006878, 2010.
5. A. J. Kuryba, N. A. Scott, J. Hill, J. H. van der Meulen and K. Walker. Determinants of stoma reversal in rectal cancer patients who had an anterior resection between 2009 and 2012 in the English National Health Service. Colorectal Disease. 2016.
6. Peter Matthiessen, Olof Hallbook, Jorgen Rutegård, Goran Simert, Rune Sjodahl. Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer. Annals of Surgery. 2007, Vol. Volume 246, Number 2.
7. Carl Pontus Gustafsson, Ulf Gunnarsson, Ursula Dahlstrand, Ulrik Lindforss. Loop-ileostomy reversal—patient-related characteristics influencing time to closure. International Journal of Colorectal Disease. 2018.
8. Chul Min Lee, Jung Wook Huh, Yoon Ah Park, Yong Beom Cho, Hee Cheol Kim, Seong Hyeon Yun, Woo Yong Lee, Ho-Kyung Chun. Risk Factors of Permanent Stomas in Patients with Rectal Cancer after Low Anterior Resection with Temporary Stomas. Yonsei Med J. 2015, Vols. 56(2):447-453.
9. Xin Zhou, Bingyan Wang, Fei Li, Jilian Wang, Wei Fu. Risk Factors Associated With Nonclosure of Defunctioning Stomas After Sphincter-Preserving Low Anterior Resection of Rectal Cancer: A Meta-Analysis. Dis Colon Rectum. 2017, Vols. 60: 544–554.
10. Rodrigo Oom, Rita Barroca, Francisca Rebelo, Ricardo Nogueira, Luís D’Orey Manoel, Manuel Limbert, Nuno Abecasis. Estomas de proteção na cirurgia do reto — fatores de risco para o não encerramento. Revista portuguesa de coloproctologia. MAIO/OUT 2017.
11. Åkesson O, Syk I, Lindmark G, Buchwald P. Morbidity related to defunctioning loop ileostomy in low anterior resection. Int J Color Dis. 27(12):1619–1623, 2012.
12. Yin TC, Tsai HL, Yang PF, Su WC, Ma CJ, Huang CW, Huang MY, Huang CM, Wang JY. Early closure of defunctioning stoma increases complications related to stoma closure after concurrent chemoradiotherapy and low anterior resection in patients with rectal cancer. World J Surg Oncol. 15(1):80, 2017.
13. Pan HD, Peng YF, Wang L, Li M, Yao YF, Zhao J, Zhan TC, Gu J. Risk factors for nonclosure of a temporary Defunctioning ileostomy following anterior resection of rectal Cancer. Dis Colon Rectum. 59(2):94–100, 2016.
14. Alkhamis, Ahmed A. Aljorfi and Abdulhameed H. A Systematic Review of Early versus Late Closure of Loop Ileostomy. Hindawi Surgery Research and Practice. 2020.
15. Theodor Junginger, Ursula Gonner, Tong T. Trinh, Andre ́Lollert, Katja Oberholzer, Manfred Berres. Permanent Stoma After Low Anterior Resection for Rectal Cancer. Dis Colon Rectum. 2010, Vols. 53: 1632–1639.
16. Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Ann Surg. 2010;251(5):807-818
17. Portier G, Ghouti L, Kirzin S, Guimbaud R, Rives M, Lazorthes F. Oncological outcome of ultra-low coloanal anastomosis with and without intersphincteric resection for low rectal adenocarcinoma. Br J Surg. 2007;94(3):341-345.
18. Shin US, Kim CW, Yu CS, Kim JC. Delayed anastomotic leakage following sphincter-preserving surgery for rectal cancer. Int J Color Dis. 2010;25(7):843-849.
19. Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005;92(9):1137-1142.
20. Bakx R, Busch ORC, Bemelman WA, Veldink GJ, Slors JFM, Van Lanschot JJB. Morbidity of temporary loop ileostomies. Dig Surg. 2004;21(4):277-281.
21. C-T Germer, C Isbert. Quality of life after rectal cancer surgery, Chirurg. 2009 Apr;80(4):316-23.
22. Alexander D.Croes, James M.Loniea, Alexandra F.Trollope, Venkat N.Vangaveti, Yik-HongHob. A meta-analysis of the prevalence of Low Anterior Resection Syndrome and systematic review of risk factors. International Journal of Surgery, Volume 56, August 2018, Pages 234-241
23. Keane, C.; Wells, C.; O'Grady, G.; Bissett, I.P. Defining Low Anterior Resection Syndrome: A systematic review of the literature. Colorectal Disease, (2017).
24. Theresa H Nguyen , Reena V Chokshi. Low Anterior Resection Syndrome. Curr Gastroenterol Rep, 2020 Aug 4;22(10):48.
25. Lim SW, Kim HJ, Kim CH, Huh JW, Kim YJ, Kim HR. Risk factors for permanent stoma after low anterior resection for rectal cancer. Langenbecks Arch Surg. 2013;398(2):259-264
