DEFUNCTIONING LOOP ILEOSTOMY IN RECTAL CANCER SURGERY: THE EXPERIENCE OF A REFERRAL CENTER
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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