Advantages of Early Preventive Ileostomy Closure after Total Mesorectal Excision Surgery for Rectal Cancer: An Institutional Retrospective Study of 123 Consecutive Patients

Abstract

Background/Aim: Preventive ileostomy is frequently constructed to minimizethe consequences of anastomotic leakage after resection of rectal cancer. There is no consensus regarding the best timing for temporary stoma closure after proctectomy for rectal cancer. This retrospective study sought to determine whether the timing of stoma closure influenced postoperative outcomes. Methods: Subjects were 123 patients with rectal cancer undergoing laparoscopic or open total mesorectal excision surgery with preventive ileostomy from 2012 to 2015. They were divided into 2 groups according the timing of stoma closure: the standard group who had closure within 90 (60-120) days (n = 78) and the late group who had closure after 180 (150-210) days (n = 45). Results: There was no significant difference in operative time, operative blood loss or postoperative complications between the 2 groups. Timing of postoperative fasting and length of hospital stay was similar in both groups. Adjuvant chemotherapy was not a risk factor for postoperative complications after stoma closure. Conclusions: There was no significant difference between different timings of temporary stoma closure in relation to postoperative complications. Delayed stoma closure showed no benefit in prevention of morbidity. Early closure is safe and can provide better quality of life for patients.

Defunctioning ileostomy and mechanical bowel preparation may contribute to development of low anterior resection syndrome.

“…To date it seems that if ileostomy is performed it should be reversed within 6 months, since the LARS incidence in that case may be lower [ 27 ]. Moreover, there is evidence that very early ileostomy closure is beneficial and does not influence adjuvant treatment [ 30 – 32 ].…”

Diverting Ileostomy Duration Is the Main Determinant of Ileostomy-Related Complications after Surgical Treatment of Rectum Cancer

“…Furthermore, these patients have been reported to have an impaired quality of life [4]. us, although the closure of ileostomy as early as possible after surgery is a priority for both the surgeons and patients alike [4,5], a delay is not uncommon, mainly due to risk factors such as complications at the site of anastomosis or adjuvant treatment of cancer [6]. Additionally, pelvic irradiation (with neoadjuvant radiotherapy) imposes further risks and the terminal ileum may be exposed to irradiation; thus, neoadjuvant treatment may increase the risk of complications at the site of ileostomy [6,7].…”

Meta-analysis of early versus late closure of a temporary ileostomy after proctectomy

“…After the removal of 166 duplicates and 699 exclusions, because their titles or abstracts described topics that were unsuitable for this study, 23 full-text articles were reviewed. Of these, four were reviews [17,18] or only abstracts [15,19], one was a duplicate report [20], one was a trial without related data pertaining to the outcome of an early orlate ileostomy closure [21], and a comparative protocol was unfeasible in 10 studies [22][23][24][25][26][27][28][29][30][31]. The remaining six studies [13,14,16,[32][33][34]] that compared early with late closure ileostomy were included in the meta-analysis.…”