Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients

Abstract

Background: One of the most severe complications of low anterior rectal resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the prevalence of AL requiring surgical intervention. However, up to one-third of temporary stomas may never be closed. The first aim of the study was to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study was to assess preoperative PS risk factors in patients with LI. Methods: A total of 286 consecutive patients who underwent low anterior rectal resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and the values of selected peripheral blood parameters were analysed. Results: PS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p < 0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p < 0.001). In the LI group, the only significant risk factor for PS in the multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.007, 97.5% CI 1.002-1.013, p = 0.013). Conclusions: Although protective LI may reduce the incidence of symptomatic AL, it can be related to a higher risk of PS in this group of patients. The preoperative plasma fibrinogen concentration can be a risk factor for PS in LI patients and may be a useful variable in decision-making models.

Outcomes on diverting ostomy formation and reversal after low anterior resection in the older more advanced rectal cancer patient

“…Before ostomy reversal was performed, the anastomotic integrity was confirmed by additional diagnostic modalities such as contrast enema or endoscopy. In line with other studies, a permanent diverting ostomy due to non-reversal was defined as a persistent diverting ostomy at 18 months after creation [18,19]. Delayed reversal was defined as reversal after more than 6 months after creation [20].…”

One Decade of Declining Use of Defunctioning Stomas After Rectal Cancer Surgery in the Netherlands: Are We on the Right Track?

“…However, it is important to mention that up to one-third of stomas are never reversed. 10 The question arises whether we are on a good track or not. The decrease of 40% in stoma use coincided with an increase in AL, and like several other studies, our data showed a protective effect of the defunctioning stoma on both the incidence and severity of AL.…”

“…Many patients with a defunctioning stoma have stoma-related complications (eg, stoma necrosis or stenosis, retraction, parastomal hernia dehydration). 10 In many cases, the prolonged length of stay was likely because of stoma management or so that the problem that initially required the stoma could be further managed. 27 It is likely that patients also had a longer length of stay because of the associated increased likelihood of minor surgical complications and vice versa.…”

“…9 Moreover, one-third of the patients never undergo closure of their defunctioning stoma. 10 In New Zealand and Australia, surgeons seem to advocate the first strategy, and defunctioning stomas are routinely performed. The binational colorectal cancer audit reported that between 2007 to 2019, 89% of patients obtained a defunctioning stoma after rectal cancer surgery.…”

Effect of Anterograde Lavage via Temporary Loop Ileostoma on the Recovery of Bowel Function in Patients Receiving Stoma Closure: A Retrospective Cohort Study

“…[3][4][5] During this period, although the distal bowel of the loop stoma is in an open state, there will still be the production of intestinal secretions and partial excrement because of the untimely shunt, which will impact the recovery of bowel function after stoma closure. 6,7 Moreover, postoperative ileus caused by intestinal dysmotility induced by mechanical stimulation of colorectal surgery can aggravate postoperative bowel dysfunction. 8 Anterograde lavage is performed from the distal end of the stoma.…”