Early closure of defunctioning stoma increases complications related to stoma closure after concurrent chemoradiotherapy and low anterior resection in patients with rectal cancer

Abstract

BackgroundAfter a low anterior resection, creating a defunctioning stoma is vital for securing the anastomosis in low-lying rectal cancer patients receiving concurrent chemoradiotherapy. Although it decreases the complication and reoperation rates associated with anastomotic leakage, the complications that arise before and after stoma closure should be carefully evaluated and managed.MethodsThis study enrolled 95 rectal cancer patients who received neoadjuvant concurrent chemoradiotherapy and low anterior resection with anastomosis of the bowel between July 2010 and November 2012. A defunctioning stoma was created in 63 patients during low anterior resection and in another three patients after anastomotic leakage.ResultsThe total complication rate from stoma creation to closure was 36.4%. Ileostomy led to greater renal insufficiency than colostomy did and significantly increased the readmission rate (all p < 0.05). The complication rate related to stoma closure was 36.0%. Patients with ileostomy had an increased risk of developing complications (p = 0.017), and early closure of the defunctioning stoma yielded a higher incidence of morbidity (p = 0.006). Multivariate analysis revealed that a time to closure of ≤109 days was an independent risk factor for developing complications (p = 0.007).ConclusionsThe optimal timing of stoma reversal is at least 109 days after stoma construction in rectal cancer patients receiving concurrent chemoradiotherapy and low anterior resection.

Guidelines of the Brazilian Society of Oncologic Surgery for pelvic exenteration in the treatment of cervical cancer

“…There is no conclusive study in the literature about the superiority of colostomy or protective ileostomy after transit reconstruction surgery …”

Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma

“…Median time to stoma reversal in this study was 9.4 months (287 days) and 77% of stoma reversals were performed more than 6 months after index surgery. A similar study, which also included rectal cancer patients only, reported a median time to reversal of 129 days (range 58-326) [25]. Another, slightly larger study, also assessing reversal rates of defunctioning stoma, reported a corresponding time of 192 days (range 14-865) [26].…”

Stress and other factors associated with colorectal cancer outpatients with temporary colostomies

“…CRC was ranked as the third leading cause of death in Taiwan based on the standardised mortality rate (MOHW, ). Most CRC patients receive temporary loop colostomy treatment in Taiwan because protective loop ileostomy increases the risk of prolonged post‐operative paralytic ileus after open oncologic rectal resection, and high fluid and electrolyte loss are well‐known complications (Yin et al, ). The total complication rate from stoma creation to closure was reported to be 36.4% in Taiwan (Yin et al, ).…”

“…Most CRC patients receive temporary loop colostomy treatment in Taiwan because protective loop ileostomy increases the risk of prolonged post‐operative paralytic ileus after open oncologic rectal resection, and high fluid and electrolyte loss are well‐known complications (Yin et al, ). The total complication rate from stoma creation to closure was reported to be 36.4% in Taiwan (Yin et al, ). The most common CRC treatments were low‐anterior resection or coloanal anastomosis, supplemented with radiotherapy and chemotherapy, with the aim of removing the tumour and retaining pelvic organ function (Chiang, ; Vonk‐Klaassen, Vocht, Ouden, Eddes, & Schuurmans, ).…”