Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer

Abstract

PurposeThe current study aims to analyze the risk factors for the failure of ileostomy reversal after laparoscopic low anterior resection for rectal cancer.MethodsAll patients who underwent a laparoscopic low anterior resection for rectal cancer with a diverting ileostomy between 2007 and 2014 were abstracted. The patients who underwent and did not undergo a diverting ileostomy procedure were compared regarding patient, tumor, treatment related parameters, and survival.ResultsAmong 160 (103 males [64.4%], mean [± standard deviation] age was 58.1 ± 11.9 years) patients, stoma reversal was achieved in 136 cases (85%). Anastomotic stricture (n = 13, 52.4%) was the most common reason for stoma reversal. These were the risk factors for the failure of stoma reversal: Male sex (P = 0.035), having complications (P = 0.01), particularly an anastomotic leak (P < 0.001), or surgical site infection (P = 0.019) especially evisceration (P = 0.011), requirement for reoperation (P = 0.003) and longer hospital stay (P = 0.004). Multivariate analysis revealed that male sex (odds ratio [OR], 7.82; P = 0.022) and additional organ resection (OR, 6.71; P = 0.027) were the risk factors. Five-year survival rates were similar (P = 0.143).ConclusionFifteen percent of patients cannot receive a stoma reversal after laparoscopic low anterior resection for rectal cancer. Anastomotic stricture is the most common reason for the failure of stoma takedown. Having complications, particularly an anastomotic leak and the necessity of reoperation, limits the stoma closure rate. Male sex and additional organ resection are the risk factors for the failure in multivariate analyses. These patients require a longer hospitalization period, but have similar survival rates as those who receive stoma closure procedure.

Quantitative Indocyanine Green Fluorescence Imaging Used to Predict Anastomotic Leakage Focused on Rectal Stump During Laparoscopic Anterior Resection

“…Furthermore, 16% of cases in which DS is used cannot receive stoma reversal, the patient must therefore live with stoma permanently. 4 Studies have reported male sex, low anastomosis, preoperative chemoradiation, advanced tumor stage, one perioperative bleeding, and multiple firings of linear stapler as risk factors for AL after laparoscopic anterior resection (AR) with total mesorectal excision (TME) for rectal cancer. [5][6][7] Blood flow disorder at the anastomosis site has also been reported to be a risk factor, but still there has been no method to evaluate blood flow of the anastomosis-site, and sufficient analysis could not be performed.…”

Long‐term significance of an anastomotic leak in patients undergoing an ultra‐low anterior resection for rectal cancer

“…reported a non‐closure rate of 35% in patients who acquired a leak . A large population study by Haksal et al . established anastomotic stricture (54%) and patient refusal (16.7%) as reasons for non‐reversal.…”

Causes For the Delay of Ileostomy Closure in Rectal Cancer Surgery

“…In his article from 2008, Brian RK has described early postoperative complications that can occur and influence not only the morbidity and mortality of the patient, but [11]. Matthiessen et al reported that for 10.3% of all patients who had a lower anterior resection and a protective ileostomy, the presence of an anastomotic fistula has delayed the reestablishment of the intestinal continuation with up to 50 months [24].…”

“…The same study by Haksal M. et al stated that three of their patients had additional urinary problems (fistula, nephrostomy and/or urinary incontinence) that needed to be addressed before the closure of the ileostomy due to advanced (clinical T4) initial disease. The closure of their ileostomies was postponed due to a potential need of further medical or surgical treatments [11]. while the average interval before the ileostomy closure grew by 50 days [19].…”

“…The limitation of the study is that there is little data available regarding the factors that could lead to a delay of ileostomy closure. Those few studies that have underlined their existence have been criticized for analyzing heterogeneous patient populations, benign as well as malignant diseases, elective or emergent procedures, including different types of stomas in the same study, as well as other reasons[11].…”