Morbidity of Diverting Ileostomy for Rectal Cancer: Analysis of the American College of Surgeons National Surgical Quality Improvement Program

Abstract

There is controversy regarding the potential benefits of diverting ileostomy after low anterior resection (LAR). This study aims to examine the morbidity associated with diverting ileostomy in rectal cancer. A retrospective review of LAR cases was performed using the American College of Surgeons National Surgical Quality Improvement Program (2005 to 2011). Patients who underwent LAR with and without diversion were selected. Demographics, intraoperative events, and postoperative complications were reviewed. Among the 6337 cases sampled, 991 (16%) received a diverting ileostomy. Patients who were diverted were younger (60 vs 63 years), predominantly male (64 vs 53%), and more likely to have received pre-operative radiation (39 vs 12%). There was no significant difference in steroid use, weight loss, or intraoperative transfusion. Postoperatively, there was no significant difference in length of stay, rate of septic complications, wound infections, and mortality. The rate of reoperation was lower in the diverted group (4.5 vs 6.9%). Diversion was associated with a higher risk-adjusted rate of acute renal failure (OR 2.4; 95% CI (1.2, 4.6); P < 0.05). The use of diverting ileostomy reduces the rate of reoperation but is associated with an increased risk of acute renal insufficiency. These findings emphasize the need for refinement of patient selection and close follow-up to limit morbidity.

Risk and consequences of dehydration following colorectal cancer resection with diverting ileostomy. A systematic review and meta‐analysis

“…Of the 22 studies included in the review, eight were cohort-comparison studies comparing rates of dehydration between patients with [11,[37][38][39][40][41][42][43]. A further three studies were cohort-comparison studies [44][45][46]; however, these only presented data relating to dehydration for ileostomates.…”

“…All studies used a diverting loop ileostomy as the intervention. Of the eight studies which were comparative, the control arm of four was primary anastomosis in continuity [11,[37][38][39]. For the other four studies, the comparator was diverting colostomy [40][41][42][43].…”

Reversal of defunctioning stoma following rectal cancer surgery: are we getting better? A population‐based single centre experience

“…Other adverse events such as parastomal hernia and stoma stenosis have been reported as well . These consequences may impact negatively on the patient's overall quality of life .…”

Chyme reinfusion in patients with intestinal failure due to temporary double enterostomy: A 15-year prospective cohort in a referral centre

“…In England, the annual incidence of temporary double enterostomy requiring parenteral nutrition (PN) for more than 14 days would be of 18 patients per million [1]. Enterostomy may lead to serious complications, such as acute or chronic dehydration, reported in 18 to 29% of patients [2,3] and responsible for 40 to 50% of hospital readmissions [4,5], renal failure [6], electrolyte disturbances, micronutrients and mineral deficiencies, and malnutrition. These complications are responsible for hospital readmissions, increased healthcare-related costs [7] and affect patients' quality of life [8].…”