The Effect of a Temporary Stoma on Long-term Functional Outcomes Following Surgery for Rectal Cancer

Abstract

BACKGROUND: Patients with rectal cancer may undergo surgical resection with or without a temporary stoma. OBJECTIVE: This study primary aimed to compare long-term functional outcomes between patients with and without a temporary stoma following surgery for rectal cancer. The secondary aim was to investigate the effect of time to stoma reversal on functional outcomes. DESIGN: This was a multicenter, cross-sectional study. SETTINGS: This study was conducted at seven Dutch hospitals. PATIENTS: Included were patients who had undergone rectal cancer surgery (2009-2015). Excluded were deceased patients, patients with a permanent stoma, or intellectual disability. MAIN OUTCOME MEASURES: Functional outcomes were measured using the Rome IV criteria for constipation and fecal incontinence and the low anterior resection syndrome (LARS) score. RESULTS: Out of 656 patients, 32% received a temporary ileostomy and 20% a temporary colostomy (86% response). Follow-up was at 56.0 (IQR 38.5-79.0) months. Patients who had a temporary ileostomy experienced less constipation, more fecal incontinence, and more major low anterior resection syndrome, than patients without a temporary stoma. Patients who had a temporary colostomy experienced more major low anterior resection syndrome than patients without a temporary stoma. A temporary ileostomy or colostomy was not associated with constipation or fecal incontinence following correction for confounding factors (e.g., anastomotic height, anastomotic leakage, radiotherapy). Time to stoma reversal was not associated with constipation, fecal incontinence, or major low anterior resection syndrome. LIMITATIONS: The current study is limited by its cross-sectional design. CONCLUSIONS: Although patients with a temporary ileostomy or colostomy have worse functional outcomes in the long term, it seems that the reason for creating a temporary stoma, rather than the stoma itself, underlies this phenomenon. Time to reversal of a temporary stoma does not influence functional outcomes