Ann Surg Treat Res.  2017 Jan;92(1):35-41. 10.4174/astr.2017.92.1.35.

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

• Haksal M
• Okkabaz N
• Atici AE
• Civil O
• Ozdenkaya
• Erdemir A
• Aksakal N
• Oncel M

• KMID: 2364712
• DOI: http://doi.org/10.4174/astr.2017.92.1.35

Abstract

PURPOSE
The current study aims to analyze the risk factors for the failure of ileostomy reversal after laparoscopic low anterior resection for rectal cancer.
METHODS
All 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.
RESULTS
Among 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).
CONCLUSION
Fifteen 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.

Keyword

Ileostomy; Laparoscopy; Rectal neoplasms

MeSH Terms

Anastomotic Leak
Constriction, Pathologic
Hospitalization
Humans
Ileostomy*
Laparoscopy
Length of Stay
Male
Multivariate Analysis
Rectal Neoplasms*
Reoperation
Risk Factors
Surgical Wound Infection
Survival Rate

Figure

• 

  Fig. 1 A Kaplan-Meier analysis has revealed that the 5-year survival rates were similar between patients whose stomas were reversed and those whose stomas were not (80.8% vs. 72.2%, P = 0.143).

Reference

1. Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis. 2009; 24:711–723.

2. Shiomi A, Ito M, Maeda K, Kinugasa Y, Ota M, Yamaue H, et al. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg. 2015; 220:186–194.

3. Tilney HS, Sains PS, Lovegrove RE, Reese GE, Heriot AG, Tekkis PP. Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World J Surg. 2007; 31:1142–1151.

4. Saghir JH, McKenzie FD, Leckie DM, McCourtney JS, Finlay IG, McKee RF, et al. Factors that predict complications after construction of a stoma: a retrospective study. Eur J Surg. 2001; 167:531–534.

5. Huser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg. 2008; 248:52–60.

6. Karanjia ND, Corder AP, Holdsworth PJ, Heald RJ. Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis. Br J Surg. 1991; 78:196–198.

7. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007; 246:207–214.

8. Kaidar-Person O, Person B, Wexner SD. Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg. 2005; 201:759–773.

9. Poon RT, Chu KW, Ho JW, Chan CW, Law WL, Wong J. Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg. 1999; 23:463–467.

10. Bailey CM, Wheeler JM, Birks M, Farouk R. The incidence and causes of permanent stoma after anterior resection. Colorectal Dis. 2003; 5:331–334.

11. den Dulk M, Smit M, Peeters KC, Kranenbarg EM, Rutten HJ, Wiggers T, et al. A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol. 2007; 8:297–303.

12. Chand M, Talbot R, Nash G. Closure of temporary stoma after anterior resection. Colorectal Dis. 2007; 9:758–759.

13. Daluvoy S, Gonzalez F, Vaziri K, Sabnis A, Brody F. Factors associated with ostomy reversal. Surg Endosc. 2008; 22:2168–2170.

14. David GG, Slavin JP, Willmott S, Corless DJ, Khan AU, Selvasekar CR. Loop ileostomy following anterior resection: is it really temporary? Colorectal Dis. 2010; 12:428–432.

15. Kim YA, Lee GJ, Park SW, Lee WS, Baek JH. Multivariate analysis of risk factors associated with the nonreversal ileostomy following sphincter-preserving surgery for rectal cancer. Ann Coloproctol. 2015; 31:98–102.

16. Floodeen H, Lindgren R, Matthiessen P. When are defunctioning stomas in rectal cancer surgery really reversed? Results from a population-based single center experience. Scand J Surg. 2013; 102:246–250.

17. Sier MF, van Gelder L, Ubbink DT, Bemelman WA, Oostenbroek RJ. Factors affecting timing of closure and non-reversal of temporary ileostomies. Int J Colorectal Dis. 2015; 30:1185–1192.

18. Waterland P, Goonetilleke K, Naumann DN, Sutcliff M, Soliman F. Defunctioning ileostomy reversal rates and reasons for delayed reversal: does delay impact on complications of ileostomy reversal? A study of 170 defunctioning ileostomies. J Clin Med Res. 2015; 7:685–689.

19. Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005; 92:1137–1142.

20. Pilipshen SJ, Heilweil M, Quan SH, Sternberg SS, Enker WE. Patterns of pelvic recurrence following definitive resections of rectal cancer. Cancer. 1984; 53:1354–1362.

21. Peeters KC, Tollenaar RA, Marijnen CA, Klein Kranenbarg E, Steup WH, Wiggers T, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 2005; 92:211–216.

22. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998; 85:355–358.

23. Gezen C, Kement M, Altuntas YE, Okkabaz N, Seker M, Vural S, et al. Results after multivisceral resections of locally advanced colorectal cancers: an analysis on clinical and pathological t4 tumors. World J Surg Oncol. 2012; 10:39.

24. Phatak UR, Kao LS, You YN, Rodriguez-Bigas MA, Skibber JM, Feig BW, et al. Impact of ileostomy-related complications on the multidisciplinary treatment of rectal cancer. Ann Surg Oncol. 2014; 21:507–512.

25. Seo SI, Yu CS, Kim GS, Lee JL, Yoon YS, Kim CW, et al. The role of diverting stoma after an ultra-low anterior resection for rectal cancer. Ann Coloproctol. 2013; 29:66–71.