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Protective ileostomy after low anterior resection for extraperitoneal rectal cancer: does the reversal surgery timing affect closure failure?

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Abstract

Loop ileostomy is commonly performed after LAR with TME to temporarily protect the anastomosis. Usually, defunctioning stoma is closed after 1–6 months, although sometimes it becomes definitive de facto. The aim of this study is to investigate the long-term risk of no-reversal of protective ileostomy after LAR for middle–low rectal cancer and the predictive risk factors. A retrospective analysis of a consecutive cohort of patients who underwent curative LAR with covering ileostomy for extraperitoneal rectal cancer in two colorectal units was performed. A different policy for scheduling stoma closure was applied between centers. All the data were collected through an electronic database (Microsoft Excel®). Descriptive statistical analysis was performed using Fisher’s exact and Student’s t test. Multivariate logistic regression analysis was conducted. Two-hundred twenty-two patients were analysed: reversal procedure was carried out in 193 patients, in 29 cases stoma was never closed. The mean interval time from index surgery was 4.9 months (Center1: 3 vs. Center2: 7.8). At the univariate analysis, mean age and tumor stage were significantly higher in the “no-reversal” group. Unclosed ostomies were significantly lower in Center 1 than Center 2 (8% vs. 19.6%). At the multivariate analysis female gender, anastomotic leakage and Center 2 had significant higher risk of unclosed ileostomy. Currently, no clinical recommendations have been established and the policy of scheduling stoma reversal is variable. Our study suggests that an established protocol could avoid closure delay, decreasing permanent stomas. Consequently, ileostomy closure should be weighed as standardized step in cancer therapeutic pathway.

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Data availability

The data sets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

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Authors and Affiliations

  1. General Surgical Department, Ospedale Di Imperia, Via Sant’Agata 57, 18100, Imperia, Italy

    P. Batistotti & A. Amato

  2. Department of Gastroenterology and Digestive Endoscopy, E. O. Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy

    A. Montale

  3. Clinical Epidemiology Unit, IRCCS Ospedale San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy

    M. Bruzzone

  4. General Surgery, Biomedical Institute, Genoa, Italy

    G. A. Binda

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  1. P. Batistotti
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  2. A. Montale
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Contributions

All authors contributed to the study conception and design. All authors read and approved the final manuscript.

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Correspondence to P. Batistotti.

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All authors have no relevant financial or non-financial interests to disclose. All authors declare they have no conflicts of interests to disclose.

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Informed consent was obtained from all individual participants included in the study.

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Ethical approval was waived by the local Ethical Commitee in view of the observational nature of the study and all the procedures being performed were part of the standard care.

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Batistotti, P., Montale, A., Bruzzone, M. et al. Protective ileostomy after low anterior resection for extraperitoneal rectal cancer: does the reversal surgery timing affect closure failure?. Updates Surg 75, 1811–1818 (2023). https://doi.org/10.1007/s13304-023-01573-w

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  • DOI: https://doi.org/10.1007/s13304-023-01573-w

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