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When is the best time for temporary stoma closure in laparoscopic sphincter-saving surgery for rectal cancer? A study of 259 consecutive patients

Techniques in Coloproctology volume 19, pages 469–474 (2015)Cite this article

Abstract

Background

There is no consensus regarding the best timing for temporary stoma closure after proctectomy for rectal cancer, especially if the patient requires adjuvant chemotherapy. This study aimed to assess whether the timing of stoma closure could influence postoperative morbidity.

Methods

Patients with rectal cancer undergoing laparoscopic proctectomy with temporary stoma were included and divided into three groups according to the delay of stoma closure after proctectomy: ≤60 days (Group A), 61–90 days (Group B), and >90 days (Group C).

Results

From 2008 to 2013, 259 patients (146 men, median age 61 years) were divided into Groups A (n = 65), B (n = 115), and C (n = 79). At the time of stoma closure, seven (11 %) patients received adjuvant chemotherapy in Group A versus 42 (37 %) in Group B (p = 0.0002) and 24 (30 %) in Group C (p = 0.004), and peristomal hernia was noted in four patients (6 %) in Group A versus 14 (12 %) in Group B and 21 (27 %) in Group C (p < 0.0001). Although overall postoperative morbidity was similar between groups, anastomotic leakage (at the stoma closure site) was noted in one patient in Group A versus zero in Group B versus four in Group C (p = 0.03). Median hospital stay was 5 days in Group A versus 6 in Group B versus 6 in Group C (p = 0.004).

Conclusions

Our results suggested that timing of temporary stoma closure can influence postoperative morbidity. Best results were obtained if stoma closure was performed before 90 days, even during adjuvant chemotherapy. There is no benefit in delaying stoma closure after completion of adjuvant chemotherapy.

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References

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

    Article  CAS  PubMed  Google Scholar 

  2. Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214

    PubMed Central  Article  PubMed  Google Scholar 

  3. Hüser N, Michalski CW, Erkan M et al (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248:52–60

    Article  PubMed  Google Scholar 

  4. Tan WS, Tang CL, Shi L, Eu KW (2009) Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg 96:462–472

    Article  CAS  PubMed  Google Scholar 

  5. Alves A, Panis Y, Lelong B, Dousset B, Benoist S, Vicaut E (2008) Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy. Br J Surg 95:693–698

    Article  CAS  PubMed  Google Scholar 

  6. Shabbir J, Britton DC (2010) Stoma complications: a literature overview. Colorectal Dis 12:958–964

    Article  CAS  PubMed  Google Scholar 

  7. Biagi JJ, Raphael MJ, Mackillop WJ, Kong W, King WD, Booth CM (2011) Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA 305:2335–2342

    Article  CAS  PubMed  Google Scholar 

  8. Reid K, Pockney P, Pollitt T, Draganic B, Smith SR (2010) Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds. Br J Surg 97:1511–1517

    Article  CAS  PubMed  Google Scholar 

  9. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    PubMed Central  Article  PubMed  Google Scholar 

  10. Montedori A, Cirocchi R, Farinella E, Sciannameo F, Abraha I (2010) Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev 12:CD006878

    Google Scholar 

  11. Perez RO, Habr-Gama A, Seid VE et al (2006) Loop ileostomy morbidity: timing of closure matters. Dis Colon Rectum 49:1539–1545

    Article  PubMed  Google Scholar 

  12. Robertson I, Leung E, Hughes D et al (2005) Prospective analysis of stoma-related complications. Colorectal Dis 7:279–285

    Article  CAS  PubMed  Google Scholar 

  13. Jordi-Galais P, Turrin N, Tresallet C, Nguyen-Thanh Q, Chigot JP, Menegaux F (2003) Early closure of temporary stoma of the small bowel. Gastroenterol Clin Biol 27:697–699

    PubMed  Google Scholar 

  14. Omundsen M, Hayes J, Collinson R, Merrie A, Parry B, Bissett I (2012) Early ileostomy closure: is there a downside? Anz J Surg 82:352–354

    Article  PubMed  Google Scholar 

  15. Perdawid SK, Andersen OB (2011) Acceptable results of early closure of loop ileostomy to protect low rectal anastomosis. Dan Med Bull 58:a4280

    PubMed  Google Scholar 

  16. Bakx R, Busch O, Van Geldere D, Bemelman WA, Slors JFM, Van Lanschot JJB (2003) Feasibility of early closure of loop ileostomies: a pilot study. Dis Colon Rectum 46:1680–1684

    Article  PubMed  Google Scholar 

  17. Wong KS, Remzi FH, Gorgun E et al (2005) Loop ileostomy closure after restorative proctocolectomy: outcome in 1504 patients. Dis Colon Rectum 48:243–250

    Article  PubMed  Google Scholar 

  18. Cipe G, Erkek B, Kuzu A, Gecim E (2012) Morbidity and mortality after the closure of a protective loop ileostomy: analysis of possible predictors. Hepatogastroenterology 59:2168–2172

    PubMed  Google Scholar 

  19. Tulchinsky H, Shacham-shmueli E, Klausner JM, Inbar M, Geva R (2014) Should a loop ileostomy closure in rectal cancer patients be done during or after adjuvant chemotherapy? J Surg Oncol 109:266–269

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The authors declare that informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Beaujon Hospital, Public Assistance Hospitals of Paris, University of Paris VII, 100 Boulevard du Général Leclerc, Clichy, 92110, France

    M. N. Figueiredo, D. Mège, L. Maggiori, M. Ferron & Y. Panis

  2. Department of Gastroenterology, University of São Paulo Medical School, Rua Alves Guimarães 380 apt 54, Pinheiros, SP, 05410-000, Brazil

    M. N. Figueiredo

Authors
  1. M. N. Figueiredo
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  2. D. Mège
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  3. L. Maggiori
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  4. M. Ferron
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  5. Y. Panis
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Correspondence to Y. Panis.

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Figueiredo, M.N., Mège, D., Maggiori, L. et al. When is the best time for temporary stoma closure in laparoscopic sphincter-saving surgery for rectal cancer? A study of 259 consecutive patients. Tech Coloproctol 19, 469–474 (2015). https://doi.org/10.1007/s10151-015-1328-z

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  • DOI: https://doi.org/10.1007/s10151-015-1328-z

Keywords

  • Temporary stoma
  • Stoma closure
  • Anastomotic leak
  • Rectal cancer