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Variations of the renal function parameters in rectal cancer patients with a defunctioning loop ileostomy

  • Nephrology - Original Paper
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The objective of this study is to investigate the impact of the temporary loop ileostomy on renal function and also to assess the factors associated with the change in renal function observed between the index surgery (the moment of the radical surgical procedure) and the closure of the ileostomy (the moment of the secondary surgical act of suppression of the ileostomy).


A total of 69 rectal cancer patients from a single referral surgical unit who had a loop ileostomy during low anterior resection of the rectum were included in this study. Serum creatinine levels were evaluated, and estimated glomerular filtration rate (eGFR) was calculated prior to index surgery and closure of the ileostomy.


During this time interval, there was a significant decrease in eGFR levels (mean difference − 4.5 mL/min/1.73 m2, 95% CI − 7.8 to − 1.3 mL/min/1.73 m2), and also a significant increase in the serum creatinine values (mean difference 0.07, 95% CI 0.02–0.12 mg/dL). The eGFR decrease was more pronounced in diabetic patients, in those with a baseline Charlson Comorbidity Index score ≥ 1 or in those that received chemotherapy. In a multivariable regression analysis, the use of neoadjuvant chemotherapy was the only variable significantly associated with the change in eGFR levels between the two surgical interventions.


Renal function impairment is an important event that the surgeon has to take into consideration when deciding upon opting for a loop ileostomy to temporarily defunction a colorectal anastomosis.

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Charlson Comorbidity Index


Clinical tumor staging—stage 3 or 4


Clinical lymph node staging—positive lymph nodes


Difference in difference


Estimated glomerular filtration rate


Inter-quartile range


Standard deviation


  1. GLOBOCAN (2012) [Internet]. 2012

  2. Tamas K, Walenkamp AM, de Vries EG, van Vugt MA, Beets-Tan RG, van Etten B et al (2015) Rectal and colon cancer: Not just a different anatomic site. Cancer Treat Rev 41(8):671–679

    Article  PubMed  CAS  Google Scholar 

  3. Tarantino I, Muller SA, Warschkow R, Kulu Y, Schmied BM, Buchler MW et al (2014) Baseline mortality-adjusted survival in resected rectal cancer patients. J Gastrointest Surg 18(10):1837–1844

    Article  PubMed  Google Scholar 

  4. Beyond TME, Collaborative (2013) Consensus statement on the multidisciplinary management of patients with recurrent and primary rectal cancer beyond total mesorectal excision planes. Br J Surg 100(8):1009–1014

    Article  CAS  Google Scholar 

  5. Vignali A, De Nardi P (2014) Multidisciplinary treatment of rectal cancer in 2014: where are we going? World J Gastroenterol 20(32):11249–11261

    Article  PubMed  PubMed Central  Google Scholar 

  6. Walker J, Gregory K (2017) Who needs a loop ileostomy after low anterior resection for rectal cancer? In: Hyman N, Umanskiy K (eds) Difficult decisions in colorectal surgery. Springer, Basel

    Google Scholar 

  7. Boutros M, Gordon P (2017) Anatomy and physiology of the colon, rectum and anal canal. In: Fazio V, Church J, Delaney C, Kiran R (eds) Current therapy in colon and rectal surgery, 3rd edn. Elsevier, Philadelphia, pp 3–11

    Google Scholar 

  8. Baker ML, Williams RN, Nightingale JM (2011) Causes and management of a high-output stoma. Colorectal Dis 13(2):191–197

    Article  PubMed  CAS  Google Scholar 

  9. Chen J, Wang XT, Luo PH, He QJ (2015) Effects of unidentified renal insufficiency on the safety and efficacy of chemotherapy for metastatic colorectal cancer patients: a prospective, observational study. Support Care Cancer 23(4):1043–1048

    Article  PubMed  Google Scholar 

  10. Beck-Kaltenbach N, Voigt K, Rumstadt B (2011) Renal impairment caused by temporary loop ileostomy. Int J Colorectal Dis 26(5):623–626

    Article  PubMed  Google Scholar 

  11. Gessler B, Haglind E, Angenete E (2014) A temporary loop ileostomy affects renal function. Int J Colorectal Dis 29(9):1131–1135

    Article  PubMed  Google Scholar 

  12. Jessup JM, Goldberg R, Asare EA (2017) Colon and rectum. In: Amin MB (ed) AJCC cancer staging manual, 8th edn. Springer, Chicago, pp 251–274

    Chapter  Google Scholar 

  13. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40(5):373–383

    Article  PubMed  CAS  Google Scholar 

  14. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI et al (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612

    Article  PubMed  PubMed Central  Google Scholar 

  15. NCCN. NCCN guidelines version 1.2018—rectal cancer 2018. Accessed 20 Feb 2018

  16. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rodel C, Cervantes A et al (2017) Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 28(Suppl_4):iv22–iv40

    Article  PubMed  CAS  Google Scholar 

  17. Sherman KL, Wexner SD (2017) Considerations in stoma reversal. Clin Colon Rectal Surg 30(3):172–177

    Article  PubMed  PubMed Central  Google Scholar 

  18. Shabbir J, Britton DC (2010) Stoma complications: a literature overview. Colorectal Dis 12(10):958–964

    Article  PubMed  CAS  Google Scholar 

  19. Okamoto T, Kusunoki M, Kusuhara K, Yamamura T, Utsunomiya J (1995) Water and electrolyte balance after ileal J pouch-anal anastomosis in ulcerative colitis and familial adenomatous polyposis. Int J Colorectal Dis 10(1):33–38

    Article  PubMed  CAS  Google Scholar 

  20. Jafari MD, Halabi WJ, Jafari F, Nguyen VQ, Stamos MJ, Carmichael JC et al (2013) Morbidity of diverting ileostomy for rectal cancer: analysis of the American College of Surgeons National Surgical Quality Improvement Program. Am Surg 79(10):1034–1039

    PubMed  Google Scholar 

  21. Figueiredo MN, Mege D, Maggiori L, Ferron M, Panis Y (2015) 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(8):469–474

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Dragos Viorel Scripcariu.

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The authors declare no conflict of interest.

Ethical approval

This study was approved by the ethics boards of the Regional Institute of Oncology and the University of Medicine and Pharmacy “Grigore T Popa” Iasi. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Patients had given their written consent for clinical data to be used in scientific purposes.

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Scripcariu, D.V., Siriopol, D., Moscalu, M. et al. Variations of the renal function parameters in rectal cancer patients with a defunctioning loop ileostomy. Int Urol Nephrol 50, 1489–1495 (2018).

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