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Determination of Factors Related to the Reversal and Perioperative Outcomes of Defunctioning Ileostomies in Patients Undergoing Rectal Cancer Surgery: A Regression Analysis Model

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Abstract

Purpose

Defunctioning ileostomies are often performed during rectal cancer surgery. However, stomas are sometimes associated with complications, while 20–30% of them are never reversed. Additionally, ileostomy closure can have associated morbidity, with rates as high as 45%, with the respective literature evidence being scarce and conflicting. Thus, we evaluated the stoma reversal outcomes and the risk factors for non-closure after rectal cancer surgery.

Methods

This is a retrospective analysis of a prospectively collected database of all patients who had a defunctioning ileostomy at the time of resection for rectal cancer. All operations were performed by the same surgical team. A multivariable regression model was implemented.

Results

In this study, 129 patients (male: 68.2%, female: 31.8%) were included. Ileostomy formation was associated with a total of 31% complication rate. Eventually 73.6% of the stomas were reversed at a mean time to closure of 26.6 weeks, with a morbidity of 13.7%. Non-reversal of ileostomy was correlated with neoadjuvant CRT (OR: 0.093, 95% CI: 0.012–0.735), anastomotic leakage (OR: 0.107, 95% CI: 0.019–0.610), and lymph node yield (OR: 0.946, 95% CI: 0.897–0.998). Time to reversal was affected by the N status, the LNR, the need for adjuvant chemotherapy, and the histologic grade.

Conclusion

In patients with rectal cancer resections, defunctioning stoma closure rate and time to closure were associated with several perioperative and pathological outcomes.

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Data Availability

Data available on request from the authors.

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Authors and Affiliations

  1. Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece

    Ioannis Baloyiannis, Ioannis Mamaloudis, Effrosyni Bompou & George Tzovaras

  2. Department of Surgery, General Hospital of Volos, Polymeri 134, 38222, Volos, Greece

    Konstantinos Perivoliotis

  3. University of Thessaly, Viopolis, 41500, Larissa, Greece

    Konstantinos Perivoliotis

  4. Department of Surgery, University Hospital of Larissa, Viopolis, 41110, Larissa, Greece

    Konstantinos Perivoliotis

  5. Department of Anesthesiology, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece

    Chamaidi Sarakatsianou

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Contributions

Conception and design of the study: Tzovaras, Baloyiannis. Acquisition of data: Sarakatsianou, Bompou. Drafting the article: Perivoliotis, Mamaloudis. Critical revision: Baloyiannis. Final approval: Tzovaras, Baloyiannis.

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Correspondence to Konstantinos Perivoliotis.

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This study was performed in line with the principles of the Declaration of Helsinki.

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Appendix

Appendix

Table 1 Baseline patient characteristics
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Table 2 Defunctioning ileostomy outcomes
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Table 3 Ileostomy reversal and time to reversal multivariable analysis
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Fig. 1
figure 1

Cumulative incidence of the ileostomies reversed during the follow-up (weeks)

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Fig. 2
figure 2

ROC of the ileostomy reversal regression model

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Baloyiannis, I., Perivoliotis, K., Mamaloudis, I. et al. Determination of Factors Related to the Reversal and Perioperative Outcomes of Defunctioning Ileostomies in Patients Undergoing Rectal Cancer Surgery: A Regression Analysis Model. J Gastrointest Canc 54, 782–790 (2023). https://doi.org/10.1007/s12029-022-00862-8

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