Ann Surg Treat Res.  2018 Apr;94(4):203-208. 10.4174/astr.2018.94.4.203.

Risk factors of stoma re-creation after closure of diverting ileostomy in patients with rectal cancer who underwent low anterior resection or intersphincteric resection with loop ileostomy

Affiliations
  • 1Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Korea. drkhr@chonnam.ac.kr

Abstract

PURPOSE
The aim of this study was to identify the risk factors of stoma re-creation after closure of diverting ileostomy in patients with rectal cancer who underwent low anterior resection (LAR) or intersphincteric resection (ISR) with loop ileostomy.
METHODS
We retrospectively reviewed 520 consecutive patients with rectal cancer who underwent LAR or ISR with loop ileostomy from January 2005 to December 2014 at Chonnam National University Hwasun Hospital. Risk factors for stoma re-creation after ileostomy closure were evaluated.
RESULTS
Among 520 patients with rectal cancer who underwent LAR or ISR with loop ileostomy, 458 patients underwent stoma closure. Among these patients, 45 (9.8%) underwent stoma re-creation. The median period between primary surgery and stoma closure was 5.5 months (range, 0.5-78.3 months), and the median period between closure and re-creation was 6.8 months (range, 0-71.5 months). Stoma re-creation was performed because of anastomosis-related complications (26, 57.8%), local recurrence (15, 33.3%), and anal sphincter dysfunction (3, 6.7%). Multivariate analysis showed that independent risk factors for stoma re-creation were anastomotic leakage (odds ratio [OR], 4.258; 95% confidence interval [CI], 1.814-9.993), postoperative radiotherapy (OR, 3.947; 95% CI, 1.624-9.594), and ISR (OR, 3.293; 95% CI, 1.462-7.417).
CONCLUSION
Anastomotic leakage, postoperative radiotherapy, and ISR were independent risk factors for stoma re-creation after closure of ileostomy in patients with rectal cancer.

Keyword

Rectal neoplasms; Ileostomy; Operative surgical procedures

MeSH Terms

Anal Canal
Anastomotic Leak
Humans
Ileostomy*
Jeollanam-do
Multivariate Analysis
Radiotherapy
Rectal Neoplasms*
Recurrence
Retrospective Studies
Risk Factors*
Surgical Procedures, Operative

Figure

  • Fig. 1 Patient selection flow chart. LAR, low anterior resection; ISR, intersphincteric resection.


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Reference

1. Janjan NA, Khoo VS, Abbruzzese J, Pazdur R, Dubrow R, Cleary KR, et al. Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys. 1999; 44:1027–1038. PMID: 10421535.
Article
2. Kinoshita Y, Nokes KM, Kawamoto R, Kanaoka M, Miyazono M, Nakao H, et al. Health-related quality of life in patients with lower rectal cancer after sphincter-saving surgery: a prospective 6-month follow-up study. Eur J Cancer Care (Engl). 2017; 26:e12417.
Article
3. Rullier E, Laurent C, Bretagnol F, Rullier A, Vendrely V, Zerbib F. Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg. 2005; 241:465–469. PMID: 15729069.
4. Allal AS, Bieri S, Pelloni A, Spataro V, Anchisi S, Ambrosetti P, et al. Sphincter-sparing surgery after preoperative radiotherapy for low rectal cancers: feasibility, oncologic results and quality of life outcomes. Br J Cancer. 2000; 82:1131–1137. PMID: 10735495.
Article
5. Wibe A, Syse A, Andersen E, Tretli S, Myrvold HE, Søreide O, et al. Oncological outcomes after total mesorectal excision for cure for cancer of the lower rectum: anterior vs. abdominoperineal resection. Dis Colon Rectum. 2004; 47:48–58. PMID: 14719151.
Article
6. Mileski WJ, Joehl RJ, Rege RV, Nahrwold DL. Treatment of anastomotic leakage following low anterior colon resection. Arch Surg. 1988; 123:968–971. PMID: 3395240.
Article
7. Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg. 1994; 81:1224–1226. PMID: 7953369.
Article
8. Bokey EL, Chapuis PH, Fung C, Hughes WJ, Koorey SG, Brewer D, et al. Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum. 1995; 38:480–486. PMID: 7736878.
Article
9. Chude GG, Rayate NV, Patris V, Koshariya M, Jagad R, Kawamoto J, et al. Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology. 2008; 55:1562–1567. PMID: 19102343.
10. 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. PMID: 18580207.
11. 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. PMID: 9529492.
Article
12. Bretagnol F, Rullier E, Laurent C, Zerbib F, Gontier R, Saric J. Comparison of functional results and quality of life between intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum. 2004; 47:832–838. PMID: 15108027.
Article
13. Prieto L, Thorsen H, Juul K. Development and validation of a quality of life questionnaire for patients with colostomy or ileostomy. Health Qual Life Outcomes. 2005; 3:62. PMID: 16219109.
Article
14. Fucini C, Gattai R, Urena C, Bandettini L, Elbetti C. Quality of life among five-year survivors after treatment for very low rectal cancer with or without a permanent abdominal stoma. Ann Surg Oncol. 2008; 15:1099–1106. PMID: 18181002.
Article
15. Nugent KP, Daniels P, Stewart B, Patankar R, Johnson CD. Quality of life in stoma patients. Dis Colon Rectum. 1999; 42:1569–1574. PMID: 10613475.
Article
16. Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum. 2000; 43:650–655. PMID: 10826426.
17. Lindgren R, Hallbook O, Rutegard J, Sjodahl R, Matthiessen P. What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum. 2011; 54:41–47. PMID: 21160312.
Article
18. Gessler B, Haglind E, Angenete E. Loop ileostomies in colorectal cancer patients: morbidity and risk factors for nonreversal. J Surg Res. 2012; 178:708–714. PMID: 22940030.
19. Chun LJ, Haigh PI, Tam MS, Abbas MA. Defunctioning loop ileostomy for pelvic anastomoses: predictors of morbidity and nonclosure. Dis Colon Rectum. 2012; 55:167–174. PMID: 22228160.
20. Anderin K, Gustafsson UO, Thorell A, Nygren J. The effect of diverting stoma on long-term morbidity and risk for permanent stoma after low anterior resection for rectal cancer. Eur J Surg Oncol. 2016; 42:788–793. PMID: 27132071.
Article
21. Kim MJ, Kim YS, Park SC, Sohn DK, Kim DY, Chang HJ, et al. Risk factors for permanent stoma after rectal cancer surgery with temporary ileostomy. Surgery. 2016; 159:721–727. PMID: 26490725.
Article
22. Lee CM, Huh JW, Park YA, Cho YB, Kim HC, Yun SH, et al. Risk factors of permanent stomas in patients with rectal cancer after low anterior resection with temporary stomas. Yonsei Med J. 2015; 56:447–453. PMID: 25683994.
Article
23. Lim SW, Kim HJ, Kim CH, Huh JW, Kim YJ, Kim HR. Risk factors for permanent stoma after low anterior resection for rectal cancer. Langenbecks Arch Surg. 2013; 398:259–264. PMID: 23224628.
Article
24. Pan HD, Peng YF, Wang L, Li M, Yao YF, Zhao J, et al. Risk factors for nonclosure of a temporary defunctioning ileostomy following anterior resection of rectal cancer. Dis Colon Rectum. 2016; 59:94–100. PMID: 26734966.
Article
25. Lee WS, Yun SH, Roh YN, Yun HR, Lee WY, Cho YB, et al. Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg. 2008; 32:1124–1129. PMID: 18259805.
Article
26. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004; 351:1731–1740. PMID: 15496622.
Article
27. Kollmorgen CF, Meagher AP, Wolff BG, Pemberton JH, Martenson JA, Illstrup DM. The long-term effect of adjuvant postoperative chemoradiotherapy for rectal carcinoma on bowel function. Ann Surg. 1994; 220:676–682. PMID: 7979617.
Article
28. Holm T, Singnomklao T, Rutqvist LE, Cedermark B. Adjuvant preoperative radiotherapy in patients with rectal carcinoma. Adverse effects during long term follow-up of two randomized trials. Cancer. 1996; 78:968–976. PMID: 8780533.
Article
29. Akasu T, Takawa M, Yamamoto S, Yamaguchi T, Fujita S, Moriya Y. Risk factors for anastomotic leakage following intersphincteric resection for very low rectal adenocarcinoma. J Gastrointest Surg. 2010; 14:104–111. PMID: 19841989.
Article
30. Adam IJ, Mohamdee MO, Martin IG, Scott N, Finan PJ, Johnston D, et al. Role of circumferential margin involvement in the local recurrence of rectal cancer. Lancet. 1994; 344:707–711. PMID: 7915774.
Article
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