Impact of Ileostomy-Related Complications on the Multidisciplinary Treatment of Rectal Cancer

Abstract

Background Radical resection is the primary treatment for rectal cancer. When anastomosis is possible, a temporary ileostomy is used to decrease morbidity from a poorly healed anastomosis. However, ileostomies are associated with complications, dehydration, and need for a second operation. Our purpose was to evaluate the impact of ileostomy related complications on the treatment of rectal cancer. Methods A retrospective cohort study of patients who underwent sphincter preserving surgery between January 2005 and December 2010 at a tertiary cancer center. The primary outcome was the overall rate of ileostomy related complications. Secondary outcomes included complications related to ileostomy status, ileostomy closure, anastomotic complications at primary resection, rate of stoma closure, and completion of adjuvant chemotherapy. Statistical analyses were performed with STATA 12. Results A total of 294 patients were analyzed, 32% (n=95) were women. Two hundred seventy-one (92%) received neoadjuvant chemoradiation. The median tumor distance from the anal verge was 7 centimeters (interquartile range 5-10). Two hundred eighty-one (96%) underwent stoma closure at a median 7 months (interquartile range 5.4 – 8.3). The most common complication related to readmission was dehydration (n=32, 11%). Readmission within 60 days of primary resection was associated with delay in initiating adjuvant chemotherapy (OR 3.01, 95% CI 1.42-6.38, p=0.004). Conclusion Diverting ileostomies created during surgical treatment of rectal cancers are associated with morbidity; however this is balanced against the risk of anastomosis-related morbidity at rectal resection. Given the potential benefit of fecal diversion, patient-oriented interventions to improve ostomy management, particularly during adjuvant chemotherapy, can be expected to yield marked benefits.

Cost Analysis of Early versus Delayed Loop Ileostomy Closure: A Case-Matched Study

“…Such concerns appear valid, given the increased wound infection rates associated with early closure. However, recent studies have also demonstrated defunctioning loop ileostomies and ileostomy-related complications to be independent risk factors in both the delayed administration and omission of adjuvant chemotherapy [34,35]. Consequently, EC could potentially result in the improved delivery of adjuvant chemotherapy; however, further studies evaluating early ileostomy closure in the setting of adjuvant chemotherapy administration are still required.…”

Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy for ulcerative colitis

“…However, diverting loop‐ileostomy potentially increases the risks for stoma‐related complications including small bowel obstruction (SBO), stoma prolapse, stoma retraction, parastomal hernia, parastomal dermatitis, and mucocutaneous dehiscence. Risks for stoma‐related complications are reportedly 5‐46% 6, 7, 8, 9…”

A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer

“…Moreover, diverting stoma also increases patient discomfort, overall cost, and the duration of hospitalization since the patient will need a second operation for closure of the stoma [17,18]. Phatak et al [19] reported that diverting ileostomies are associated with a significant risk for ileostomy-related morbidity including dehydration and perioperative complications of stoma closure. Although this morbidity may be balanced by the benefit of decreasing anastomosis leak, these disadvantages should be considered.…”