Loop ileostomy following anterior resection: is it really temporary?

David, G. G.; Slavin, John; Willmott, S.; Corless, D.; Khan, Arif; Selvasekar, CR

doi:10.1111/j.1463-1318.2009.01815.x

Cited by 109 publications

(115 citation statements)

References 24 publications

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“…12 Therefore, we sought to further characterize factors associated with non-reversal and delayed reversal among elderly patients, those most at risk for non-reversal, to aid in pre-operative counseling and realistic expectation setting. 7,26,27 While our 18.4% rate of stoma creation is within the wide range of other reported rates (17-71%) 3 and comparable with other multi-institutional evaluations of stomas in the treatment of rectal cancer, 7,28 our rate of 51% for stoma reversal, is significantly lower than 68-92% previously reported by single institution and multi-institution studies of reversal among rectal cancer patients of all ages. 8,10 This reflects, in part, patients who did not survive long enough to have their stoma reversed.…”

Section: Discussioncontrasting

confidence: 49%

“…However, after correcting for those patients who died or were lost to follow-up before reversal, the 57% rate of stoma reversal remains below the range previously reported. These previous evaluations of stoma reversal have found that receipt of post-operative chemotherapy, 7,10 increasing age, 7 metastatic disease, 8 comorbidities, 7 and perioperative complications, 8,9,11 were associated with non-reversal. Our multivariable results corroborated the influence of older age and greater comorbidity on non-reversal, but we also found male gender (similar to diverticulitis 26 ) and higher income increased a patient's chance of reversal.…”

Section: Discussionmentioning

confidence: 99%

“…[30][31][32][33][34][35] A study by David et al found that permanent stoma rates may be decreased at higher volume institutions 7 which has been suggested to be an indicator variable for unmeasured institutional influence. 36 However, while we did find some institutional variability in our sample in both creation and reversal rates, we did not identify any measurable hospital characteristics to explain this variation.…”

Section: Discussionmentioning

confidence: 99%

“…Since the majority of patients with temporary stomas undergo reversal by 18 months, 7,8,10,12,17,18 all patients who did not undergo reversal by 18 months after LAR were excluded from this analysis. Patients who died before reversal or were lost to follow up were included in the analysis and censored.…”

Section: Discussionmentioning

confidence: 99%

“…5,[7][8][9][10] Previously identified predictors of delay or failure in reversal include post-operative chemotherapy, 7,10 increasing age, 7 metastatic disease, 8 comorbidities 7 and perioperative complications 8,9,11,12 , but only two studies have reported factors associated with ileostomy reversal failure after multivariable adjustment. 7,9 Additionally, while higher volume hospitals have been associated with decreased rates of permanent colostomy in rectal cancer patients, 13 little is known about the role of institution in reversal of temporary stoma patients. Given the association with age and comorbidities, we sought to evaluate institutional, patient and clinical characteristics that influence the likelihood of reversal or reversal delay for elderly rectal cancer patients undergoing LAR with diverting stoma.…”

Section: Introductionmentioning

confidence: 99%

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Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

Dodgion¹,

Neville²,

Lipsitz³

et al. 2010

JCO

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Objective-For low-lying rectal cancers, proximal diversion can reduce anastomotic leak after sphincter preserving surgery; however, evidence suggests that such temporary diversions are often not reversed. We aimed to evaluate non-reversal and delayed stoma reversal in elderly patients undergoing low anterior resection (LAR). The authors report no conflict of interest. Design-SEER-MedicareAuthor Contributions: Dodgion -study design, analysis and interpretation of data, manuscript preparation. Neville -acquisition of data, manuscript preparation. Lipsitz -study design, analysis and interpretation of data, manuscript preparation. Schrag -study design, interpretation of data, manuscript preparation. Breen -study design, interpretation of data, manuscript preparation. Greenberg -study design, analysis and interpretation of data, manuscript preparation and project oversight.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

Dodgion¹,

Neville²,

Lipsitz³

et al. 2010

JCO

View full text Add to dashboard Cite

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Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer

et al. 2020

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for the TURNBULL-BCN Study Group IMPORTANCE Two-stage Turnbull-Cutait pull-through hand-sewn coloanal anastomosis seems to provide benefits in terms of postoperative morbidity compared with standard hand-sewn coloanal anastomosis associated with diverting ileostomy and further ileostomy reversal in patients operated on for low rectal cancer. OBJECTIVE To compare 30-day postoperative and 1-year follow-up results of Turnbull-Cutait pull-through hand-sewn coloanal anastomosis and standard hand-sewn coloanal anastomosis after ultralow rectal resection for rectal cancer. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial. Neither patients nor surgeons were blinded for technique. Patients were recruited in 3 centers,

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Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

Keane

Park

Öberg

et al. 2019

British Journal of Surgery

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Background Low anterior resection syndrome (LARS) has a significant impact on postoperative quality of life. Although early closure of an ileostomy is safe in selected patients, functional outcomes have not been investigated. The aim was to compare bowel function and the prevalence of LARS in patients who underwent early or late closure of an ileostomy after rectal resection for cancer. Methods Early closure (8–13 days) was compared with late closure (after 12 weeks) of the ileostomy following rectal cancer surgery in a multicentre RCT. Exclusion criteria were: signs of anastomotic leakage, diabetes mellitus, steroid treatment and postoperative complications. Bowel function was evaluated using the LARS score and the Memorial Sloan Kettering Cancer Center Bowel Function Instrument (BFI). Results Following index surgery, 112 participants were randomized (55 early closure, 57 late closure). Bowel function was evaluated at a median of 49 months after stoma closure. Eighty‐two of 93 eligible participants responded (12 had died and 7 had a permanent stoma). Rates of bowel dysfunction were higher in the late closure group, but this did not reach statistical significance (major LARS in 29 of 40 participants in late group and 25 of 42 in early group, P = 0·250; median BFI score 63 versus 71 respectively, P = 0·207). Participants in the late closure group had worse scores on the urgency/soiling subscale of the BFI (14 versus 17; P = 0·017). One participant in the early group and six in the late group had a permanent stoma ( P = 0·054). Conclusion Patients undergoing early stoma closure had fewer problems with soiling and fewer had a permanent stoma, although reduced LARS was not demonstrated in this cohort. Dedicated prospective studies are required to evaluate definitively the association between temporary ileostomy, LARS and timing of closure.

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Loop ileostomy following anterior resection: is it really temporary?

Abstract: One in four loop ileostomies performed to defunction an elective anterior resection is not reversed, and in the presence of significant comorbidity one in three is not reversed. Only 12% is reversed within 12 weeks.

Cited by 109 publications

References 24 publications

Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

Two-Stage Turnbull-Cutait Pull-Through Coloanal Anastomosis for Low Rectal Cancer

Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer

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