Prospective study on the safety and feasibility of early ileostomy closure 2 weeks after lower anterior resection for rectal cancer

Abstract

PurposeTransient loop ileostomies in rectal cancer surgery are generally closed after 2 or more months to allow adequate time for anastomotic healing. Maintaining the ileostomy may cause medical, surgical, or psychological complications; it also reduces the quality of life, and increase treatment costs. We performed this study to evaluate the safety and feasibility of early ileostomy closure 2 weeks postoperatively.MethodsIf a patient who underwent total mesorectal excision had 2 or more risk factors for anastomotic leakage, a loop ileostomy was created. After confirmation of intact anastomosis via sigmoidoscopy and proctography 1 week postoperatively, the patient was enrolled and ileostomy was closed 2 weeks postoperatively. The primary endpoint was the frequency of complication after ileostomy repair.ResultsThirty patients were enrolled in the study and 6 were excluded due to anastomotic leakage. Except for 1 case of wound infection (4.2%), no patient experienced any complication including newly developed leakage after the ileostomy closure. The mean duration to repair was 13.1 days (range, 8–16 days) and mean duration to the start of adjuvant treatment after radical surgery was 5.37 weeks (range, 3.0–8.1 weeks).ConclusionTransient loop ileostomy, which is confirmed to be intact endoscopically and radiologically, can be safely closed 2 weeks postoperatively without requiring a significant delay in adjuvant chemotherapy.

Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

“…A temporary ileostomy may not prevent the AL but rather diminish its symptoms and consequences. Further, the true rate of AL in patients receiving ileostomy may be underestimated because usually asymptomatic patients do not undergo testing for anastomosis integrity at the early postoperative period [21,22]. Similarly, in our study, asymptomatic patients underwent anastomosis integrity testing just before the ileostomy closure; thus, some cases of AL in patients who receive ileostomy might have been underestimated as well.…”

Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

“…19,20 A temporary ileostomy may not prevent the AL but rather diminish its symptoms and consequences. Further, the true rate of AL in patients receiving ileostomy may be underestimated because usually asymptomatic patients do not undergo testing for anastomosis integrity at the early postoperative period 21,22 Similar, in our study, asymptomatic patients underwent anastomosis integrity testing just before the ileostomy closure, thus some cases of AL in patients who receive ileostomy might have been underestimated as well. Therefore, further studies are required to clarify the role of ileostomy in the prevention of the AL.…”

Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery

“…Further, the true rate of AL in patients receiving ileostomy may be underestimated because usually asymptomatic patients do not undergo testing for anastomosis integrity at the early postoperative period. 21,22 Therefore, further studies are required to clarify the role of ileostomy in the prevention of the AL.…”