Protective ileostomy in rectal cancer surgery-is it really temporary?

Yıl 2023, Cilt: 4 Sayı: 2, 163 - 167, 27.03.2023

Cemal Ulusoy , Mehmet Güray Duman , Sıla Güçlü Mete Andrej Nikolovski

https://doi.org/10.47582/jompac.1254537

Öz

Aim: This single-center retrospective study aimed to evaluate the rate of protective ileostomy closure in patients with rectosigmoid junction/rectal cancer and to investigate the factors that prevent ileostomy reversal.
Material and Method: Patients with rectal cancer treated with/without neoadjuvant chemoradiotherapy were included in this study. All were treated with anterior rectal resection and temporary protective ileostomy creation. Decision for ileostomy closure was brought upon predefined ileostomy closure protocol.
Results: Total number of 115 patients (17 with rectosigmoid junction and 98 with rectal cancer) were operated. Neoadjuvant chemoradiotherapy was conducted in 90 of them. Ileostomy closure rate was 73.9%. Mean time for stoma closure in patients with chemoradiotherapy conduction was 227.8 days, while in the rest, time was shorter (168.3 days), without statistical difference. Multivariate analysis revealed that endoscopic examination of the anastomosis during its creation was independent prognostic factor that affected ileostomy closure.
Conclusion: More than one quarter of the patients with protective ileostomy experienced non-closure of their stoma due to various events after index rectal cancer surgery. Endoscopic examination of the anastomosis during its creation presented as independent factor affecting ileostomy closure.

Anahtar Kelimeler

Loop ileostomy, protective ileostomy, ileostomy reversal, ileostomy closure, rectal cancer

Rektal kanser cerrahisinde koruyucu ileostomi, koruyucu ileostomi gerçekten geçici mi?

Öz

Amaç: Bu tek merkezli retrospektif çalışma, rektosigmoid ve rektum kanseri hastalarında koruyucu ileostomi kapatılması oranlarını değerlendirmeyi ve ileostomi kapatılmasını engelleyen faktörleri araştırmayı amaçlamıştır.
Metod: Neoadjuvan tedavi almış veya almamış rektum kanseri hastaları çalışmaya dahil edilmiştir. Bütün hastalara anterior rezeksiyon ve koruyucu ileostomi ameliyatı yapılmıştır. İleostomi kapatılması kararları, tanımlanmış ileostomi kapatılma prosedürüne uygun olarak verilmiştir. Toplamda 115 hasta çalışmaya dahil edilmiştir (17 rektosigmoid, 98 rektum kanseri. Hastaların 98’i daha önceden neoadjuvan tedavi almıştır. İleostomi kapatılma oranları %73.9 ’dur. İleostomi kapatılma süreleri neoadjuvan tedavi alan hastalarda ortalama 227..8 gün almayanlarda daha az olmak üzere 168.3 gündür ancak bu fark istatistiksel olarak anlamlı değildir. Multivariate analiz primer cerrahi sırasında yapılan anastomozun endoskopik olarak değerlendirilmesinin ileostomi kapatılması üzerinde bağımsız prognostik faktör olduğunu göstermiştir.
Sonuç: Koruyucu ileostomili hastaların ¼’ünden fazlası değişik sebeplerle stoma kapatılma deneyimlerini yaşayamamaktadır. Primer cerrahi sırasında yapılan endoskopik değerlendirme ileostomi kapatılmasını etkileyen prognostik faktördür.

Anahtar Kelimeler

koruyucu ileostomi, loop ileostomi, ileostomi kapatılması, rektal kanser

Kaynakça

• Zhu H, Bai B, Shan L, et al. Preoperative radiotherapy for patients with rectal cancer: A risk factor for non-reversal of ileostomy caused by stenosis or stiffness proximal to colorectal anastomosis. Oncotarget 2017; 8: 100746–53.
• Hüser N, Michalski CW, Erkan M, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 2008; 248: 52–60.
• Gadan S, Brand JS, Rutegård M, Matthiessen P. Defunctioning stoma and short- and long-term outcomes after low anterior resection for rectal cancer-a nationwide register-based cohort study. Int J Colorectal Dis 2021; 36: 1433-42.
• Åkesson O, Syk I, Lindmark G, Buchwald P. Morbidity related to defunctioning loop ileostomy in low anterior resection. Int J Colorectal Dis 2012; 27: 1619-23.
• Bertelsen CA, Andreasen AH, Jørgensen T, Harling H; Danish Colorectal Cancer Group. Anastomotic leakage after anterior resection for rectal cancer: risk factors. Colorectal Dis 2010; 12: 37-43.
• Rhemouga A, Buettner S, Bechstein WO, Woeste G, Schreckenbach T. The association of age with decline in renal function after low anterior resection and loop ileostomy for rectal cancer: a retrospective cohort prognostic factor study. BMC Geriatr 2021; 21: 65.
• Fielding A, Woods R, Moosvi SR, et al. Renal impairment after ileostomy formation: a frequent event with long-term consequences. Colorectal Dis 2020; 22: 269-78.
• Krebs B, Ivanecz A, Potrc S, Horvat M. Factors affecting the morbidity and mortality of diverting stoma closure: retrospective cohort analysis of twelve-year period. Radiol Oncol 2019; 53: 331-6.
• Waterland P, Goonetilleke K, Naumann DN, Sutcliff M, Soliman F. Defunctioning ileostomy reversal rates and reasons for delayed reversal: does delay impact on complications of ileostomy reversal? A study of 170 defunctioning ileostomies. J Clin Med 2015; 7: 685–9.
• O’Sullivan NJ, Temperley HC, Nugent TS, et al. Early vs. standard reversal ileostomy: a systematic review and meta-analysis. Tech Coloproctol 2022; 26: 851-62.
• Whitehead A, Cataldo PA. Technical considerations in stoma creation. Clin Colon Rectal Surg 2017; 30: 162-71.
• Markides GA, Wijetunga I, McMahon M, Gupta P, Subramanian A, Anwar S. Reversal of loop ileostomy under an enhanced recovery programme - Is the stapled anastomosis technique still better than the handsewn technique? Int J Surg 2015; 23: 41-5.
• Kwiatt M, Kawata M. Avoidance and management of stomal complications. Clin Colon Rectal Surg 2013; 26: 112-21.
• Dukes’ Club Research Collaborative. Factors impacting time to ileostomy closure after anterior resection: the UK closure of ileostomy timing cohort study (CLOSE-IT). Colorectal Dis. 2021; 23: 1109-19.
• Turner GA, Clifford KA, Holloway R, Woodfield JC, Thompson-Fawcett M. The impact of prolonged delay to loop ileostomy closure on postoperative morbidity and hospital stay: a retrospective cohort study. Colorectal Dis 2022; 24: 854-61.
• Aktaş A, Kayaalp C, Ateş M, Dirican A. Risk factors for postoperative ileus following loop ileostomy closure. Turk J Surg 2020; 36: 333-9.
• Podda M, Coccolini F, Gerardi C, et al. Early versus delayed defunctioning ileostomy closure after low anterior resection for rectal cancer: a meta-analysis and trial sequential analysis of safety and functional outcomes. Int J Colorectal Dis 2022; 37: 737-56.
• Cheng Z, Dong S, Bi D, Wang Y, Dai Y, Zhang X. Early versus late preventive ileostomy closure following colorectal surgery: systematic review and meta-analysis with trial sequential analysis of randomized controlled trials. Dis Colon Rectum 2021; 64: 128-37.
• Werner JM, Kupke P, Ertl M, Opitz S, Schlitt HJ, Hornung M. Timing of closure of a protective loop-ileostomy can be crucial for restoration of a functional digestion. Front Surg 2022; 9: 821509.
• Danielsen AK, Park J, Jansen JE, et al. Early closure of a temporary ileostomy in patients with rectal cancer: a multicenter randomized controlled trial. Ann Surg 2017; 265: 284-90.
• Gustafsson CP, Gunnarsson U, Dahlstrand U, Lindforss U. Loop-ileostomy reversal-patient-related characteristics influencing time to closure. Int J Colorectal Dis 2018; 33: 593-600.
• da-Fonseca LM, Buzatti KCLR, Castro LL, Lacerda Filho A, Correia MITD, da-Silva RG. Factors preventing restoration of bowel continuity in patients with rectal cancer submitted to anterior rectal resection and protective ileostomy. Rev Col Bras Cir 2019; 45: 6