Abstract
Background. The management of patients with colorectal liver metastases and loop ileostomies remains controversial. This study was performed to assess the outcome of combined liver resection and loop ileostomy closure. Methods. Analysis of prospectively collected perioperative data, including morbidity and mortality, of 283 consecutive hepatectomies for colorectal liver metastases was undertaken. Consecutive liver resections were performed from 1996 to 2006 in one centre by a single surgeon (NDK). Fourteen of these patients had combined liver resection and ileostomy closure. Case-matched analysis was undertaken. Results. Six (2.2%) patients died in the hepatectomy only group and none died in the combined group. There was no difference in operative blood loss between the two groups (0.09). Perioperative morbidity was 36% in the combined group and 23% in the hepatectomy alone group (P = 0.33). Mean hospital stay was 14 days in the combined group and 11 days in the hepatectomy only group (P = 0.046). Case-matched analysis showed a significant increase in hospital stay (P = 0.03) and complications (P = 0.049) in the combined group. Conclusion. In patients with CRLM, combined liver resection and closure of ileostomy may be associated with a higher operative morbidity and a prolonged hospital stay.
Highlights
Hospital stay was longer in the group who had a concomitant liver resection and loop ileostomy closure (P = .04)
Defunctioning, ileostomies are often created to minimise the impact of peritoneal sepsis from an anastomotic dehiscence following coloanal or low-colorectal anastomosis [5, 7]
Loop ileostomy closure is often considered low priority by clinicians [5, 7], and it is likely that more consideration was given to treating the liver metastases, with neoadjuvant chemotherapy followed by liver resection
Summary
The management of patients with colorectal liver metastases and loop ileostomies remains controversial. This study was performed to assess the outcome of combined liver resection and loop ileostomy closure. Analysis of prospectively collected perioperative data, including morbidity and mortality, of 283 consecutive hepatectomies for colorectal liver metastases was undertaken. Consecutive liver resections were performed from 1996 to 2006 in one centre by a single surgeon (NDK). Fourteen of these patients had combined liver resection and ileostomy closure. Case-matched analysis showed a significant increase in hospital stay (P = 0.03) and complications (P = 0.049) in the combined group. In patients with CRLM, combined liver resection and closure of ileostomy may be associated with a higher operative morbidity and a prolonged hospital stay
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