Abstract
BackgroundLow anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer. We aim to analyze, if older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients.MethodsA retrospective cohort study from a database including 151 patients undergoing LAR for rectal carcinoma with DLI was used. Patients were divided in two age groups (Group A: <65 years, n = 79; Group B: ≥65 years, n = 72). For 123 patients undergoing DLI reversal prognostic factors for an impairment of serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) 3 months after DLI reversal was analyzed using a multivariate linear regression analysis.ResultsSCr before LAR(T0) was significant higher in Group B (P = 0.04). Accordingly, the eGFR at T0 in group B was significantly lower (P < 0.001). No patients need to undergo hemodialysis after LAR or DLI reversal.Age and SCr at T0were able to statistically significant predict an increase in SCr (P<0.001) and eGFR (P=0.001) three months after DLI reversal (The R² for the overall model was .82 (adjusted R² = .68).ConclusionDLI creation may result in a reduction of eGFR in older patients 3 months after DLI closure. Apart from this, patients do not have a higher morbidity after creation and closure of DLI resulting from LAR regardless of their age.
Highlights
Low anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer
The routine use of DLI for LAR has been questioned [11]. In this retrospective cohort study, we aim to analyze if older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients
In the chronic kidney disease (CKD) stage, Group B showed a higher number of patients with CKD stage 2 and above relative to Group A (P < 0.001)
Summary
Low anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer. If older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients. Apart from this, patients do not have a higher morbidity after creation and closure of DLI resulting from LAR regardless of their age. Low anterior resection (LAR) for rectal carcinoma is one reason for creation of diverting loop ileostomy (DLI) in older patients. The readmission rate after performing a DLI is up to 30%, and most readmissions are associated with dehydration [5, 8] This rate could be even higher in patients with an already impaired kidney function [9]. The routine use of DLI for LAR has been questioned [11]
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