Abstract
BackgroundThis study aimed to clarify the safety of early closure in diverting ileostomy with lower anterior rectal-cancer resection.MethodsWe retrospectively reviewed consecutive 47 patients who underwent diverting ileostomy with lower rectal-cancer resection between May 2009 and October 2017. The results of the stoma closure were compared between patients who underwent stoma closure within 90 days (early closure [EC] group) and those who underwent late closure (LC group; closure after 90 days). Because of the small sample size, the frequency of severe complications post closure was analyzed.ResultsAmong 47 patients, 29 were in the EC group. Postoperative complications occurred in 48.3% (14/29) and 27.8% (5/18) of patients in the EC and LC groups, respectively. This difference was due to minor complications (Clavien-Dindo Classification I/II), such as superficial incisional surgical site infections (n=5) in the EC group. The rate of severe complications (Clavien-Dindo Classification ≥ III) was similar between the groups (20.7% vs. 16.7%, p=1, Fisher’s exact test).ConclusionsNo association was observed between the time of closure and development of major complications; however, there was an increased likelihood of minor complications after EC. This study provides a basis on which future treatment guidelines for early stoma closure may be developed without affecting patient quality of life.
Highlights
This study aimed to clarify the safety of early closure in diverting ileostomy with lower anterior rectalcancer resection
Those who underwent stoma closure within 3 months were grouped into the early closure (EC) group, while those who underwent stoma closure after 90 days or more were grouped into the late closure group (LC group)
Most patients had been diagnosed with early rectal cancer, and they were treated with laparoscopic lower anterior resection
Summary
This study aimed to clarify the safety of early closure in diverting ileostomy with lower anterior rectalcancer resection. Anastomotic leakage is one of the most serious complications after lower anterior resection, with an occurrence rate of 3–28% based on a meta-analysis and literature review [1, 2]. A few randomized clinical trials have elucidated the optimal timing for reversal of the diverting ileostomy [12, 13]. A recent trial comparing the safety of closing an ileostomy within 8–13 days after rectal (2021) 15:7 resection and 12 weeks after initial surgery demonstrated a similar rate of severe postoperative complications between the groups [12]. Alves et al reported that early stoma closure on day 8 after initial surgery was feasible, with reduced hospital stay, bowel obstruction, and medical complications [13]. Colorectal surgery has been proven to be safe in elderly patients [16], repeated surgical interventions within a short period of time must be carefully assessed in patients with poor general health
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