Risk Factors for Nonclosure of a Temporary Defunctioning Ileostomy Following Anterior Resection of Rectal Cancer

• Published in: Diseases of the colon & rectum Vol. 59; no. 2; pp. 94 - 100
• Main Authors: Pan, Hong-Da, Peng, Yi-Fan, Wang, Lin, Li, Ming, Yao, Yun-Feng, Zhao, Jun, Zhan, Tian-Cheng, Gu, Jin
• Format: Journal Article
• Language: English
• Published: United States The American Society of Colon and Rectal Surgeons 01.02.2016
• Subjects: Abdominal Wound Closure Techniques - adverse effects; Abdominal Wound Closure Techniques - statistics & numerical data; Aged; Anastomotic Leak - etiology; Anastomotic Leak - surgery; China; Colectomy - methods; Female; Humans; Ileostomy - adverse effects; Ileostomy - methods; Male; Neoplasm Metastasis; Neoplasm Staging; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Reoperation; Retrospective Studies; Risk Factors; Surgical Stomas - adverse effects; Surgical Stomas - pathology; Treatment Failure; China
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1097/DCR.0000000000000520

BACKGROUND:In patients with colorectal cancer, a defunctioning ileostomy is commonly constructed to reduce anastomotic complications. However, many patients do not undergo a subsequent procedure to have their temporary stoma closed. OBJECTIVE:This study investigated the incidence of nonclosure of ileostomies and identified factors associated with nonclosure. DESIGN:This study is a retrospective analysis of prospectively collected data. SETTING:This study was conducted at a tertiary referral cancer hospital. PATIENTS:A total of 296 patients who received anterior resection with a defunctioning ileostomy with protective intention from 2006 to 2013 were included. MAIN OUTCOME MEASURES:The primary outcomes measured were the incidence of nonclosure of ileostomy and associated risk factors. RESULTS:Patients were followed for a median time of 29 months (range, 21–100 months). At the end of the study, 51 (17.2%) patients were left with a permanent ileostomy. The median time interval from the creation of a defunctioning ileostomy to closure was 192 days (range, 14–865 days). Multivariate analyses using a logistic regression model showed that metastatic diseases (OR, 0.179, p < 0.001), Charlson Comorbidity Index score >1 (OR, 0.268; p < 0.01), and complications from the index surgery (OR, 0.391; p = 0.013) were significant independent risk factors for failing to close a defunctioning ileostomy. LIMITATIONS:Although our study has a large patient cohort, it is limited by its retrospective nature. It is difficult to fully evaluate stoma complications after hospital discharge, and the prevalence may be underestimated. CONCLUSION:One in 6 temporary ileostomies constructed during an elective anterior resection for rectal cancer was not closed. Patients should be told before the index surgery that there is a risk of nonclosure and possible complications associated with permanent ileostomy.