Risk factors associated with the delay reversal ileostomy following sphincter-preserving surgery for rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QIU Suyu ^1,2 , HU Minhui ³ , GUO Wentai ¹ , HUANG Rongkang ¹ ,  WANG Hui ¹

1. District Three of Department of Colorectal and Anal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, P. R. China;
2. Department of General Surgery, New Rong Qi Hospital, Foshan, Guangdong 528203, P. R. China;
3. Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, P. R. China;

Corresponding author：

WANG Hui, Email: wanghuislh@hotmail.com

Keywords：

rectal cancer; delay reversal; sphincter-preserving surgery; defunctioning ileostomy

DOI：

10.7507/1007-9424.201901003

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Objective This study aimed to discuss the risk factors associated with the delay reversal ileostomy following sphincter-preserving surgery for rectal cancer.Methods Clinical data were collected retrospectively on 130 consecutive patients undergoing defunctioning ileostomy following sphincter-preserving surgery for rectal cancer, between January 2014 and December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University. According to the reversal time of ileostomy, the patients were divided into two groups, including the delay reversal ileostomy group (≥120 d, n=72) and the normal ileostomy group (<120 d, n=58).Results One hundred and thirty patients were studied (median time to reversal 132 d, range 39–692 d). Logistic regression model showed that adjuvant chemotherapy (OR=14.106, P=0.002), distance of tumor from the anal verge (OR=0.019, P=0.002), and anastomotic leakage (OR=32.440, P=0.001) were significant independent risk factors for delayed reversal. Time to reversal was significantly longer in those patients who had adjuvant chemotherapy, anastomotic leakage, and short distance of tumor from the anal verge.Conclusion Adjuvant chemotherapy, short distance of tumor from the anal verge, and anastomotic leakage are the independent risk factors for delay reversal ileostomy following sphincter-preserving surgery for rectal cancer.

Citation： QIU Suyu, HU Minhui, GUO Wentai, HUANG Rongkang, WANG Hui. Risk factors associated with the delay reversal ileostomy following sphincter-preserving surgery for rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(4): 418-422. doi: 10.7507/1007-9424.201901003 Copy

1.	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(1): 52-60.
2.	Gastinger I. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg, 2005, 92(9): 1137-1142.
3.	Chen J, Wang DR, Yu HF, et al. Defunctioning stoma in low anterior resection for rectal cancer: a meta- analysis of five recent studies. Hepatogastroenterology, 2012, 59(118): 1828-1831.
4.	Tan WS, Tang CL, Shi L, et al. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg, 2009, 96(5): 462-472.
5.	Snijders HS, van den Broek CB, Wouters MW, et al. An increasing use of defunctioning stomas after low anterior resection for rectal cancer. Is this the way to go? Eur J Surg Oncol, 2013, 39(7): 715-720.
6.	Åkesson O, Syk I, Lindmark G, et al. Morbidity related to defunctioning loop ileostomy in low anterior resection. Int J Colorectal Dis, 2012, 27(12): 1619-1623.
7.	Ihnát P, Guňková P, Peteja M, et al. Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc, 2016, 30(11): 4809-4816.
8.	Tsunoda A, Tsunoda Y, Narita K, et al. Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum, 2008, 51(2): 218-222.
9.	苏端玉, 吴君心, 侯如蓉. 长期生存直肠癌患者生存质量的临床影响因素分析. 中国肿瘤临床, 2014, 41(3): 175-179.
10.	Rubio-Perez I, Leon M, Pastor D, et al. Increased postoperative complications after protective ileostomy closure delay: an institutional study. World J Gastrointest Surg, 2014, 6(9): 169-174.
11.	Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis, 2009, 24(6): 711-723.
12.	Akiyoshi T, Fujimoto Y, Konishi T, et al. Complications of loop ileostomy closure in patients with rectal tumor. World J Surg, 2010, 34(8): 1937-1942.
13.	Mengual-Ballester M, García-Marín JA, Pellicer-Franco E, et al. Protective ileostomy: complications and mortality associated with its closure. Rev Esp Enferm Dig, 2012, 104(7): 350-354.
14.	Chun LJ, Haigh PI, Tam MS, et al. Defunctioning loop ileostomy for pelvic anastomoses: predictors of morbidity and nonclosure. Dis Colon Rectum, 2012, 55(2): 167-174.
15.	Messaris E, Sehgal R, Deiling S, et al. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum, 2012, 55(2): 175-180.
16.	den Dulk M, Smit M, Peeters KC, et al. A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol, 2007, 8(4): 297-303.
17.	Waterland P, Goonetilleke K, Naumann DN, et al. 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 Res, 2015, 7(9): 685-689.
18.	Pan HD, Peng YF, Wang L, et al. Risk factors for nonclosure of a temporary defunctioning ileostomy following anterior resection of rectal cancer. Dis Colon Rectum, 2016, 59(2): 94-100.
19.	Gustafsson CP, Gunnarsson U, Dahlstrand U, et al. Loop-ileostomy reversal-patient-related characteristics influencing time to closure. Int J Colorectal Dis, 2018, 33(5): 593-600.
20.	Luglio G, Pendlimari R, Holubar SD, et al. Loop ileostomy reversal after colon and rectal surgery: a single institutional 5-year experience in 944 patients. Arch Surg, 2011, 146(10): 1191-1196.
21.	Chand M, Nash GF, Talbot RW. Timely closure of loop ileostomy following anterior resection for rectal cancer. Eur J Cancer Care (Engl), 2008, 17(6): 611-615.
22.	Lordan JT, Heywood R, Shirol S, et al. Following anterior resection for rectal cancer, defunctioning ileostomy closure may be significantly delayed by adjuvant chemotherapy: a retrospective study. Colorectal Dis, 2007, 9(5): 420-422.
23.	丛进春, 陈春生, 冯勇, 等. 新辅助治疗对低位直肠癌经内外括约肌间切除术后肛门功能的影响. 中国肿瘤临床, 2013, 40(23): 1450-1454.
24.	Snijders HS, Wouters MW, van Leersum NJ, et al. Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol, 2012, 38(11): 1013-1019.
25.	van Koperen PJ, van der Zaag ES, Omloo JM, et al. The persisting presacral sinus after anastomotic leakage following anterior resection or restorative proctocolectomy. Colorectal Dis, 2011, 13(1): 26-29.
26.	Kim MJ, Kim YS, Park SC, et al. Risk factors for permanent stoma after rectal cancer surgery with temporary ileostomy. Surgery, 2016, 159(3): 721-727.
27.	Sier MF, van Gelder L, Ubbink DT, et al. Factors affecting timing of closure and non-reversal of temporary ileostomies. Int J Colorectal Dis, 2015, 30(9): 1185-1192.

1. 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(1): 52-60.
2. Gastinger I. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg, 2005, 92(9): 1137-1142.
3. Chen J, Wang DR, Yu HF, et al. Defunctioning stoma in low anterior resection for rectal cancer: a meta- analysis of five recent studies. Hepatogastroenterology, 2012, 59(118): 1828-1831.
4. Tan WS, Tang CL, Shi L, et al. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg, 2009, 96(5): 462-472.
5. Snijders HS, van den Broek CB, Wouters MW, et al. An increasing use of defunctioning stomas after low anterior resection for rectal cancer. Is this the way to go? Eur J Surg Oncol, 2013, 39(7): 715-720.
6. Åkesson O, Syk I, Lindmark G, et al. Morbidity related to defunctioning loop ileostomy in low anterior resection. Int J Colorectal Dis, 2012, 27(12): 1619-1623.
7. Ihnát P, Guňková P, Peteja M, et al. Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc, 2016, 30(11): 4809-4816.
8. Tsunoda A, Tsunoda Y, Narita K, et al. Quality of life after low anterior resection and temporary loop ileostomy. Dis Colon Rectum, 2008, 51(2): 218-222.
9. 苏端玉, 吴君心, 侯如蓉. 长期生存直肠癌患者生存质量的临床影响因素分析. 中国肿瘤临床, 2014, 41(3): 175-179.
10. Rubio-Perez I, Leon M, Pastor D, et al. Increased postoperative complications after protective ileostomy closure delay: an institutional study. World J Gastrointest Surg, 2014, 6(9): 169-174.
11. Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis, 2009, 24(6): 711-723.
12. Akiyoshi T, Fujimoto Y, Konishi T, et al. Complications of loop ileostomy closure in patients with rectal tumor. World J Surg, 2010, 34(8): 1937-1942.
13. Mengual-Ballester M, García-Marín JA, Pellicer-Franco E, et al. Protective ileostomy: complications and mortality associated with its closure. Rev Esp Enferm Dig, 2012, 104(7): 350-354.
14. Chun LJ, Haigh PI, Tam MS, et al. Defunctioning loop ileostomy for pelvic anastomoses: predictors of morbidity and nonclosure. Dis Colon Rectum, 2012, 55(2): 167-174.
15. Messaris E, Sehgal R, Deiling S, et al. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum, 2012, 55(2): 175-180.
16. den Dulk M, Smit M, Peeters KC, et al. A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol, 2007, 8(4): 297-303.
17. Waterland P, Goonetilleke K, Naumann DN, et al. 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 Res, 2015, 7(9): 685-689.
18. Pan HD, Peng YF, Wang L, et al. Risk factors for nonclosure of a temporary defunctioning ileostomy following anterior resection of rectal cancer. Dis Colon Rectum, 2016, 59(2): 94-100.
19. Gustafsson CP, Gunnarsson U, Dahlstrand U, et al. Loop-ileostomy reversal-patient-related characteristics influencing time to closure. Int J Colorectal Dis, 2018, 33(5): 593-600.
20. Luglio G, Pendlimari R, Holubar SD, et al. Loop ileostomy reversal after colon and rectal surgery: a single institutional 5-year experience in 944 patients. Arch Surg, 2011, 146(10): 1191-1196.
21. Chand M, Nash GF, Talbot RW. Timely closure of loop ileostomy following anterior resection for rectal cancer. Eur J Cancer Care (Engl), 2008, 17(6): 611-615.
22. Lordan JT, Heywood R, Shirol S, et al. Following anterior resection for rectal cancer, defunctioning ileostomy closure may be significantly delayed by adjuvant chemotherapy: a retrospective study. Colorectal Dis, 2007, 9(5): 420-422.
23. 丛进春, 陈春生, 冯勇, 等. 新辅助治疗对低位直肠癌经内外括约肌间切除术后肛门功能的影响. 中国肿瘤临床, 2013, 40(23): 1450-1454.
24. Snijders HS, Wouters MW, van Leersum NJ, et al. Meta-analysis of the risk for anastomotic leakage, the postoperative mortality caused by leakage in relation to the overall postoperative mortality. Eur J Surg Oncol, 2012, 38(11): 1013-1019.
25. van Koperen PJ, van der Zaag ES, Omloo JM, et al. The persisting presacral sinus after anastomotic leakage following anterior resection or restorative proctocolectomy. Colorectal Dis, 2011, 13(1): 26-29.
26. Kim MJ, Kim YS, Park SC, et al. Risk factors for permanent stoma after rectal cancer surgery with temporary ileostomy. Surgery, 2016, 159(3): 721-727.
27. Sier MF, van Gelder L, Ubbink DT, et al. Factors affecting timing of closure and non-reversal of temporary ileostomies. Int J Colorectal Dis, 2015, 30(9): 1185-1192.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk factors associated with the delay reversal ileostomy following sphincter-preserving surgery for rectal cancer

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