Loop-ileostomy Reversal-patient-related Characteristics Influencing Time to Closure

Overview

Journal Int J Colorectal Dis

Specialties Gastroenterology
General Surgery

Date 2018 Mar 7

PMID 29508050

Citations 18

Authors

Carl Pontus Gustafsson

Ulf Gunnarsson

Ursula Dahlstrand

Ulrik Lindforss

Affiliations

Soon will be listed here.

Abstract

Purpose: To identify factors associated with timing of stoma reversal after rectal cancer surgery in a large Swedish register-based cohort.

Methods: Three thousand five hundred sixty-four patients with rectal cancer who received a protective stoma during surgery in 2007-2013 were identified in the Swedish colorectal cancer register. Time to stoma reversal was evaluated over a follow-up period of one and a half years. Factors associated with timing of stoma reversal were analysed using Cox regression analysis. Reversal within 9 months (12 months if adjuvant chemotherapy) was considered latest expected time to closure.

Results: Stoma reversal was performed in 2954 (82.9%) patients during follow-up. Patients with post-secondary education had an increased chance for early stoma reversal (HR 1.13; 95% CI 1.02-1.25). Postoperative complications (0.67; 0.62-0.73), adjuvant chemotherapy (0.63; 0.57-0.69), more advanced cancer stage (stage III 0.74; 0.66-0.83 and stage IV 0.38; 0.32-0.46) and higher ASA score (0.80; 0.71-0.90 for ASA 3-4) were associated with longer time to reversal. Two thousand four hundred thirty-seven (68.4%) patients had stoma reversal within latest expected time to closure. Factors associated to decreased chance of timely reversal were more advanced cancer stage (stage III 0.64; 0.50-0.81 and stage IV 0.19; 0.13-0.27), postoperative complications (0.50; 0.42-0.59) and higher ASA score (0.77; 0.61-0.96 for ASA 3-4).

Conclusions: Patients with a high level of education had a higher chance of timely reversal but medical factors had a stronger association to time to reversal. Patients with advanced rectal cancer are at high risk for non-reversal and should be considered for permanent stoma.

Citing Articles

Dahlstrand U, Gustafsson P, Nasvall P, Johansson J, Gunnarsson U, Lindforss U Inquiry. 2023; 60:469580231212126.

PMID: 38105185 PMC: 10729635. DOI: 10.1177/00469580231212126.

Revolutionizing sphincter preservation in ultra-low rectal cancer: exploring the potential of transanal endoscopic intersphincteric resection (taE-ISR): a propensity score-matched cohort study.

Xu X, Zhong H, You J, Ren M, Fingerhut A, Zheng M Int J Surg. 2023; 110(2):709-720.

PMID: 38016136 PMC: 10871607. DOI: 10.1097/JS9.0000000000000945.

Impact of ileostomy in the adjuvant treatment and outcome of colon cancer.

Calderillo-Ruiz G, Lopez-Basave H, Munoz-Montano W, Diaz-Romero M, Carbajal-Lopez B, Castillo-Morales C Int J Colorectal Dis. 2023; 38(1):158.

PMID: 37261538 DOI: 10.1007/s00384-023-04421-w.

Impact of chemotherapy on surgical outcomes in ileostomy reversal: a propensity score matching study from a single centre.

Cheng H, Shao Y, Lin C, Chiang T, Chen M, Chiu T Tech Coloproctol. 2023; 27(12):1227-1234.

PMID: 36973527 DOI: 10.1007/s10151-023-02790-6.

The impact of postoperative complications severity on stoma reversal following sphincter-preserving surgery for rectal cancer.

Hu K, Tan K, Li W, Zhang A, Li F, Li C Langenbecks Arch Surg. 2022; 407(7):2959-2967.

PMID: 35802267 DOI: 10.1007/s00423-022-02589-3.

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