Predictors of Complications After Prophylactic Ileostomy Reversal for Rectal Cancer: A Retrospective Study

Overview

Journal World J Gastrointest Surg

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2024 May 31

PMID 38817282

Authors

Quan Lv

Xin-Peng Shu

Dong Peng

Si-Qi Li

Zheng Xiang

Affiliations

Soon will be listed here.

Abstract

Background: Previous studies have analyzed the risk factors for complications after ileostomy reversal for rectal cancer (RC), but there were significant differences in the reported risk factors for complications after stoma reversal. No studies have analyzed the risk factors for stoma-related complications and overall postoperative complications separately.

Aim: To analyze the risk factors for overall complications and stoma-related complications after ileostomy reversal for patients with RC.

Methods: This was a retrospective study of 439 patients who underwent ileostomy reversal at a clinical center and were followed up between September 2012 and September 2022. Continuous variables are expressed as the mean ± SD and were analyzed with independent-sample tests, while frequency variables are expressed as (%), and the test or Fisher's exact test was used. Univariate and multivariate logistic regression analyses were used to identify predictors of overall complications and stoma-related complications.

Results: The overall complication rate after ileostomy reversal was 11.4%. Patients with lower preoperative albumin concentration ( < 0.01), greater blood loss ( = 0.017), and longer operative times ( < 0.01) were more likely to experience postoperative complications. The incidence of stoma-related complications was 6.4%. Analysis of the study showed that a higher body mass index (BMI) ( < 0.01), preoperative comorbid hypertension ( = 0.049), time from primary surgery to ileostomy reversal ( < 0.01) and longer operation time ( = 0.010) were more likely to result in stoma-related complications postoperatively. Multivariate logistic regression analysis revealed that a lower preoperative albumin level ( < 0.01, OR = 0.888, 95%CI: 0.828-0.958) was an independent risk factor for overall complications. Moreover, multivariate analysis revealed that BMI ( < 0.01, OR = 1.176, 95%CI: 1.041-1.330) and time from primary surgery to ileostomy reversal ( < 0.01, OR = 1.140, 95%CI: 1.038-1.252) were independent risk factors for stoma-related complications after stoma reversal.

Conclusion: The preoperative albumin level was a predictor of overall complications. Preoperative BMI and the time from primary surgery to ileostomy reversal were predictors of stoma-related complications.

Citing Articles

Timing and morbidity of loop ileostomy closure after rectal cancer resection: a prospective observational multicentre snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO).

Rizzo G, Ferrara F, Parini D, Pata F, Forni C, Anania G Int J Colorectal Dis. 2025; 40(1):43.

PMID: 39964558 PMC: 11836177. DOI: 10.1007/s00384-025-04827-8.

References

Hsieh M, Kuo L, Chi C, Huang W, Chin C . Pursestring Closure versus Conventional Primary Closure Following Stoma Reversal to Reduce Surgical Site Infection Rate: A Meta-analysis of Randomized Controlled Trials. Dis Colon Rectum. 2015; 58(8):808-15. DOI: 10.1097/DCR.0000000000000401. View

Dekker E, Tanis P, Vleugels J, Kasi P, Wallace M . Colorectal cancer. Lancet. 2019; 394(10207):1467-1480. DOI: 10.1016/S0140-6736(19)32319-0. View

Liu Z, Ge X, Ai S, Wang H, Sun F, Chen L . Postoperative decrease of serum albumin predicts short-term complications in patients undergoing gastric cancer resection. World J Gastroenterol. 2017; 23(27):4978-4985. PMC: 5526768. DOI: 10.3748/wjg.v23.i27.4978. View

Vogel I, Reeves N, Tanis P, Bemelman W, Torkington J, Hompes R . Impact of a defunctioning ileostomy and time to stoma closure on bowel function after low anterior resection for rectal cancer: a systematic review and meta-analysis. Tech Coloproctol. 2021; 25(7):751-760. PMC: 8187190. DOI: 10.1007/s10151-021-02436-5. View

Hardt J, Pilz L, Magdeburg J, Kienle P, Post S, Magdeburg R . Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection. Int J Colorectal Dis. 2017; 32(10):1439-1446. DOI: 10.1007/s00384-017-2884-7. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Guren M . The global challenge of colorectal cancer. Lancet Gastroenterol Hepatol. 2019; 4(12):894-895. DOI: 10.1016/S2468-1253(19)30329-2. View

Baik H, Bae K . Low albumin level and longer interval to closure increase the early complications after ileostomy closure. Asian J Surg. 2020; 44(1):352-357. DOI: 10.1016/j.asjsur.2020.09.007. View

Schneider V, Lee L, Stroux A, Buhr H, Ritz J, Kreis M . Risk factors for reoperation after ileostomy reversal - Results from a prospective cohort study. Int J Surg. 2016; 36(Pt A):233-239. DOI: 10.1016/j.ijsu.2016.10.043. View

10.

McDermott F, Heeney A, Kelly M, Steele R, Carlson G, Winter D . Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015; 102(5):462-79. DOI: 10.1002/bjs.9697. View

11.

Mennigen R, Sewald W, Senninger N, Rijcken E . Morbidity of loop ileostomy closure after restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis: a systematic review. J Gastrointest Surg. 2014; 18(12):2192-200. DOI: 10.1007/s11605-014-2660-8. View

12.

Phan K, Oh L, Ctercteko G, Pathma-Nathan N, Khoury T, Azam H . Does a stoma reduce the risk of anastomotic leak and need for re-operation following low anterior resection for rectal cancer: systematic review and meta-analysis of randomized controlled trials. J Gastrointest Oncol. 2019; 10(2):179-187. PMC: 6465490. DOI: 10.21037/jgo.2018.11.07. View

13.

Silva M, Ratnayake G, Deen K . Quality of life of stoma patients: temporary ileostomy versus colostomy. World J Surg. 2003; 27(4):421-4. DOI: 10.1007/s00268-002-6699-4. View

14.

Rubinkiewicz M, Witowski J, Wysocki M, Pisarska M, Klek S, Budzynski A . Investigating Risk Factors for Complications after Ileostomy Reversal in Low Anterior Rectal Resection Patients: An Observational Study. J Clin Med. 2019; 8(10). PMC: 6832752. DOI: 10.3390/jcm8101567. View

15.

Peng D, Yu D, Liu X, Tao W, Kang B, Zhang H . Does temporary ileostomy via specimen extraction site affect the short outcomes and complications after laparoscopic low anterior resection in rectal cancer patients? A propensity score matching analysis. BMC Surg. 2022; 22(1):263. PMC: 9264509. DOI: 10.1186/s12893-022-01715-8. View

16.

Fielding A, Woods R, Moosvi S, Wharton R, Speakman C, Kapur S . Renal impairment after ileostomy formation: a frequent event with long-term consequences. Colorectal Dis. 2019; 22(3):269-278. DOI: 10.1111/codi.14866. View

17.

Ouro S, Ferreira M, Albergaria D, Maio R . Loop ileostomy in rectal cancer surgery: factors predicting reversal and stoma related morbidity. Langenbecks Arch Surg. 2021; 406(3):843-853. DOI: 10.1007/s00423-021-02169-x. View

18.

Garg P, Goel A, Sharma S, Chishi N, Gaur M . Protective Diversion Stoma in Low Anterior Resection for Rectal Cancer: A Meta-Analysis of Randomized Controlled Trials. Visc Med. 2019; 35(3):156-160. PMC: 6616072. DOI: 10.1159/000497168. View

19.

Gu W, Wu S . Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies. World J Surg Oncol. 2015; 13:9. PMC: 4311499. DOI: 10.1186/s12957-014-0417-1. View

20.

Shiga M, Maeda H, Oba K, Okamoto K, Namikawa T, Fujisawa K . Safety of laparoscopic surgery for colorectal cancer in patients over 80 years old: a propensity score matching study. Surg Today. 2017; 47(8):951-958. DOI: 10.1007/s00595-017-1470-5. View