Risk Factors of Complications Associated with Reversal of Defunctioning Ileostomy in patients with Rectal Cancer Undergoing Sphincter Preservation Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HUANGRong-kang ¹ ,  HEDan-dan ¹ , ZHAOJie ¹ , ZHOUWen-bin ¹ , LiYang ¹ ,  YEXin-mei ²

1. Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China;
2. Department of Nursing, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China;

Corresponding author：

YEXin-mei, Email: sanfanzhou@126.com

Keywords：

Rectal cancer; Defunctioning ileostomy; Postoperative complications; Risk factor

DOI：

10.7507/1007-9424.20160342

Video：

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Objective To analyze risk factors of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. Method Data were collected retrospectively for consecutive patients undergoing defunctioning ileostomy following sphincter preservation surgery for rectal cancer, from January 2014 to December 2014. Results One hundred and thirty patients were included (median time to reversal 132 d, range 39-692 d), of whom 35 patients (26.92%) had postoperative complications after stoma reversal. The main complications included 23 cases of diarrhea, 6 cases of bowel obstruction, 9 cases of incision infection, and 4 cases of perianal eczema. The results of univariate analysis showed that the distant of tumor from anal verge <5 cm (P=0.010), postoperative adjuvant chemotherapy (P=0.002), and time to reversal (P=0.025) were related to the postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. The result of multivariate analysis by using a logistic regression model showed that the time to reversal (OR=1.006, P=0.021) was a significant independent risk factor for it. Conclusion Delay reversal of defunctiong ileostomy might increase risk of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery.

Citation： HUANGRong-kang, HEDan-dan, ZHAOJie, ZHOUWen-bin, LiYang, YEXin-mei. Risk Factors of Complications Associated with Reversal of Defunctioning Ileostomy in patients with Rectal Cancer Undergoing Sphincter Preservation Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(11): 1335-1338. doi: 10.7507/1007-9424.20160342 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, Marusch F, Steinert R, et al. 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.	郑芳, 阳川华, 汪晓东, 等. 全直肠系膜切除+经肛门内括约肌切除术治疗超低位直肠癌和直肠肛管癌的近期疗效. 中国普外基础与临床杂志, 2012, 19(7):753-756.
7.	刘坤, 赵任. 预防性造口在中低位直肠癌保肛手术的应用. 中国实用外科杂志, 2014, 34(9):903-905.
8.	傅传刚. 预防性肠造口在低位直肠癌手术中的应用. 中国实用外科杂志, 2005, 25(3):138-139.
9.	马从超, 吴胜文. 预防性造口在低位直肠癌前切除术中应用价值的Meta分析. 中国现代普通外科进展, 2012, 15(12):963-967.
10.	Åkesson O, Syk I, Lindmark G, et al. Morbidity related to defunction-ing loop ileostomy in low anterior resection. Int J Colorectal Dis, 2012, 27(12):1619-1623.
11.	Ihnát P, Guňková P, Peteja M, et al. Diverting ileostomy in laparos-copic rectal cancer surgery:high price of protection. Surg Endosc, 2016 Feb 22.
12.	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.
13.	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.
14.	Rubio-Perez I, Leon M, Pastor D, et al. Increased postoperative com-plications after protective ileostomy closure delay:An institutional study. World J Gastrointest Surg, 2014, 6(9):169-174.
15.	Man VC, Choi HK, Law WL, et al. Morbidities after closure of ileostomy:analysis of risk factors. Int J Colorectal Dis, 2016, 31(1):51-57.
16.	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.
17.	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.
18.	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.
19.	Thalheimer A, Bueter M, Kortuem M, et al. Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum, 2006, 49(7):1011-1017.
20.	Sajid MS, Craciunas L, Baig MK, et al. Systematic review and meta-analysis of published, randomized, controlled trials comparing suture anastomosis to stapled anastomosis for ileostomy closure. Tech Coloproctol, 2013, 17(6):631-639.
21.	Gong J, Guo Z, Li Y, et al. Stapled vs hand suture closure of loop ileostomy:a meta-analysis. Colorectal Dis, 2013, 15(10):e561-e568.
22.	Löffler T, Rossion I, Gooßen K, et al. Hand suture versus stapler for closure of loop ileostomy-a systematic review and meta-analysis of randomized controlled trials. Langenbecks Arch Surg, 2015, 400(2):193-205.
23.	Camacho-Mauries D, Rodriguez-Díaz JL, Salgado-Nesme N, et al. Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection. Dis Colon Rectum, 2013, 56(2):205-211.
24.	Lee JT, Marquez TT, Clerc D, et al. Pursestring closure of the stoma site leads to fewer wound infections:results from a multicenter rand-omized controlled trial. Dis Colon Rectum, 2014, 57(11):1282-1289.
25.	Saito Y, Takakura Y, Hinoi T, et al. Body mass index as a predictor of postoperative complications in loop ileostomy closure after rectal resection in Japanese patients. Hiroshima J Med Sci, 2014, 63(4):33-38.
26.	Löffler T, Rossion I, Bruckner T, et al. Hand suture versus stapling for closure of loop ileostomy (HASTA Trial):results of a multicenter randomized trial (DRKS00000040). Ann Surg, 2012, 256(5):828-836.
27.	Mirbagheri N, Dark J, Skinner S. Factors predicting stomal wound closure infection rates. Tech Coloproctol, 2013, 17(2):215-220.
28.	Banerjee A. Pursestring skin closure after stoma reversal. Dis Colon Rectum, 1997, 40(8):993-994.
29.	Lasithiotakis K, Aghahoseini A, Alexander D. Is early reversal of defunctioning ileostomy a shorter, easier and less expensive operation? World J Surg, 2016, 40(7):1737-1740.
30.	Alves A, Panis Y, Lelong B, et al. Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy. Br J Surg, 2008, 95(6):693-698.
31.	Robertson J, Linkhorn H, Vather R, et al. Cost analysis of early versus delayed loop ileostomy closure:a case-matched study. Dig Surg, 2015, 32(3):166-172.

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, Marusch F, Steinert R, et al. 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. 郑芳, 阳川华, 汪晓东, 等. 全直肠系膜切除+经肛门内括约肌切除术治疗超低位直肠癌和直肠肛管癌的近期疗效. 中国普外基础与临床杂志, 2012, 19(7):753-756.
7. 刘坤, 赵任. 预防性造口在中低位直肠癌保肛手术的应用. 中国实用外科杂志, 2014, 34(9):903-905.
8. 傅传刚. 预防性肠造口在低位直肠癌手术中的应用. 中国实用外科杂志, 2005, 25(3):138-139.
9. 马从超, 吴胜文. 预防性造口在低位直肠癌前切除术中应用价值的Meta分析. 中国现代普通外科进展, 2012, 15(12):963-967.
10. Åkesson O, Syk I, Lindmark G, et al. Morbidity related to defunction-ing loop ileostomy in low anterior resection. Int J Colorectal Dis, 2012, 27(12):1619-1623.
11. Ihnát P, Guňková P, Peteja M, et al. Diverting ileostomy in laparos-copic rectal cancer surgery:high price of protection. Surg Endosc, 2016 Feb 22.
12. 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.
13. 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.
14. Rubio-Perez I, Leon M, Pastor D, et al. Increased postoperative com-plications after protective ileostomy closure delay:An institutional study. World J Gastrointest Surg, 2014, 6(9):169-174.
15. Man VC, Choi HK, Law WL, et al. Morbidities after closure of ileostomy:analysis of risk factors. Int J Colorectal Dis, 2016, 31(1):51-57.
16. 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.
17. 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.
18. 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.
19. Thalheimer A, Bueter M, Kortuem M, et al. Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum, 2006, 49(7):1011-1017.
20. Sajid MS, Craciunas L, Baig MK, et al. Systematic review and meta-analysis of published, randomized, controlled trials comparing suture anastomosis to stapled anastomosis for ileostomy closure. Tech Coloproctol, 2013, 17(6):631-639.
21. Gong J, Guo Z, Li Y, et al. Stapled vs hand suture closure of loop ileostomy:a meta-analysis. Colorectal Dis, 2013, 15(10):e561-e568.
22. Löffler T, Rossion I, Gooßen K, et al. Hand suture versus stapler for closure of loop ileostomy-a systematic review and meta-analysis of randomized controlled trials. Langenbecks Arch Surg, 2015, 400(2):193-205.
23. Camacho-Mauries D, Rodriguez-Díaz JL, Salgado-Nesme N, et al. Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection. Dis Colon Rectum, 2013, 56(2):205-211.
24. Lee JT, Marquez TT, Clerc D, et al. Pursestring closure of the stoma site leads to fewer wound infections:results from a multicenter rand-omized controlled trial. Dis Colon Rectum, 2014, 57(11):1282-1289.
25. Saito Y, Takakura Y, Hinoi T, et al. Body mass index as a predictor of postoperative complications in loop ileostomy closure after rectal resection in Japanese patients. Hiroshima J Med Sci, 2014, 63(4):33-38.
26. Löffler T, Rossion I, Bruckner T, et al. Hand suture versus stapling for closure of loop ileostomy (HASTA Trial):results of a multicenter randomized trial (DRKS00000040). Ann Surg, 2012, 256(5):828-836.
27. Mirbagheri N, Dark J, Skinner S. Factors predicting stomal wound closure infection rates. Tech Coloproctol, 2013, 17(2):215-220.
28. Banerjee A. Pursestring skin closure after stoma reversal. Dis Colon Rectum, 1997, 40(8):993-994.
29. Lasithiotakis K, Aghahoseini A, Alexander D. Is early reversal of defunctioning ileostomy a shorter, easier and less expensive operation? World J Surg, 2016, 40(7):1737-1740.
30. Alves A, Panis Y, Lelong B, et al. Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy. Br J Surg, 2008, 95(6):693-698.
31. Robertson J, Linkhorn H, Vather R, et al. Cost analysis of early versus delayed loop ileostomy closure:a case-matched study. Dig Surg, 2015, 32(3):166-172.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Risk Factors of Complications Associated with Reversal of Defunctioning Ileostomy in patients with Rectal Cancer Undergoing Sphincter Preservation Surgery

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