Outcome of early versus late ileostomy closure in patients with rectal cancers undergoing low anterior resection: A prospective cohort study

Background: Protective loop ileostomy is performed following low anterior resection (LAR) in patients with rectal cancer to reduce the complications of primary anastomosis. The optimal timing for ileostomy closure remains controversial. The aim of the current study was to compare the effects of early (<2 weeks) versus late (>= 2 months) closure of the stoma in patients with rectal cancer undergoing LAR on surgical outcome and complications rates. Methods: This prospective cohort study was conducted in two referral centers in Shiraz, Iran, during a 2 -year period. We have consecutively and prospectively included adult patients with rectal adenocarcinoma who underwent LAR followed by protective loop ileostomy in our center during the study period. The baseline, tumor characteristics and complication as well as outcome was recorded in a 1-year follow-up and was compared between early and late ileostomy closure.Results: Overall, 69 patients (32 in early and 37 in late group) were included. The mean age of the patients was 59.40 +/- 9.30 years and there were 46 (66.7%) men and 23 (33.3%) women. Patients undergoing early closure of the ileostomy had significantly shorter operation duration (p<0.001) and lower intra-operative bleeding (p<0.001) compared to late ileostomy closure. There was no significant difference between two study groups regarding the complications. Early closure was also not found to be a predictive factor of post-ileostomy closure complications.Conclusion: Early closure (<2 weeks) of ileostomy after LAR in patients with rectal adenocarcinoma is a safe and feasible technique which is associated with favorable outcome.(c) 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Automated summary

This study compared the effects of early versus late closure of the stoma in patients with rectal cancer undergoing low anterior resection. The results showed that early closure was associated with shorter operation duration and lower intra-operative bleeding. There was no difference in complications between the two groups. Therefore, early closure of the stoma is a safe and feasible technique.