Following anterior resection for rectal cancer, defunctioning ileostomy closure may be significantly delayed by adjuvant chemotherapy: a retrospective study.
OBJECTIVE
A temporary loop ileostomy is often created to minimize the impact of peritoneal sepsis from an anastomotic dehiscence following colo-anal or low colorectal anastomosis. These stomas are not without complications. Clinicians tend to advise patients that their loop ileostomy will be reversed within 6-12 weeks of formation. However, factors such as adjuvant chemotherapy may affect the timing of closure. The aim of this study was to review the time between formation and closure of loop ileostomies following total mesorectal excision in patients with rectal cancer.


METHODS
A retrospective study of 50 patients with loop ileostomies to defunction total mesorectal excisions for rectal cancer, between April 2002 and July 2005.


RESULTS
Of the 50 patients with defunctioning loop ileostomies, 24 received adjuvant chemo-radiotherapy, and 26 did not. There was a 28% morbidity. The overall median time from formation to closure was 142 days (35-575). Median time from formation to closure in those with adjuvant therapy was 197 days (35-575) and in those with no adjuvant therapy was 133 days (75-395). This was a significant delay (P = 0.049). Sixteen stomas were not closed to date.


CONCLUSIONS
Time between formation and closure of loop ileostomy following anterior resection of rectum is significantly delayed by adjuvant chemotherapy. Because of their high morbidity, defunctioning ileostomies should be closed as early as medically possible, especially if adjuvant chemotherapy is planned.
Lordan
J T
JT
Frimley Park Hospital, Portsmouth Road, Camberley, UK. dr_lordan@yahoo.co.uk
Heywood
R
R
Shirol
S
S
Edwards
D P
DP
D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors