title: Should a loop ileostomy closure in rectal cancer patients be done during or after adjuvant chemotherapy?
abstract: OBJECTIVE
  The influence of ileostomy closure timing on surgical and oncologic outcome was investigated in patients with locally advanced rectal cancer receiving adjuvant chemotherapy after low anterior resection.
  
  
  METHODS
  Consecutive patients diagnosed with T3-4/N+ rectal cancer, treated by neoadjuvant chemoradiation and low anterior resection during 2000-2012 were retrospectively evaluated. Patients undergoing closure during adjuvant chemotherapy (Group A) were compared to patients undergoing closure after completing chemotherapy (Group B).
  
  
  RESULTS
  A total of the 165 patients met inclusion criteria, of whom 104 received adjuvant chemotherapy (25 in Group A and 79 in Group B). The pathologic stage was higher in Group B (P = 0.015). The rates of postoperative complications were similar (16% for Group A and 15% for Group B, P = 0.88), as was hospital stay (mean 5.78 days for Group A and 6.25 days for Group B, P = 0.7). There was no significant difference in recurrence rate and overall survival between the groups.
  
  
  CONCLUSIONS
  Referral to ileostomy closure in relation to adjuvant chemotherapy is influenced by pathologic stage. Early referral appears to be reserved to a small number of patients with lower pathologic stage. Timing of ileostomy closure does not change short- or long-term results.
authors.affiliation: Proctology Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Division of Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Hagit
authors.initials: H
authors.lastname: Tulchinsky
authors.forename: Einat
authors.initials: E
authors.lastname: Shacham-Shmueli
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Klausner
authors.forename: Moshe
authors.initials: M
authors.lastname: Inbar
authors.forename: Ravit
authors.initials: R
authors.lastname: Geva
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007081:Ileostomy; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: chemotherapy; complications; ileostomy; rectal cancer