Stoma reversal in patients who underwent low anterior resection and diversion stoma for rectal cancer

Abstract

BACKGROUND: Defunctioning ileostomy or colostomy is usually used to protect a high-risk anastomosis after low anterior resection for rectal cancer. Although the stoma is usually considered temporary, many a time, closure of the stoma is not performed because of various reasons. We aimed to review the incidence of reversal of stoma in patients after low anterior resection (LAR) with a diversion stoma. The factors associated with non stomal closure were analyzed. METHODS: Five hundred and eighty-five patients who underwent LAR and diversion stoma from January 1999 to December 2010 were reviewed from our prospective collected database. LAR was performed with either laparoscopic or open approach. Diversion stoma was performed when the anastomosis was within 5 cm from the anal verge. Contrast enema was performed to assess the integrity of the anastomosis before closure. Patients' characteristics, disease status, operative details and adjuvant treatment were reviewed. The reasons for not closing the stoma were also studied. RESULTS: Closure of stoma after initial LAR was performed in 469 patients. The median age was 67.3 months and duration between the two operations was 6.1 months. The remaining patients (n=111, 19.1%) did not undergo stoma closure. The reasons for unable underwent closure were broadly divided into two categories, anastomotic-related (47.7%) and non-anastomotic-related (52.3%). Of those anastomotic-related, persistent leakage, fistula and stricture composed 79.2% (n=42/53); while disease progression (n=39/58, 67.2%) predominated in non-anastomotic related group. Preoperative radiotherapy significantly decreased the chance of subsequent closure of stoma(26/ 84, 31.0%, p=0.001). Adjuvant chemotherapy did not have any adverse effect to the closure of stoma nor post-operative complications. The result of closure of ileostomy and colostomy were similar in terms of the types and incidences of post-operative. CONCLUSIONS: The temporary stoma after low anterior resection may become permanent in some patients. Over half of the patients who did not undergo closure of stoma were due to reasons other than anastomotic complications. Preoperative radiation therapy is associated with a higher chance of not closing the stoma. Thus a careful assessment of the disease status and general condition of the patient before deciding the use of a diversion stoma is recommended.