Early closure compared to late closure of temporary ileostomy in rectal cancer: a randomized controlled trial study

Background A temporary loop ileostomy is one of the most common methods for the prevention of anastomotic leakage in rectal cancer patients who underwent low anterior resection. However, the optimal timing of loop ileostomy reversal remains unknown. The main objective of this study was to evaluate t...
Ausführliche Beschreibung

Background A temporary loop ileostomy is one of the most common methods for the prevention of anastomotic leakage in rectal cancer patients who underwent low anterior resection. However, the optimal timing of loop ileostomy reversal remains unknown. The main objective of this study was to evaluate the debilitating complications caused by early closure of ileostomy in comparison with late closure in rectal cancer patients. Design A randomized, controlled, unblinded, and monocentric trial. Methods A total of 104 rectal cancer patients were randomly assigned to the case group of early closure of ileostomy (n = 50) and the control group of late closure of ileostomy (n = 54). This trial was undertaken in a single colorectal institution, a university-affiliated teaching hospital in Tehran, Iran. Randomization and allocation to the trial group were conducted by using variable block randomization based on quadruple numbers. The primary endpoint of this trial was determined by the complications of early ileostomy closure versus those of late closure in rectal cancer patients who had undergone low anterior resection. In early closure, loop ileostomy is reversed 2–3 weeks after the first two courses of adjuvant chemotherapy, while in late closure, the ileostomy is reversed 2–3 weeks after the last course of adjuvant chemotherapy. Results Follow-up of 1 year demonstrated a reduction in the risk of complications and an improved quality of life in patients with rectal cancer following low anterior resection and chemotherapy (neoadjuvant and adjuvant) in the case group but did not reach a significant difference (p = 0.555). In addition, there was no significant difference in perioperative outcomes, such as blood loss, operative time, readmission, and reoperation; also, no statistically significant differences were reported between the groups in patients’ quality of life or LARS score. Conclusion In summary, it seems that early closure of ileostomy is not better than late closure in improving patients’ quality of life with rectal cancer following low anterior resection and chemotherapy (neoadjuvant and adjuvant); no statistical difference was observed for reduction of risk of ostomy complications. Thus, neither of these methods (early closure versus late closure) is superior to the other, and controversy still exists. Trial registration number and date of registration IRCT20201113049373N1 Ausführliche Beschreibung

Autor*in:	Ahmadi-Amoli, Hadi [verfasserIn] Rahimi, Mohsen Abedi-kichi, Raziyeh Ebrahimian, Nazli Hosseiniasl, Seyed-Mohammad Hajebi, Reza Rahimpour, Ehsan

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Schlagwörter:	Closure of ileostomy Low anterior resection Rectal cancer Quality of life (QOL) Low anterior resection syndrome (LARS)

Anmerkung:

© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Übergeordnetes Werk:	Enthalten in: Langenbeck's archives of surgery - Berlin : Springer, 1948, 408(2023), 1 vom: 14. Juni
Übergeordnetes Werk:	volume:408 ; year:2023 ; number:1 ; day:14 ; month:06

Links:	Volltext

DOI / URN:	10.1007/s00423-023-02934-0

Katalog-ID:	SPR05189257X