Comparison of clinical outcomes of stoma reversal during versus after chemotherapy for rectal cancer patients

doi:10.21203/rs.3.rs-2079493/v1

Download PDF

Research Article

Comparison of clinical outcomes of stoma reversal during versus after chemotherapy for rectal cancer patients

https://doi.org/10.21203/rs.3.rs-2079493/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 11 Jul, 2023

Read the published version in Langenbeck's Archives of Surgery →

You are reading this latest preprint version

Purpose:

The optimal timing of stoma closure during or after adjuvant chemotherapy for rectal cancer patients undergoing sphincter-preserving surgery remains unknown. This study aimed to investigate the influence of clinical and oncological outcomes depending on the timing of stoma closure.

Methods:

Between January 2006 and December 2015, we enrolled 244 consecutive rectal cancer patients who underwent curative-intent sphincter-preserving surgery with diverting colostomy and adjuvant chemotherapy. Patients with stoma closure during (During group) adjuvant chemotherapy were compared to those who had stoma closure after adjuvant chemotherapy (After group).

Results:

Parastomal hernia occurred more frequently in the after group than in the during group. (10% vs. 2.9%, p = 0.028). Overall, no significant difference was observed in overall survival (OS) or disease-free survival (DFS) between the two groups (p = 0.911 for OS, p = 0.505 for DFS). However, an inferior OS occurred if reopen surgery was performed within 30 days of stoma closure in the during group, as compared with the after group (p = 0.004). In addition, a marginally poor DFS was observed in the group of patients who received further operations due to 30-day stoma closure complications compared to the other patients (p = 0.07).

Conclusions:

For rectal cancer patients who underwent sphincter-preserving surgery, attention should be given to avoid 30-day major complications after stoma reversal because patients who require reoperation during adjuvant chemotherapy may have poor long-term survival.

rectal cancer

adjuvant chemotherapy

stoma closure

survival

In rectal cancer patients who underwent sphincter-preserving surgery, a diverting stoma is commonly used to reduce the pelvic sepsis risk from anastomotic leakage.[1] Nevertheless, there is no standard guideline for the optimal timing of stoma closure. Usually, stoma reversal is often scheduled 8 to 12 weeks after the primary surgery[2] because this interval not only allows the patient to recover but can also soften intra-abdominal adhesions and can resolve inflammation and edema within the abdominal cavity and around the stoma orifice.[3] Studies have shown that early closure of a temporary stoma is safe[4] and may have benefits in lowering the risk of a permanent stoma.[5]

During this period, a portion of patients will receive adjuvant chemotherapy within the following 6 months to reduce cancer recurrence.[6] Therefore, whether stoma reversal should be performed during adjuvant chemotherapy remains controversial. There is concern that interrupting or delaying chemotherapy due to stoma closure may alter the effects of chemotherapy.[7] One prospective study[8] showed that the total doses of adjuvant chemotherapy were significantly lower in patients whose stoma was closed during chemotherapy than in those whose stoma was reversed after chemotherapy (p = 0.01). Another nationwide study from Japan also concluded that more doses of adjuvant chemotherapy were administered in the late stoma closure group than in the patients with early closure. However, both of the studies lack long-term survival outcomes.[9]

Moreover, Thalheimer et al.[10] revealed that the morbidity following the closure of a temporary loop ileostomy during adjuvant chemotherapy in colorectal cancer patients is much higher than in patients whose stoma closed after adjuvant chemotherapy. In addition, severe complications at closure may cause the patient to postpone or discontinue adjuvant chemotherapy, which may lead to inferior survival.[11, 12] Therefore, adjuvant chemotherapy significantly delays stoma closure.[13, 14] In contrast, several studies presented no difference in the short-term complication rate and long-term oncological outcomes between patients whose stoma closed during or after adjuvant chemotherapy.[8, 15–18] However, these studies were limited to a small case number and had significantly uneven clinical parameters between their groups, such as patient age,[8] pathological cancer staging,[16] and percentage of neoadjuvant chemotherapy received, and many of the studies lacked chemotherapy regimen data.[8, 10, 18] Moreover, the available literature is scarce about the impact of short-term closure complications on long-term outcomes.

Therefore, this study aims to evaluate the clinical and oncological outcomes of diverting stoma closure during and after adjuvant chemotherapy in rectal cancer patients undergoing curative resection.

The demographic data and clinical information were retrospectively analyzed from a prospectively collected colorectal cancer database at the Division of Colorectal Surgery, Chang Gung Memorial Hospital, Linkou. IRB approval was obtained from the Chang Gung Medical Foundation Institutional Review Board (IRB No. 202001577B0).

Between January 2006 and December 2015, patients who had pathologically confirmed, nonmetastatic rectal adenocarcinoma and underwent sphincter-preserving surgery with a diverting loop transverse colostomy for curative intent were included (Fig. 1). The exclusion criteria were patients with unclosed stoma, with the absence of or incomplete adjuvant chemotherapy, and who underwent concomitant surgery at stoma closure operation.

We divided the patients into two groups according to the timing of stoma closure: the During group who underwent stoma closure during chemotherapy and the After Group who underwent stoma closure after the completion of chemotherapy. The demographics and clinical characteristics, including adjuvant chemotherapy information, short-term postoperative outcomes, length of hospital stay, and long-term disease-free survival, were compared between the groups.

The standard protocol in our hospital is to administer adjuvant chemotherapy for the next 6 months postoperatively, and the regimen is fluorouracil-based chemotherapy with additional oxaliplatin after being considered by each surgeon or oncologist. In this study, we defined completion of adjuvant chemotherapy if a patient could finish at least 5 months of postoperative chemotherapy. For the During group patient, the last chemotherapy was administered at least two weeks before stoma closure and to restart chemotherapy at least two weeks from the surgery, depending on the patient’s condition.

Before stoma closure, the anastomosis site was assessed by digital rectum examination, lower gastrointestinal series, or colonoscopy to ensure the absence of leakage, fistula, or any other anastomotic problems. The timing of stoma closure is on surgeon’s decision after comprehensive discussion with patient. Stoma closure was performed via the hand-sewn anastomosis method.

Stoma-related complications were recorded by the surgeons or stoma care therapists. The 30-day postoperative morbidity after stoma closure was defined as any complications that developed within 30 days. The primary anastomotic site complications include anastomotic leakage, stricture, and perianal enterocutaneous fistula formation after stoma reversal. The complications were classified according to the Clavien–Dindo classification.[19] Grade III to IV complications were defined as severe complications.

Overall survival (OS) and disease-free survival (DFS) were defined as the duration of death or the first recurrence related to rectal cancer from the index surgery, respectively. The last follow-up date was August 31, 2020. The reason for incomplete chemotherapy was also extensively reviewed in the chart. Low anterior resection syndrome (LARS) was defined as a patient complaining and unable to tolerate the incontinence, fecal soiling, urgency, and frequency, even improved after medication treatment.[20]

We used SPSS statistics software (version 24.0; SPSS Inc., Chicago, IL, USA) for statistical analysis. A comparative analysis between the groups was performed using an independent samples t test for continuous variables and a chi-square test or Fisher’s exact test for categorical variables. The survival curve between the groups was calculated by Kaplan–Meier analysis and compared with the log-rank test. Statistical significance was set at p < 0.05.

A total of 622 patients were initially evaluated for eligibility (Fig. 1). Of those, 244 patients were enrolled and then were divided into two groups according to the timing of stoma closure. The During group was comprised of 105 patients who underwent stoma closure during adjuvant chemotherapy, and the After group was comprised of 139 patients who received stoma closure after adjuvant chemotherapy was completed. No significant difference was observed between the groups regarding age, cancer staging, percentage of neoadjuvant chemotherapy received, or chemotherapy regimen (Table 1). No significant difference was detected in the overall stoma-related complications, but more parastomal hernias occurred in the After group than in the During group (Table 2). The duration from stoma creation to stoma closure was 138.01 ± 70.15 days in the During group and 267.30 ± 74.27 days in the After group (p < 0.001). There was no mortality from stoma closure surgery in either cohort. The operative details, including operation time, estimated blood loss, and hospital stay, were comparable between the groups. No significant difference was noted in the 30-day stoma closure complications, primary anastomotic complications, reoperation rate, or long-term morbidity depending on the closure timing.

Table 1

Demographics and clinicopathologic characteristics of the groups
	During N = 105	After N = 139	P value
Age (Std. dev)	59.26 ± 11.95	60.32 ± 11.73	0.489
Follow-up duration (months)	78.05 ± 37.30	75.50 ± 32.93	0.580
Sex male (%)	66 (62.8%)	96 (69.0%)	0.309
Hypertension (%)	28 (26.6%)	44 (31.6%)	0.398
Diabetes mellitus (%)	9 (8.5%)	21 (15.1%)	0.124
Cardiac disease (%)	2 (1.9%)	8 (5.7%)	0.133
Stroke (%)	1 (0.9%)	5 (3.5%)	0.187
ASA (%)
I	5 (4.7%)	6 (4.3%)	0.952
II	73 (69.5%)	95 (68.3%)
III	27 (25.7%)	38 (27.3%)
BMI (kg/m²)	24.48 ± 3.09	24.59 ± 3.48	0.803
Tumor location (%)			0.108
Upper rectum (> 10 cm)	4 (3.8%)	10 (7.1%)
Middle rectum (6 ~ 10 cm)	51 (48.5%)	50 (35.9%)
Lower rectum (≤ 5 cm)	50 (47.6%)	79 (56.8%)
Neo-sRT (%)	28 (26.6%)	29 (20.8%)	0.198
Neo-CCRT (%)	28 (26.6%)	31 (22.3%)	0.430
Laparoscopic approach (%)	24 (22.8%)	21 (15.1%)	0.122
Primary stoma (%)	100 (95.2%)	131 (94.2%)	0.732
cTNM stage (%)			0.633
1	10 (9.5%)	15 (10.8%)
2	21 (20.0%)	34 (24.4%)
3	74 (70.5%)	90 (64.7%)
ypTNM stage (%)			0.745
1	2 (1.9%)	4 (2.8%)
2	22 (20.9%)	24 (17.2%)
3	77 (73.3%)	101 (72.6%)
Adjuvant chemotherapy regimen (%)			0.269
Oxaliplatin-based	14 (13.3%)	29 (20.8%)
Intravenous fluorouracil-based	21 (20.0%)	29 (20.8%)
Oral fluorouracil-based	70 (66.6%)	81 (58.2%)
Std, standard deviation; Neo-sRT, Neoadjuvant short course radiotherapy; Neo-CCRT, Neoadjuvant concurrent chemoradiotherapy; ASA, American Society of Anesthesiologists (ASA) physical status classification system

Table 2

Perioperative outcomes of transverse colostomy closure
	During N = 105	After N = 139	P value
Stoma related complications (%)	16 (15.2%)	23 (16.5%)	0.782
parastomal skin irritations	7 (6.6%)	5 (3.5%)	0.272
parastomal hernia	3 (2.9%)	14 (10.0%)	0.028
stoma prolapse	5 (4.7%)	4 (2.8%)	0.439
stoma retraction	2 (1.9%)	0 (0.0%)	0.102
stoma stenosis	1 (0.9%)	1 (0.7%)	0.842
Interval from stoma creation to stoma closure (days, Std. dev)	138.01 ± 70.15	267.30 ± 74.27	< 0.001
Op time (minutes, Std. dev)	99.1 ± 32.0	106.9 ± 30.8	0.054
Blood loss (ml, Std. dev)	13.81 ± 15.50	14.17 ± 12.80	0.841
Hospital stay (days, Std. dev)	8.75 ± 5.76	8.90 ± 2.68	0.791
30-day stoma closure complications (%)
Wound infection	13 (12.3%)	18 (12.9%)	0.923
Postoperative ileus	8 (7.6%)	7 (5.0%)	0.391
Closure site leakage	1 (0.9%)	1 (0.7%)	0.835
Primary anastomotic complications	1 (0.9%)	2 (1.4%)	0.740
30-day Grade III or IV complications	6 (5.7%)	5 (3.5%)	0.417
Long term stoma closure complications (%)
Closure site hernia	3 (2.8%)	4 (2.8%)	0.992
Primary anastomotic complications*	2 (0.9%)	1 (0.7%)	0.490
Std, standard deviation; OP, operation;
*primary anastomosis leakage and stenosis

The mean follow-up duration was 78.05 ± 37.30 months in the During group and 75.50 ± 32.93 months in the After group. Overall, no significant difference in the OS and DFS (p = 0.911 for OS, p = 0.505 for DFS) was observed between the groups (Fig. 2a). However, eleven patients had Grade III or IV closure complications within 30 days after stoma reversal (during group = 6, after group = 5, p = 0.417). The etiologies of reoperation are postoperative ileus, closure site leakage, and primary anastomotic leakage. In the During group, three patients only received 2 cycles of adjuvant chemotherapy, which was discontinued permanently because of the complications. The remaining three patients had delayed adjuvant chemotherapy due to closure morbidity.

In the subgroup analysis, an inferior OS was noted if reopen surgery took place within 30 days of stoma closure in the During groups but not in the After group (p = 0.004). Although it did not reach a significant difference, there was a trend showing that the DFS was poor in the patients in the During group who received further operation due to stoma closure complications compared to the other patients (p = 0.07) (Fig. 2b).

In the During group, 12 (11.4%) patients did not complete their adjuvant chemotherapy after stoma closure. The chemotherapy regimen they received was only fluorouracil-based chemotherapy. Five patients who had LARS (41.6%) discontinued chemotherapy, and one patient who had postoperative ileus (8.3%) discontinued chemotherapy. Other patients discontinued chemotherapy due to a poor-healed wound that requires long-term care (8.3%), fatigue, and poor general condition (8.3%), closure site anastomotic leakage (8.3%), primary anastomotic leakage (8.3%), pericardial effusion (8.3%) and deep vein thrombosis (8.3%). In addition, nine patients had their chemotherapy regime shifted the IV form (six Folfox and three Roswell park regimens) to the oral form (tegafur) because of intolerable side effects. Nevertheless, there seems to be no significant difference in OS and DFS of the patients who discontinued their adjuvant chemotherapy compared to those who completed chemotherapy (p = 0.822 for OS, p = 0.589 for DFS).

This study is the largest series from a single medical center database that focused on the impact of stoma closure timing during or after adjuvant chemotherapy in rectal cancer patients who underwent sphincter-preserving surgery. Currently, there is no optimal guideline about whether to reverse a stoma during or after adjuvant chemotherapy. In this study, we found that temporary stoma closure during adjuvant chemotherapy could be safe and had the same overall survival and disease-free survival compared to stoma closure after treatment, which was consistent with previous studies (Table 3). Although the major complication rate was low in both cohorts (during group: 5.7% and after group: 3.5%), 30-day Grade III or IV complications secondary to stoma reversal may lead to a poor long-term outcome while reversal surgery was performed during adjuvant chemotherapy.

Many oncologists and surgeons are unwilling to close the stoma before adjuvant chemotherapy because it is associated with specific morbidity[11] that would postpone or cancel the chemotherapy.[18] Nevertheless, there are no data available according to former studies.[8, 15–18] Several studies have revealed that colorectal cancer patients with curative surgery may have poor long-term survival if postoperative complications occur.[21, 22] Nevertheless, data about the impact of stoma closure complications on patient survival are limited. In the present study, the 30-day grade III or IV complications were similar between the groups (5.7% vs. 3.5%, p = 0.417). Interestingly, further subgroup analysis revealed that the During group patients might suffer from inferior overall survival and disease-free survival if reoperation is required due to stoma closure complications compared to the After group patients. Several potential mechanisms for the negative effect of closure complications on survival are possible. Canceled or delayed adjuvant chemotherapy due to anastomotic leakage has increased rates of distant recurrence and long-term mortality in colon cancer patients.[23] All patients' chemotherapy was postponed or cancelled because of major complications in the During group but not in the After group. Another possible reason for the poor long-term outcomes is the immunologic mechanism. Complications and surgery, including reoperation, could cause physical stress that decreases cell-mediated immunity, leading to tumor recurrence.[21] The During group of patients who also had severe complications suffered from at least two surgical interventions in a short period, which might lower the immunity against cancer. In summary, our findings indicate that the stoma closure should be done after adjuvant chemotherapy for patient who had higher risk of stoma closure related complications, such as patient with poor nutritional status[24] or they had lower coloanal anastomosis[25].

Twelve (11.4%) patients in the During group could not complete adjuvant chemotherapy after stoma closure. However, compared to those who completed chemotherapy, there was no significant difference in OS and DFS in the patients who discontinued adjuvant chemotherapy. The ideal duration of adjuvant chemotherapy has been debated, and an increasing number of studies have been published on the duration of adjuvant chemotherapy in colorectal patients. One randomized trial comparing 3 and 6 months of adjuvant oxaliplatin-based chemotherapy for colorectal cancer showed that a shorter duration of adjuvant chemotherapy leads to similar survival outcomes and better quality of life.[26] This might explain the similar oncological outcome between this study's incomplete and complete patients.

Most patients who underwent incomplete adjuvant chemotherapy developed LARS after stoma closure. This dreadful syndrome is frequently reported in patients with rectal cancer who received TME with low colorectal anastomosis. Juul et al.[27] showed that the severity of the LARS scores strongly correlates with quality of life. Moreover, in their study, diarrhea was the most common symptom associated with low quality of life. However, the most common side effect of adjuvant chemotherapy is gastrointestinal discomfort, especially diarrhea.[28] This might be why some patients cannot tolerate adjuvant chemotherapy after their stoma is closed. There is nearly no stool passage through the anus that could cause LARS while the diverting stoma exists. Although some studies suggest that early closure of stoma to restore bowel continuity in patients might have lower LARS scores,[18] other studies have suggested that the interval from creation to the closure of the ileostomy was not associated with the development of major LARS.[29] Moreover, one meta‑analysis concluded that the rate of both minor and major LARS did not differ between patients with early or delayed diverting ileostomy closure.[30] Therefore, we suggest informing the patients that incomplete adjuvant chemotherapy is possible if their stoma is closed during treatment. In patients with a high risk of recurrence, we advise closing the stoma after they complete the adjuvant chemotherapy.

Parastomal hernia occurred significantly more frequently in the After group patients before stoma closure, which is compatible with a previous study. One multicenter randomized controlled trial comparing stoma early and late closure confirmed that stoma-related complications, including parastomal hernias, occurred more frequently in the late closure patients.[31] This is probably because some degree of parastomal herniation is inevitable given enough follow-up time.[32] Unfortunately, the patient reported that the parastomal hernia impaired their quality of life, and in certain situations, only stoma reversal in a timely fashion could reduce the risk.[33] Today, early stoma closure is attempted in rectal cancer patients after low anterior resection. One meta-analysis concluded that patients with early ileostomy closure might benefit from a lower incidence of small bowel obstruction and stoma-related complications.[30] Therefore, patients may receive stoma closure earlier if it is feasible to lower their stoma-related morbidity.

This study has some limitations. First, this was a retrospective data collection study with a limited sample size and some selection bias. Although there was no significant difference according to the primary characteristics between the groups, we believe certain factors must affect the patient's and surgeon's decision regarding the timing of stoma closure. From our experience, many patients would ask to have their stoma closed during chemotherapy. However, some surgeons still insist on closing the stoma after the completion of chemotherapy. Second, all the patient in this cohort did not receive total neoadjuvant therapy (TNT)[34], which is a novel approach developed in the recent years. For patient underwent TNT, there’s no impact of chemotherapy on the timing of stoma closure. Third, we only recorded the severe LARS for which medication is needed, and the data are lacking in patients with minor LARS. Further well-designed, randomized control trials are warranted to comply with adjuvant chemotherapy, LARS, and the timing of stoma closure. Last, nine patients had their regimen shifted from IV chemotherapy to PO drugs after stoma closure because of side effects. Since the influence of drug shift remained unknown, we assumed that their efficacy was the same. Nevertheless, this is still the first colostomy population-based and the most extensive study on this issue. We also performed a further subgroup analysis of the effect on patients with severe closure complications.

In conclusion, reversing a stoma during adjuvant chemotherapy in rectal cancer patients who underwent sphincter-preserving surgery has a similar oncological outcome compared to those with late closure. However, attention should be given to avoid major closure complications since patients with reintervention might have poor survival during adjuvant chemotherapy.

Funding: This study had no funding to be declared

Conflicts of interest/Competing interests: The authors have no conflicts of interest, do not use of off-label or unapproved drugs or products, use of previously copyrighted material.

Availability of data and material: The de-identificated data and material can be available after the approval of Chang Gung Medical Foundation institutional review board.

Code availability: There is no software application or custom code.

Authors' contributions:

Kun-Yu Tsai and Shu-Huan Huang had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Kun-Yu Tsai, Shu-Huan Huang and Jeng-Fu You

Acquisition of data: All authors

Drafting of the manuscript: Kun-Yu Tsai and Shu-Huan Huang

Critical revision of the manuscript for important

Intellectual content: Hsin-Yuan Hung and Wen-Sy Tsai

Statistical analysis: Kun-Yu Tsai and Shu-Huan Huang

Administrative, technical, or material support: Tzong-yun Tsai

Study supervision: Hsin-Yuan Hung and Wen-Sy Tsai

Ethics approval: IRB approval was obtained from the Chang Gung Medical Foundation Institutional Review Board (IRB No.202001577B0).

Consent to participate: Retrospective study with de-identification data requires no consent to participate

Consent for publication: All authors have reviewed and approved the submission of the final version of the manuscript.

Acknowledgments

The authors thank Professor Rei-Ping Tang from the Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Linkou for establishing this database.

Huser, N., C.W. Michalski, M. Erkan, et al., Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg, 2008. 248(1): p. 52–60. 10.1097/SLA.0b013e318176bf65
Perez, R.O., A. Habr-Gama, V.E. Seid, et al., Loop ileostomy morbidity: timing of closure matters. Dis Colon Rectum, 2006. 49(10): p. 1539–45. 10.1007/s10350-006-0645-8
Chow, A., H.S. Tilney, P. Paraskeva, et al., The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis, 2009. 24(6): p. 711–23. 10.1007/s00384-009-0660-z
Menahem, B., J. Lubrano, A. Vallois, et al., Early Closure of Defunctioning Loop Ileostomy: Is It Beneficial for the Patient? A Meta-analysis. World J Surg, 2018. 42(10): p. 3171–3178. 10.1007/s00268-018-4603-0
Keane, C., J. Park, S. Oberg, et al., Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer. Br J Surg, 2019. 106(5): p. 645–652. 10.1002/bjs.11092
Petersen, S.H., H. Harling, L.T. Kirkeby, et al., Postoperative adjuvant chemotherapy in rectal cancer operated for cure. Cochrane Database Syst Rev, 2012. 2012(3): p. CD004078. 10.1002/14651858.CD004078.pub2
Biagi, J.J., M.J. Raphael, W.J. Mackillop, et al., Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer: a systematic review and meta-analysis. JAMA, 2011. 305(22): p. 2335–42. 10.1001/jama.2011.749
Zhen, L., Y. Wang, Z. Zhang, et al., Effectiveness between early and late temporary ileostomy closure in patients with rectal cancer: A prospective study. Curr Probl Cancer, 2017. 41(3): p. 231–240. 10.1016/j.currproblcancer.2017.02.007
Hoshino, N., K. Hida, Y. Fukui, et al., Relationship between diverting stoma and adjuvant chemotherapy in patients with rectal cancer: a nationwide study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Int J Clin Oncol, 2022. 27(3): p. 545–552. 10.1007/s10147-021-02079-4
Thalheimer, A., M. Bueter, M. Kortuem, et al., Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum, 2006. 49(7): p. 1011–7. 10.1007/s10350-006-0541-2
Sharma, A., A.P. Deeb, A.S. Rickles, et al., Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal Dis, 2013. 15(4): p. 458–62. 10.1111/codi.12029
Bausys, A., J. Kuliavas, A. Dulskas, et al., Early versus standard closure of temporary ileostomy in patients with rectal cancer: A randomized controlled trial. J Surg Oncol, 2019. 120(2): p. 294–299. 10.1002/jso.25488
Lordan, J.T., R. Heywood, S. Shirol, et al., Following anterior resection for rectal cancer, defunctioning ileostomy closure may be significantly delayed by adjuvant chemotherapy: a retrospective study. Colorectal Dis, 2007. 9(5): p. 420–2. 10.1111/j.1463-1318.2006.01178.x
Herrle, F., F. Sandra-Petrescu, C. Weiss, et al., Quality of Life and Timing of Stoma Closure in Patients With Rectal Cancer Undergoing Low Anterior Resection With Diverting Stoma: A Multicenter Longitudinal Observational Study. Dis Colon Rectum, 2016. 59(4): p. 281–90. 10.1097/DCR.0000000000000545
Kye, B.H., H.J. Kim, J.G. Kim, et al., Is it safe the reversal of a diverting stoma during adjuvant chemotherapy in elderly rectal cancer patients? Int J Surg, 2014. 12(12): p. 1337–41. 10.1016/j.ijsu.2014.10.018
Tulchinsky, H., E. Shacham-Shmueli, J.M. Klausner, et al., Should a loop ileostomy closure in rectal cancer patients be done during or after adjuvant chemotherapy? J Surg Oncol, 2014. 109(3): p. 266–9. 10.1002/jso.23493
Choi, Y.J., J.M. Kwak, N. Ha, et al., Clinical Outcomes of Ileostomy Closure According to Timing During Adjuvant Chemotherapy After Rectal Cancer Surgery. Ann Coloproctol, 2019. 35(4): p. 187–193. 10.3393/ac.2018.10.18.1
Sun, Z., Y. Zhao, L. Liu, et al., Clinical Outcomes of Ileostomy Closure before Adjuvant Chemotherapy after Rectal Cancer Surgery: An Observational Study from a Chinese Center. Gastroenterol Res Pract, 2021. 2021: p. 5592721. 10.1155/2021/5592721
Clavien, P.A., J. Barkun, M.L. de Oliveira, et al., The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009. 250(2): p. 187–96. 10.1097/SLA.0b013e3181b13ca2
Bryant, C.L., P.J. Lunniss, C.H. Knowles, et al., Anterior resection syndrome. Lancet Oncol, 2012. 13(9): p. e403-e8. 10.1016/S1470-2045(12)70236-X
Artinyan, A., S.T. Orcutt, D.A. Anaya, et al., Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg, 2015. 261(3): p. 497–505. 10.1097/SLA.0000000000000854
Miyamoto, Y., Y. Hiyoshi, R. Tokunaga, et al., Postoperative complications are associated with poor survival outcome after curative resection for colorectal cancer: A propensity-score analysis. J Surg Oncol, 2020. 122(2): p. 344–349. 10.1002/jso.25961
Krarup, P.M., A. Nordholm-Carstensen, L.N. Jorgensen, et al., Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg, 2014. 259(5): p. 930–8. 10.1097/SLA.0b013e3182a6f2fc
Kye, B.H., H.J. Kim, J.G. Kim, et al., The nutritional impact of diverting stoma-related complications in elderly rectal cancer patients. Int J Colorectal Dis, 2013. 28(10): p. 1393–400. 10.1007/s00384-013-1699-4
Kitaguchi, D., Y. Nishizawa, T. Sasaki, et al., Recurrence of rectal anastomotic leakage following stoma closure: assessment of risk factors. Colorectal Dis, 2019. 21(11): p. 1304–1311. 10.1111/codi.14728
Iveson, T.J., R.S. Kerr, M.P. Saunders, et al., 3 versus 6 months of adjuvant oxaliplatin-fluoropyrimidine combination therapy for colorectal cancer (SCOT): an international, randomised, phase 3, non-inferiority trial. Lancet Oncol, 2018. 19(4): p. 562–578. 10.1016/S1470-2045(18)30093-7
Juul, T., M. Ahlberg, S. Biondo, et al., Low anterior resection syndrome and quality of life: an international multicenter study. Dis Colon Rectum, 2014. 57(5): p. 585–91. 10.1097/DCR.0000000000000116
Miller, R.C., J.A. Martenson, D.J. Sargent, et al., Acute treatment-related diarrhea during postoperative adjuvant therapy for high-risk rectal carcinoma. Int J Radiat Oncol Biol Phys, 1998. 41(3): p. 593–8. 10.1016/s0360-3016(98)00084 – 4
Jimenez-Gomez, L.M., E. Espin-Basany, L. Trenti, et al., Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer. Colorectal Dis, 2017. 10.1111/codi.13901
Podda, M., F. Coccolini, C. Gerardi, et al., Early versus delayed defunctioning ileostomy closure after low anterior resection for rectal cancer: a meta-analysis and trial sequential analysis of safety and functional outcomes. Int J Colorectal Dis, 2022. 37(4): p. 737–756. 10.1007/s00384-022-04106-w
Danielsen, A.K., J. Park, J.E. Jansen, et al., Early Closure of a Temporary Ileostomy in Patients With Rectal Cancer: A Multicenter Randomized Controlled Trial. Ann Surg, 2017. 265(2): p. 284–290. 10.1097/SLA.0000000000001829
Carne, P.W., G.M. Robertson, and F.A. Frizelle, Parastomal hernia. Br J Surg, 2003. 90(7): p. 784–93. 10.1002/bjs.4220
Aquina, C.T., J.C. Iannuzzi, C.P. Probst, et al., Parastomal hernia: a growing problem with new solutions. Dig Surg, 2014. 31(4–5): p. 366–76. 10.1159/000369279
Cercek, A., C.S.D. Roxburgh, P. Strombom, et al., Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer. JAMA Oncol, 2018. 4(6): p. e180071. 10.1001/jamaoncol.2018.0071

Table 3 is available in the Supplementary Files section

No competing interests reported.

Table3.docx
Table 3. Summary characteristics and parameters of previous and current studies

Download PDF

Journal Publication

published 11 Jul, 2023

Read the published version in Langenbeck's Archives of Surgery →

Editorial decision: Major revision
09 Apr, 2023
Reviews received at journal
31 Mar, 2023
Reviewers agreed at journal
31 Mar, 2023
Reviews received at journal
07 Nov, 2022
Reviewers agreed at journal
06 Nov, 2022
Reviewers invited by journal
03 Nov, 2022
Editor assigned by journal
22 Sep, 2022
Submission checks completed at journal
20 Sep, 2022
First submitted to journal
19 Sep, 2022

You are reading this latest preprint version

Comparison of clinical outcomes of stoma reversal during versus after chemotherapy for rectal cancer patients

Status:

Journal Publication

Version 1

Abstract

Purpose:

Methods:

Results:

Conclusions:

Figures

Introduction

Materials And Methods

Results

Discussion And Conclusion

Declarations

References

Tables

Additional Declarations

Supplementary Files

Status:

Journal Publication

Version 1